Reference no: EM133543353
Case: Asthma Exacerbation
A 38-year-old female who has suffered from moderate-persistent asthma and environmental allergies since age 6 presents to the emergency department with respiratory distress.
The patient's spouse reports that they were "out hiking" approximately 3 hours prior when the patient started sneezing and reported that "something had stirred up (her) allergies." A half hour later, she needed to use her albuterol MDI. She took two puffs and got little relief.
The couple returned home, and the patient took a chewable cetirizine (Zyrtec) tablet and another two puffs of albuterol an hour after she had taken the first two puffs from her MDI. Still, the patient felt that "(her) chest was really tight." The spouse then drove her to the ED.
On examination, the patient is in apparent respiratory distress. She has trouble speaking more than 3 or 4 words before becoming out of breath.
Vitals signs are as follows:
RR: 26
Pulse oximetry: 90% on Room Air
HR: 110 bpm
BP: 138/88
Temp: 98.8 ?
Expiratory wheezes are audible even without a stethoscope.
1. Which of the vital signs are abnormal?
2. Why might the heart rate be 110 bpm?
3. What medications and therapies should be administered as immediate priority? Consider the list below and describe which ones the nurse would make use of in treating this patient with severe respiratory distress.
AeroChamber Z-STAT/Plus
Albuterol nebulizer
Methylprednisolone Sodium Succinate 1 gram (Injection, USP)
Diphenhydramine 50 mg/ml (HCL Injection, USP)
DuoNeb (Ipratropium bromide and albuterol Sulfate)
Our patient will go home with prescription for prednisone, 20 mg, PO, twice daily for 2 weeks, and then 20 mg, once daily for 2 more weeks.
After this time, the patient is instructed to come into the clinic for evaluation and will be instructed on how to "taper" off the oral prednisone.
4. Why is it important for the patient to "taper" the prednisone, rather than stopping it abruptly?
5. Describe some of the adverse effects that might be experienced by a patient taking prednisone daily for many years? (Consider the organs found in the areas A-E below) list labs that may indicate adverse effects, and few other organs not listed.
A: Shoulder blade (arm and back)
B: Femur
C: Suprarenal gland
D: Heart
E: Stomach