Mrs. Hogan
38 year old, White American, Female
Walk-in health care center
Preexisting condition – Mild persistent asthma, GERD
Socioeconomic – Husband employed in asbestos removal
Pharmacologic – Albuterol (Proventil, Ventolin); beclomethasone dipropionate
(Beconase); multivitamin, calcium supplement; Vanceril; Omeprazole; docusate
calcium
Prioritization – Ensuring a patent airway; monitoring for status asthmaticus
Patient Profile
Mrs. Hogan is a 38year-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 Vanceril, 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?”
While auscultating Mrs. Hogan’s lung sounds, the nurse hears expiratory wheezes
and scattered rhonchi throughout. Mrs. Hogan is afebrile. Her vital signs are
blood pressure 142/96, pulse 88, and respiratory rate 34. Her oxygen saturation
on room air is 86%. Arterial blood gases (ABGs) are drawn. Mrs. Hogan is placed
on 2 liters of humidified oxygen via nasal cannula. She is started on intravenous
(IV) fluids and receives an albuterol nebulizer treatment.
Questions:
1. What other signs and symptoms might the nurse note during assessment
of Mrs. Hogan?
2. In what position should the nurse place Mrs. Hogan and why?
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)
4. Mrs. Hogan states that she took her albuterol and beclomethasone prior to
coming to the walk-in health care center. How do these medications work?
5. Briefly discuss the common adverse effects Mrs. Hogan my experience with
the albuterol nebulizer treatment.
6. Physiologically, what is happening in Mrs. Hogan’s lungs during an asthma
attack?
7. In order of priority, identify three nursing diagnoses that are appropriate
during Mrs. Hogan’s asthma exacerbation.
8. Write three outcome goals for Mrs. Hogan’s diagnosis of Ineffective
Breathing Pattern.
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 laundry.” What other questions might
the nurse ask and (and why) to assess the cause of Mrs. Hogan’s asthma
exacerbation?
10.What are some other questions the nurse might ask to get a better sense of
Mrs. Hogan’s asthma?
11.The nurse asks Mrs. Hogan to describe step-by-step 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.” Which step (s) is/are of concern for the nurse and
why?
12.Briefly discuss three nursing interventions to help decrease Mrs. Hogan’s
risk of another asthma exacerbation.
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