Miss Anna Star

Miss Anna Star is a 26 year old patient that has been admitted to the urgent care with an acute asthma exacerbation. She reports a past medical history of respiratory illness while in college and states she was diagnosed with asthma at that time. She states she has no allergies and uses a “rescue inhaler” as her only medication. She admits that the rescue inhaler did not bring her relief this time, which is why she came into the urgent care facility. She states she is a non-smoker, and lives alone with her newly adopted cat. She attended a party the night before her admission where there were quite a few people smoking. 1. What precipitating factors are associated with asthma for Miss Anna as per the case study? (2) _respiratory _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 2. What equipment is required to conduct your assessment on Miss Star? (2) ____________________________________________________________________________________________________________________________________________________________ 3. Describe how you would perform a detailed respiratory assessment on Miss Star. What findings would the practical nurse learner expect to observe/hear? (4) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 4. Describe three abnormal findings that would indicate a severe asthma attack. (3) __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Miss Star states she is feeling very short of breath, you observe that her work of breathing is increased, and there is accessory muscle use. On auscultation you hear wheezing throughout the chest on expiration. Her vital signs are as follows: T- 36.7 C, P-148 bpm and regular, BP- 155/70, RR- 36 breaths per minute and labored, SP02- 87% on room air. The respiratory therapist administers ventolin to the patient via MDI and chamber. You administer prednisone 50mg PO to the patient as per physician orders. 5. Discuss the benefits to administering inhaled medications using a chamber. Use current literature. (2) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 6. Describe the education you would give to Miss Star about positioning herself to facilitate breathing. (2) __________________________________________________________________________________________________________________________________________________________ 7. Discuss how you would assess that the treatments are working. (2) _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Miss Star rings the call bell and tells you that she “feels funny”. She says her tongue feels too big for her mouth and her throat feels itchy. You observe red, raised skin lesions on her neck and chest, and note that her lips appear to be swollen. On observation inside the oral cavity, it appears that her pharynx and tongue are swollen and she states that she is feeling very anxious. 8. Based on the assessment findings above, discuss what you believe is happening with Miss Star and why. (2) __________________________________________________________________________________________________________________________________________________________ 9. What would our priority assessments be? (3) __________________________________________________________________________________________________________________________________________________________ 10. What would your first action be? (2) __________________________________________________________________________________________________________________________________________________________ Miss Star is preparing for discharge. You complete another head to toe assessment prior to discharge due to the complications that Miss Star encountered. The following are your findings, today’s date at 1845. CVS- S1 and S2 auscultated, cap refill less than 2 seconds, colour pink, warm and dry to touch. Pulses regular to all locations, denies chest pain. RESP- Air entry adequate bilaterally and no adventitious sounds heard, work of breathing decreased, no accessory muscle use, patient states she no longer feels short of breath. No cough noted. INTEG- hives have resolved, no other rash present. VITAL SIGNS- T- 36.7 C, P-87 bpm and regular, RR- 16 breaths per minute, easy and regular, SP02- 98% on RA, BP 120/80 Patient is cooperative, thankful to the team and teary about her experience, she has her boyfriend coming to pick her up. She has been given new prescriptions and education on how to take an MDI with chamber. Discharge teaching is completed at the end of the assessment. 11. Please chart the following assessment in your own words using DARP format and on the DARP documentation sheet. (10) (Can be typed)