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Discussion

Asthma assignment need help!

hi all, hope you can help me with my assignment. i'm having trouble finding the answers.

shaun, a 24-year-old man, who lives on the mornington peninsular, is highly allergic to dust and pollen and anxiety appears to play a role in exacerbating his asthma attacks. a..b.'s partner drove him to the frankston hospital when his wheezing was unresponsive to beclomethasone (qvar) and ipratropium bromide (atrovent) inhalers. upon arrival, his vital signs are 152/84mm.hg, 124, 42, 38° c. a.b. is started on 4 l o2/nc, an iv of glucose5%w at kvo. his abgs are ph 7.31, paco2 48 mm hg, hco3 26 mmol/l, pao2 55 mm hg, sao2 88%.

2. the inflammatory response in asthma involves what mechanisms?

3. are shaun's vital signs acceptable? state your rationale.

4. comment on shaun's sao2.

6. are qvar and/or atrovent appropriate for use during an asthma attack? explain.

7. the physician orders salbutamol sulfate 3 mg nebulisation treatment stat (immediately). what is the rationale for this order? [

8. what is the rationale for immediately starting shaun. on oxygen?

9. list five short-term nursing and medical interventions that may help relieve shaun's symptoms.

thanks guys !!!

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Here's a link with pretty good information about asthma:

http://www.emedicine.com/med/topic177.htm

The pathophysiology section is pretty detailed, but if you want more a general overview, there's a Patient Education section along the right margin of the page.

The stuff on vitals and meds should be easy to find in your textbook or pocket drug reference.

Good luck!

  • Experts

the pathophysiology of asthma: the inflammatory response is a body defense mechanism that initiates once harmful chemicals, microorganisms or foreign bodies have invaded the exterior defenses of the body. this can include things such as animal dander, tobacco smoke, dust, molds, pollen, and even such innocuous activities as coughing or laughing. the area of invasion in asthma is the tissues of the airway which becomes surrounded by cells and fluids designed to isolate, destroy and remove any foreign invaders. this is due to the mast cells in the blood coming to the area of the airway tissues and releasing the substances, histamine, leukotriene and prostaglandin. histamine causes swelling in the smooth muscles of the bronchi. leukotriene causes swelling in the smooth muscles of the smaller bronchi. another fluid that is released, prostaglandin, enhances the effect of histamine. histamine also stimulates the mucus cells to secret excessive amounts of mucus. the resulting bronchial smooth muscle spasm, vascular congestion, increased vascular permeability, edema formation, and the production of thick, tenacious mucus produces obstruction of the small airways so that breathing becomes labored and difficult. the immediate threat is hypoxemia. the vital signs become elevated in the early stages due to the anxiety of suffocation and air hunger. with a sao2 of 88% the oxygen is given primarily to reduce the patient's feeling of suffocating. the medical interventions will focus on medication, iv, lab, x-ray and respiratory therapy. you can get more specific details from the family practice link i've given below. nursing interventions (1) encourage patient to breath deep and slow while sitting up as high as possible, (2) use pursed lip breathing to prolong exhalation which decreases amount of air trapped in alveoli, (3) humidify air patient is breathing (4) instruct patient in proper manner of deep breathing and effective coughing (5) remain at the patient's side to allay his anxiety.

drug treatment of acute episodes is aimed at reversing the bronchospasm and airway inflammation. so, bronchodilators, anti-inflammatories such as corticosteroids, leukotriene inhibitors and mast cell stabilitzers are usually given. i'll let you look those up and decide if the ones given in your scenario are appropriate and what the rationale is for ordering them. the brand names are all different in australia anyway, so i have to look up their generic names in order to find them. use the drugs.com link i gave you to get the professional information on them if the site has it. i've also given you a link to family practice notebook. this is an outline of what the doctor should do. it will give you an idea of what to expect the doctor to order. there are lots of links to information on the treatment of asthma on the left side of the web page as well. i've included a link to a tutorial on abgs and a link to a pamphlet of normal abg levels. there is a thread on abg interpretation running concurrently on the forum with links to abg information that you might want to check out as well. another thing you might want to do is check out the internet for information on asthma and what happens during an asthma attack. the medline plus site is a good place to find that kind of information as well as patient oriented (not healthcare professional) drug information.

