Assignment of Respiratory Case 

Assignment of Respiratory Case

Instructions/Descriptions

Assignment of Respiratory Case Study

Assignment of Respiratory Case Study

Study of respiratory cases:

Scenario: BF, the 31-year old man living in a small mountain city in Western Virginia, is very allergic to pollen and dust and has a slight asthma history. The wife of BF drove him to the emergency hospital because he had not reacted to his fluticasone/salmeterol (Advair) inhaler, could not lie down, and started using accessory muscles. The BF is begun immediately at 75 mL/h by nasal cannula and intravenous (IV) D5W with 4L of oxygen. The laboratory receives a set of blood arterial gasses (ABG). BF seems worried and says he’s breathless.

Chart:

Signs vital:

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152/84 BP

124 bpm pulse

42 breaths/min Resp rate

100.® F Temp 100.

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Topics for discussion:

1. What is the justification for starting BF immediately on oxygen?

2. With the history of BF and the presentation of complaints in mind, what are the most significant areas that you need to address during your physical evaluation?

Chart:

ABGs

7.31 pH

Paco2 48 Paco2

HCO3 26 HCO3

Paolo2 55

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Chart:

Orders for medication:

2.5 mg Albuterol with ipratropium 250 mcg Nebulizer Statistics

Inhalation of albuterol (Ventolin) 2 puffs in 4 hours

0.4 percent Nebulizer therapy q3hrs Metaproterenol sulfate (Alupent)

MDI: 220mcg, 1 puff twice daily Fluticasone (Flovent HFA)

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3. What are the reasons for STAT (immediately) with albuterol 2.5 mg with ipratropium 250 mcg nebulizer?

4. Indicate the classification of drugs and expected results of use of metaproterenol sulfate (Alupent) and fluticasone BF should (Flovent).

You examine BF and find that in all lung fields with non-productive toxins and accessory muscle use, lung sounds with inspiratory and expiratory wheezing have been reduced. He has pale, warm, and dry skin. The ECG displays ectopic sinus tachycardia. He is alert and x4-sphere oriented. He appears worried, sits straight, leans over the bedside table, and continues to complain about breathlessness.

5. What is your primary care aim now? 5.

6. For the next three hours, you will have to observe BF closely. What is the most dangerous complication?

7. Identify four symptoms and indicators of this problem for which you will evaluate in BF.

8. If combination inhalation aerosols are provided with no explicit sequencing instructions, you must be aware of the safe drug administration standards. Describe the correct sequence for BF therapy.

9. What are your aerosol therapy responsibilities? 9.

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BF wheeze and dyspnea solve after several hours and aerosol treatments and he can expectorate his secretions. The provider discusses BF’s care of asthma with him; BF states that in the last few weeks he has had multiple asthma attacks. The provider discharges BF under a “burst” (prednisone 40mg/day X 5days), fluticasone/salmeterol (Advair HFA 230/21) oral steroid prescription, two inhalations daily morning-night (Proventil), albuterol (Proventil) metered-dose inhaler (MDI, spacer) and montelukast (Singulair). He instructed BF to phone the pulmonary clinic with a pulmonary expert for further follow-up.

10. What is the justification for BF’s oral steroid explosion?

11. How does Singulair differ from other treatments for asthma?

BF states that he took his Advair that morning, then again when he began to feel breathless. He says, “It didn’t help,” and he wants to know why he had to stay there. Is fluticasone/salmeterol (Advair) suitable for usage in acute asthma attacks? Explain.

12. What specific question do you need to address in BF Discharge Teaching, based on this information?

You are asking BF to show the use of its MDI. He shakes the box vigorously, hangs the spray on the edge of his mouth (pointing towards his cheek), and squeezes the box while he takes a quick, deep breath.

13. What are the common errors made by BF using the inhaler?

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14. You review the correct use of a BF-based MDI and potential side effects such as hoarseness, dry mouth, oral cave white patches, cough and headaches. What measures can you teach him to minimize or reduce the impact of these effects? Choose everything that applies:

1. Reduce your fluid intake

1. Use an inhaler spacer

1. Only use the inhaler as specified

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1. Rinse your mouth out promptly after inhalation

1. Clean the spacer in a “hot cycle with dry heated” dishwasher every day

Assignment of Respiratory Case Study

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