Nursing Assignment | Nursing Assignment Help

L.S. is a 7-year-old who has been brought to the emergency department (ED) by his mother. She immediately tells you he has a history of ED visits for his asthma. He uses an inhaler when he wheezes, but it ran out a month ago. She is a single parent and has 2 other children at home with a babysitter. Your assessment finds L.S. alert, oriented, and extremely anxious. His color is pale, and his nail beds are dusky and cool to the touch; other findings are heart rate 136, respirations regular and even, rate 26, oral temperature T 37.3°C (99.1 °F), Spo2 89%, breath sounds decreased in lower lobes bilaterally and congested with inspiratory and expiratory wheezes, prolonged expirations, and a productive cough. As you ask LS,’s mother questions, you note that LS.’s respiratory rate is increasing; he is sitting on the side of the bed, leaning slightly forward, and having difficulty breathing. You are concerned that he is experiencing status asthmaticus.

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1. You check the orders and need to decide which interventions are the priority at this time. Select all that apply and explain why you would do this and what assessments you would make during each intervention..

a. Have L.S. lie flat.

b. Have L.S. perform incentive spirometry q 10 X hour.

c. Administer oxygen via face mask to keep his Spo2 above 90%.

d. Administer albuterol (Proventil) and ipratropium bromide (Atrovent) via hand-held nebulizer (HHN) STAT.

e. Reassess in 20 minutes, and if no improvement, administer salmeterol (Serevent Diskus) via dry-powder inhaler (DPI).

f. Reassess in 20 minutes, and if no improvement, administer albuterol (Proventil) and ipratropium (Atrovent) via hand-held nebulizer again.

g. Start IV normal saline (NS) at 15mL/hr and administer methylprednisolone 2mg/kg IV STAT

x 1 dose.

CASE STUDY PROGRESS:

You give L.S. the albuterol and Atrovent twice. His 02 saturation does not improve and remains at 88% with oxygen at 6 L/min via face mask. He says he “does not feel any better.” He is retracting and his respiratory rate remains at 34. You have started his IV infusion and administered the methylprednisolone. L.S.’s mother is pacing and tells you she is very upset and worried. You telephone the attending resident to notify him of the increasing respiratory distress in your patient.

2. Chart your assessment, actions, and patient’s response using the SBAR (Situation, Background, Assessment, and Recommendation) format.

CASE STUDY PROGRESS:

L. S. is admitted to the pediatric intensive care unit (PICU) for close monitoring. His condition improves, and 24 hours later he is transferred to the floor. Asthma teaching is ordered. You assess Ms. S.’s understanding of asthma and her understanding of the disorder.

3. Which statement by Ms. S. would indicate a need for further teaching?

a. “If he takes medications for a while, he will outgrow his asthma.”

b. “Part of his treatment should be avoiding things that irritate his lungs.”

c. “If I recognize early warning signs, he might be able to take medicine and not go to the ED.”

d. “He should go to the doctor regularly to make sure his asthma is being treated correctly.”

4. You are educating L.S. and his mother on possible asthma triggers in their environment. They live in public housing in an apartment without air conditioning. Which statements indicate possible asthma triggers? Select all that apply.

a. “We have a pet fish.”

b. “L. collects stuffed animals.”

c. “There are hardwood floors.”

d. “Our visitors smoke outside.”

e. “The building has copper pipes.”

f. “There are dark stains in our bathroom.”

g- “We had to get the housing authority to treat for blips.”

h. “He coughs when we have cold nights after a warm day.”

5. Discuss strategies to avoid the triggers you identified in the previous question. Get Nursing Help Today

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