Health Variations & Acute Life Threatening Conditions With Poppy Asthma Case Study - Nursing Assignment Help

Assignment Task

Assignment overview 

This assignment will require you to respond to a short answer questions based on a case study of acute life-threatening and/or traumatic complex health condition. 

The purpose of this assessment is to enable you to do the following: 

1. Demonstrate knowledge by analysing the information provided in the case study. 2. Apply the clinical information provided in the case study and describe this clinical information within a pathophysiological and patient focused framework. 

3. Discuss nursing strategies and evidence based rationales to manage a patient with an acute episode of asthma. 

4. Discuss the pharmacological interventions related to the management of a patient with an acute episode of asthma. 

Case study 

Poppy is a 9-year-old female, weighing 40kg. 

She presented to ED with worsening respiratory symptoms over the past few hours. Her parents state she is unable to talk in full sentences or undertake a peak flow. In ED, Poppy has been given 3 x 20 minutely nebulised Salbutamol with 6LPM of O2, IVF commenced, stat dose of Prednisone administered, chest X-ray shows hyperinflation of both lung fields. She was admitted to ICU due to her deteriorating respiratory function with a diagnosis of acute exacerbation of asthma.

Excerpt of relevant ICU notes 

Past history 

• Diagnosed with asthma age 2 (infrequent intermittent asthma). 
• Current medications: Ventolin PRN. 
• IUTD (immunisations up to date). 

Nursing assessment 

A. Clear, speaking in single words 

B. RR 42bpm, SpO2 87% RA, 92% on 6LPM O2 + nebuliser, auscultation decreased AE bibasally, inspiratory and expiratory wheeze 

C. HR 160bpm, ST, peripherally warm 

D. GCS 14/15 (E4, V4, M6) 

E. Accessory muscle use, shoulder shrugging on inspiration, tracheal tug F. IVF NaCl 53 ml/hr 

a. Mg- low 0.60mmol/L (0.70-1.10mmol/L) all other pathology is normal.

b. BGL 9.0mmol/L 

c. Beta-agonist- Salbutamol 

d. Anticholinergic - Atrovent 

e. IV Hydrocortisone 

f. ABG shows respiratory acidosis, (PH 7.32, PaCO2 49, PaO2 70, HCO3 27, BE -2.1, Lactate 1.4) 

• Plan 
• Keep SpO2 92–95% 
• Beta-agonist Salbutamol continuous via nebuliser 
• Anticholinergic Ipratropium bromide (Atrovent) 500microg 4/24 
• Hydrocortisone 100mg 6/24 
• MgSO4 6.4mmol/20 minutes 
• IVF 53ml/hr 
• Repeat ABGs in 1hour 
• Monitor BGL 
• Peakflow/spirometry.

Case study questions 

Question 1 

Explain the pathogenesis causing the clinical manifestations with which Poppy presents. 

Question 2:  

Step 1: Sit Poppy in a High Fowlers position. 

How does positioning a patient with acute asthma in a High Fowlers position assist to alleviate respiratory distress? 

Step 2: Apply and titrate oxygen. 

• What oxygen delivery device will you use? 
• Why did you choose this device? 
• How does providing supplemental oxygen work, and how will it assist Poppy?

Question 3 

For each of the following medications, explain the following:

• The mechanism of action. 
• Why your patient is receiving this medication in relation to her symptoms and diagnosis? What are the nursing considerations for this medication? 
• What clinical response you expect? 
• What continuing clinical observations will you need to undertake?

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