Difficulty: Intermediate
Setting: Hospital
Index Words: asthma, status asthmaticus, assessment, prioritization of nursing care, education
Giddens Concepts: Caregiving, Development, Gas Exchange, Patient Education
HESI Concepts: Assessment, Caregiving, Developmental, Gas Exchange, Oxygenation, Patient
Education
Name _________________________________ Class _______________ Date
_______________
Scenario
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 two 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 beats/min, R
(RR) 36 breaths/min regular and even, oral temperature T 99.1°F (37.3°C), 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 L.S.’s mother questions, you note that
L.S.’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.
1. You check the orders and need to decide which interventions are the priority at this time. Select all
that apply and explain the rationale.
a. Have L.S. lie flat.
b. Have L.S. perform incentive spirometry.
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 15 mL/hr and administer methylprednisolone 2 mg/kg
IV STAT × 1 dose.
2. Explain what the nurse will assess before, during, and after the nebulizer treatment with albuterol.
CASE STUDY PROGRESS
You give L.S. the albuterol and Atrovent twice. His O2 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 respiration rate remains 34 breaths/minute. You have started his IV infusion and
administered the methylprednisolone. L.S.’s mother is pacing and tells you she very upset and
worried. You overhead page the attending ED resident to assess, and you notify the patient-family
advocate. The ED resident, Dr. S., arrives within 2 minutes to assess L.S. and to speak to L.S.’s
mother. New orders are pending.
3. Chart your actions and the patient’s r
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