Respiratory Case Study-Amanda Sides

Mrs. Hogan is a 38 year old woman brought to a walk-in health care center by her neighbor. Mrs. Hogan is in obvious respiratory distress. She is having difficulty breathing with audible high-pitched wheezing and is having difficulty speaking. Pausing after every few words to catch her breath, she tells the nurse, “I am having a really bad asthma attack. My chest feels very tight and I cannot catch my breath. I took my albuterol and beclomethasone, but they are not helping.” Mrs. Hogan hands her neighbor her cell phone and asks the neighbor to dial a telephone number. “That number is my husband’s boss. My husband just started working for an asbestos removal company about a month ago. He is usually on the road somewhere. Can you ask his boss to get a message to him that I am here?” CASE STUDY: While auscultating Mrs. Hogan’s lung sounds, the nurse hears expiratory wheezes and scattered rhonchi throughout. Mrs. Hogan is afebrile. Her vital signs: BP 142/96, pulse 88, respiratory rate 34. Her oxygen saturation on room air is 86%. Arterial blood gasses are drawn. Mrs. Hogan is placed on 2 liters of humidified oxygen via nasal cannula. She is started on intravenous fluids and receives an albuterol nebulizer treatment. Questions. Choose 8 questions to respond to. You will receive ½ point for each correct answer. If you do not want a question graded – mark it out. If it is not easy to determine which questions you wish to have graded the first 8 not marked out will be graded. 1. What other signs and symptoms might the nurse note during assessment of Mrs. Hogan? -dyspnea -productive cough -accessory muscles of respiration -Tachycardia -Tachypnea -Respiratory arrest-drowsiness, confusion, absence of wheezing, bradycardia, retraction above the sternum 2. In what position should the nurse place Mrs. Hogan AND WHY? -fowler’s position-increase lung expansion 3. Identify at least five signs and symptoms that indicate that Mrs. Hogan is not responding to treatment and may be developing status asthmaticus (a life-threatening condition). -SOB, can’t speak in full sentences, feel breathless when lying down, chest feels tight, bluish tint to lips, feel agitated, confused, or can’t concentrate, hunched shoulders, This study source was downloaded by from CourseH on :31:21 GMT -05:00 strained abdominal and neck muscles, feel that you need to sit or stand up to breath easier- these are signs of impending respiratory failure 4. Mrs. Hogan states she took her albuterol and beclomethasone prior to coming to the walk-in health care center. How do these medications work? Albuterol-Bronchodilator Selective Beta-2: relax the smooth muscle in the bronchial airway and blood vessels Beclomethasone-stabilize mast cells to reduce the release of mediators that cause inflammation and edema. Restore bronchodilator response to sympathomimetics in treating acute bronchial constriction. 5. Briefly discuss the common adverse effects Mrs. Hogan may experience with the albuterol nebulizer treatment? Headache, dizzy, insomnia, cough, hoarseness, sore throat, runny or stuffy nose, nausea, vomiting, dry mouth, muscle pain, diarrhea 6. Physiologically, what is happening in Mrs. Hogan’s lungs during an asthma attack? The early phase begins with triggers (allergens, infections, irritants, exercise, gastroesophageal reflux, stress) activate inflammatory response system. The airways constrict and become edematous, mucus secretions increase forming plugs in airways, and tenacious sputum is produced, obstruction causes air to be trapped in the alveoli creating ventilation-perfusion mismatch. The alveoli are perfused with blood but not ventilated with fresh air. The effect is hypoxemia with compensatory hyperventilation. The early phase is 30-60 minutes after exposure to trigger and resolves some 30-90 minutes later. The late phase begins 4-8 hours after the early phase response, when the airway inflammation is pronounced. RBC and WBC infiltrate the swollen tissues of the airways. Last several hours or days, the airways are hyper responsive. The patient is at risk for another acute episode until late phase subsides. 7. In order of priority, identify three nursing diagnosis that are appropriate during Mrs. Hogan’s asthma exacerbation. Ineffective Breathing Pattern Impaired Gas Exchange Anxiety 8. Write 3 outcome goals for Mrs. Hogan’s diagnosis of ineffective breathing pattern. MUST BE A SMART GOAL. This study source was downloaded by from CourseH on :31:21 GMT -05:00 -Patient maintains an effective breathing pattern, as evidenced by relaxed breathing at normal rate and depth by the end of shift. -Patient respiratory rate remains within established limits under 20 breaths per minute by end of shift -Patient will demonstrate maximum lung expansion with adequate ventilation by end of shift 9. Mrs. Hogan has responded well to the albuterol nebulizer treatment. Her breathing is less labored and she appears less anxious. The nurse asks Mrs. Hogan what she was doing when the asthma attack began. Mrs. Hogan says “Nothing special. I was doing the laundry.” What other questions might the nurse ask (AND WHY) to assess the cause of Mrs. Hogan’s asthma exacerbation? Present Illness, Onset duration severity precipitating events associated with dyspnea, Pain, Past Medical History, Family History, Medications, allergies, known cardiac disease, sleep disruption, stress, any type of new detergent, cleaning agent, or last time she changed the dry vent. 10. What are some other questions the nurse might ask to get a better sense of Mrs. Hogan’s asthma? Frequency and severity of attacks, factors known to trigger attacks, the effect of the condition on patient’s life, strategies used to manage conditions, sources of stress and support, patient’s knowledge of asthma, and treatment obtained, patients ability to afford medical care and drug therapy should be explored. 11. The nurse asks Mrs. Hogan to describe how she uses her inhalers. Mrs. Hogan describes the following steps: “First I shake the inhaler well. Then I breathe out normally and place the mouthpiece in my mouth. I take a few breaths and then while breathing in slowly and deeply with my lips tight around the mouthpiece, I give myself a puff. I hold my breath for a count of five and breathe out slowly as if I am blowing out a candle. I wait a minute or two and then I repeat those steps all over again for my second puff.” -Remove the cap and hold the inhaler upright. -Shake the inhaler. -Tilt your head back slightly and breathe out. -If your doctor recommends, use a spacer (a hollow, plastic chamber) to filter the -medicine between the inhaler and your mouth. The chamber protects your throat from This study source was downloaded by from CourseH on :31:21 GMT -05:00 irritation from the medicine. Check your insurance plan, as not all insurers offer coverage for spacers. -Press down on the inhaler to release the medicine as you start to breathe in slowly. -Breathe in slowly for 3 to 5 seconds. Hold your breath for 10 seconds to allow medicine to go deeply into your lungs. -Repeat puffs as directed. Wait 1 minute between puffs to allow the second puff to get into the lungs better.