CASE STUDY 21 ACUTE ASTHMA MANAGEMENT
|WITH COMPLETE SOLUTIONS
Case Study 21 Acute Asthma Management
B.T., a 31-year-old man who lives in a small mountain town in Colorado, is highly allergic to
dust and pollen and has a history of mild asthma. B.T.'s wife drove him to the emergency room
when his wheezing was unresponsive to his fluticasone/salmeterol (Advair) inhaler, he was
unable to lie down, and he began to use accessory muscles to breathe. B.T. is immediately started
on 4 L oxygen by nasal cannula and intravenous (IV) D5W at 75 mL/hr. A set of arterial blood
gases is sent to the laboratory. B.T. appears anxious and says that he is short of breath.
VITAL SIGNS
Blood pressure (BP) 152/84 mm Hg
Pulse rate 124 beats/min
Respiratory rate 42 breaths/min
Temperature 100.4 ⁰ F (38.4 C)
1. Are B.T.'s vital signs acceptable? State your rationale.
No, the patient’s RR is very high and his pulse is high. His BP and temperature are also elevated.
2. What is the rationale for immediately starting B.T. on O2?
The patient is struggling to oxygenate and by supplementing his oxygen, we can compensate for
his hypoxia.
3. Keeping in mind B.T.'s health history and presenting complaint, what are the most
important areas you need to evaluate during your physical assessment?
As the nurse, we need to keep a close eye on the patient’s respiratory system. We need to listen to
his lung sounds, monitor for facial edema, and maintain a patent airway.
ARTERIAL BLOOD GASES
pH 7.31
Paco₂ 48 mm Hg
HCO₃ 26 mmol/L
Pao₂ 55 mm Hg
4. Interpret B.T.'s arterial blood gas results.
The patient’s ABGs reveal that he is in respiratory acidosis. His pH is acidic and his CO2 is
elevated. The HCO3 is wnl.
MEDICATION ORDERS
Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT
Albuterol (Ventolin) inhaler 2 puffs q4h
Metaproterenol sulfate (Alupent) 0.4% nebulizer treatment q3h
Fluticasone (Flovent HFA) MDI: 220 mcg, 1 puff twice daily
5. What is the rationale for the albuterol 2.5 mg plus ipratropium 250 mcg nebulizer
treatment STAT (immediately)?
The patient needs an emergency/fast acting beta2 agonist to open up his airways, which is what
the albuterol will do. The ipratropium is another bronchodilator that also has anticholinergic and
antimuscarinic properties. This DuoNeb has been shown to help patients who are having acute
asthma attacks.
|WITH COMPLETE SOLUTIONS
Case Study 21 Acute Asthma Management
B.T., a 31-year-old man who lives in a small mountain town in Colorado, is highly allergic to
dust and pollen and has a history of mild asthma. B.T.'s wife drove him to the emergency room
when his wheezing was unresponsive to his fluticasone/salmeterol (Advair) inhaler, he was
unable to lie down, and he began to use accessory muscles to breathe. B.T. is immediately started
on 4 L oxygen by nasal cannula and intravenous (IV) D5W at 75 mL/hr. A set of arterial blood
gases is sent to the laboratory. B.T. appears anxious and says that he is short of breath.
VITAL SIGNS
Blood pressure (BP) 152/84 mm Hg
Pulse rate 124 beats/min
Respiratory rate 42 breaths/min
Temperature 100.4 ⁰ F (38.4 C)
1. Are B.T.'s vital signs acceptable? State your rationale.
No, the patient’s RR is very high and his pulse is high. His BP and temperature are also elevated.
2. What is the rationale for immediately starting B.T. on O2?
The patient is struggling to oxygenate and by supplementing his oxygen, we can compensate for
his hypoxia.
3. Keeping in mind B.T.'s health history and presenting complaint, what are the most
important areas you need to evaluate during your physical assessment?
As the nurse, we need to keep a close eye on the patient’s respiratory system. We need to listen to
his lung sounds, monitor for facial edema, and maintain a patent airway.
ARTERIAL BLOOD GASES
pH 7.31
Paco₂ 48 mm Hg
HCO₃ 26 mmol/L
Pao₂ 55 mm Hg
4. Interpret B.T.'s arterial blood gas results.
The patient’s ABGs reveal that he is in respiratory acidosis. His pH is acidic and his CO2 is
elevated. The HCO3 is wnl.
MEDICATION ORDERS
Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT
Albuterol (Ventolin) inhaler 2 puffs q4h
Metaproterenol sulfate (Alupent) 0.4% nebulizer treatment q3h
Fluticasone (Flovent HFA) MDI: 220 mcg, 1 puff twice daily
5. What is the rationale for the albuterol 2.5 mg plus ipratropium 250 mcg nebulizer
treatment STAT (immediately)?
The patient needs an emergency/fast acting beta2 agonist to open up his airways, which is what
the albuterol will do. The ipratropium is another bronchodilator that also has anticholinergic and
antimuscarinic properties. This DuoNeb has been shown to help patients who are having acute
asthma attacks.