http://www.fpnotebook.com/lun20.htm - lots of links to outlines of information on the diagnosis and treatment of asthma from the doctor's perspective

http://www.drugs.com/ - look up information on your drugs here

http://maagnursing.com/abg/ - this is an excellent abg and acid/base balance tutorial. you do not have to register to go through the tutorial.

https://allnurses.com/forums/f205/easy-way-remember-abgs-144947.html

http://medi-smart.com/cc-gas.htm - blood gas analysis downloadable pamphlet of normal abgs parameters and brief explanation of abnormal results and what they can mean. great to put on your clipboard!

http://search.nlm.nih.gov/medlineplus/query?disambiguation=true&function=search&server2=server2&server1=server1&parameter=asthma&x=74&y=10 - medline plus links to lots of information on asthma

http://allergy.healthcentersonline.com/ - information about asthma and allergies here including some animations and videos. you may have to sign on to see all pages, but registration is free.

  • Author

Cheers eric and daytonite ... I'll work on those websites. thanks !

Hi, I just finished Med-Surg this semester. This is how I would respond. Hope this helps!

I]Shaun, a 24-year-old man, who lives on the Mornington peninsular, is highly allergic to dust and pollen and anxiety appears to play a role in exacerbating his asthma attacks. A..B.’s partner drove him to the Frankston hospital when his wheezing was unresponsive to beclomethasone (Qvar) and ipratropium bromide (Atrovent) inhalers. Upon arrival, his vital signs are 152/84mm.hg, 124, 42, 38° C. A.B. is started on 4 L O2/NC, an IV of Glucose5%W at KVO. His ABGs are pH 7.31, PaCO2 48 mm Hg, HCO3 26 mmol/L, PaO2 55 mm Hg, SaO2 88%.

2. The inflammatory response in asthma involves what mechanisms?

Someone already answered this for you

3. Are shaun's vital signs acceptable? State your rationale.

I don't think they are acceptable. His RR is high most likely due to dyspnea and anxiety. Tachycardia can be an indicator for hypoxemia. His ABGs show that he is in Respiratory acidosis meaning he is retaining too much carbon dioxide.

4. Comment on shaun's SaO2.

Shawn's Sa02 is at 88% which is a sign of impaired gas exchange I would want it above 92%

6. Are Qvar and/or Atrovent appropriate for use during an asthma attack? Explain.

Not during an acute attack because Atrovent is categorized as long-acting beta agonist which means these drugs need time to build up an effect, but the effects are longer lasting. These drugs are useful in preventing an asthma attack, but have no value during an acute attack. Qvar is an anti-inflammatory agent or corticosteroid, and corticosteroids decrease inflammatory and immune responses in many ways. The effectiveness of these drugs depends on regular use. Maximum effectiveness requires cotinued use for 48-72 hours, so are they appropriate for use during an asthma attack? No, not during an acute attack. Are they going to help his current situation? No, but they will prevent other attacks if they are used properly

7. The physician orders Salbutamol sulfate 3 mg nebulisation treatment STAT (immediately). What is the rationale for this order?

Salbutamol is the same thing as albuterol. This is a short-acting beta2 agonist. These agents provide rapid but short-term relief. These drugs are most useful when an attack begins. They are called bronchodilators and they increase bronchilar smooth muscle relaxation and are very rapid.

8. What is the rationale for immediately starting shaun. on oxygen?

Oxygen is prescribed for relief of hypoxemia and hypoxia. His ABG's show Respiratory Acidosis. His Paco2 is high because he is retaining carbon dioxide and he is having poor gas exchange. They are putting him on oxygen to prevent or reverse hypoxemia.

9. List five short-term nursing and medical interventions that may help relieve shaun's symptoms.[/i]

1. Deep breathing and coughing exercises to clear secretions

2. Semi-fowlers positioning to alleviate dyspnea

3. Incentive spirometry

4. Adequate fluid intake to help thin secretions

5. Find cause of anxiety; treat appropriately

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