You assess B.T. and find that he has diminished lung sounds with inspiratory and expiratory wheezes in all lung fields with a nonproductive cough and accessory muscle use. His skin is pale, warm and dry.
The electrocardiogram (ECG) shows sinus tachycardia without ectopy. He is alert and oriented 4 spheres.
He appears anxious and is sitting upright, leaning over the bedside table, and continuing to complain of shortness of breath.
What is your primary nursing goal at this time?
Describe six actions you must implement based on this priority.
You will need to monitor B.T. closely for the next few hours. What is the most serious complication to anticipate?
Identify four signs and symptoms of this complication you will assess for in B.T.
When combination inhalation aerosols are prescribed without specific instructions for the
sequence of administration, you need to be aware of the recommendations for safe drug
administration. Describe the correct sequence for administering B.T.'s treatments.
What are your responsibilities while administering aerosol therapy?
Question 2B.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 F (38.4 C)
Are B.T.'s vital signs acceptable? State your rationale.
What is the rationale for immediately starting B.T. on O2?
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?
Arterial Blood Gases
pH 7.31
Paco2 48 mm Hg
HCO3 26 mmol/L
Pao2 55 mm Hg
Interpret B.T.'s arterial blood gas results.
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
What is the rationale for the albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment
STAT (immediately)?
Indicate the drug classification and expected outcome B.T. should experience with using
metaproterenol sulfate (Alupent) and Fluticasone (Flovent).
Question 3S.R. and the provider decide to begin S.R. on the least invasive treatmentcontinuous positive airway pressure (CPAP). The provider writes a prescription for CPAP.
List three education topics you need to address with S.R. so he can safely self-manage CPAP therapy.
S.R. calls 2 weeks later with complaints of dry nasal membranes, nosebleeds, and sores
behind his ears. What instructions would you give S.R.?
Describe how you will document the phone call with S.R.
Question 4The polysomnogram confirms S.R.'s diagnosis of OSA. At his 6-week follow-up visit, he reports he has lost 10 pounds, but there has been little improvement in his symptoms. He states that he fell asleep while driving to work and wrecked his car. He wants t
What are the treatment options for OSA? Describe each.
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