EAQ- Lewis Med Surg CH.29, Nursing Management: Obstructive Pulmonary Diseases: Asthma Management

A 45-year-old patient is experiencing an asthma exacerbation. To facilitate airflow, the nurse should place the patient in which position? 1. Prone 2. Supine 3. High-Fowler's 4. Trendelenburg's

3. High- Fowler's The patient experiencing an asthma attack should be placed in high-Fowler's position to allow for optimal chest expansion and enlist the aid of gravity during inspiration. Prone, supine, and Trendelenburg's positions do not facilitate airflow or decrease chest expansion, and may cause respiratory distress.

The nurse determines that the patient has experienced the full benefits of medication therapy with ipratropium when which assessment finding is noted? 1. Heart rate 80 beats per minute 2. Clear lung sounds 3. Capillary refill less than three seconds 4. Positive bowel sounds in all quadrants

2. Clear lung sounds Ipratropium is an inhaled anticholinergic used for asthma management. Clear lung sounds would indicate full passage of air and well-controlled symptom management. Heart rate, capillary refill, and bowel sounds are not associated with the benefits of ipratropium administration for bronchoconstriction and inflammation.

On examining a patient with asthma the nurse finds that the patient experiences asthmatic symptoms throughout the day, besides experiencing night-time awakenings more than four times a week. The patient's forced expiratory volume in the first second of expiration (FEV1) is less than 60%, and normal activity is very limited. Which treatment option should the nurse consider appropriate? 1. Advise maintaining control of asthma symptoms. 2. Follow up after a month. 3. Reevaluate in two to six weeks. 4. Consider oral corticosteroids.

4. Consider oral corticosteroids. Experiencing symptoms of asthma throughout the day and also experiencing nighttime awakenings more than four times a week is suggestive of poorly controlled asthma. This patient also has an FEV1 less than 60%; normal activity being very limited correlates with that. Treatment with oral corticosteroids should be considered. Advice for maintaining control of asthma symptoms and following up after a month can be given in case of well controlled asthma. Reevaluation in two to six weeks is suggested if the asthma is not well controlled or if the patient experiences symptoms more than two times a month.

The nurse is evaluating an asthmatic patient's knowledge of self-care. Which statement by the patient indicates an adequate understanding of the instructions given? 1. "I will keep my rescue inhaler with me at all times." 2. "I do not need to get a flu shot because I'm under age 50." 3. "I will use my peak flow meter only when I feel like I'm getting sick." 4. "I will use my corticosteroid inhaler only when I feel short of breath."

1. "I will keep my rescue inhaler with me at all times." Part of a rescue plan for asthma patients is to have access to a short-acting bronchodilator, such as albuterol, to use for rapid control of symptoms. Asthma patients should get a flu shot annually, and the self-monitoring of one's "Personal Best" with a peak flow meter should be done at least daily as part of an asthma action plan. Corticosteroids cannot abort an asthma attack.

Which inhaler should the nurse be prepared to administer to the patient at the onset of an asthma attack? 1. Albuterol 2. Fluticasone/Salmeterol 3. Fluticasone 4. Salmeterol

1. Albuterol Albuterol is a short-acting bronchodilator that should be given first when the patient experiences an asthma attack. Fluticasone/salmeterol, fluticasone, and salmeterol are not short-acting bronchodilators and will not relieve the patient's symptoms of an acute asthma exacerbation.

The nurse provides teaching to a patient with asthma who has been advised to use nebulization. What should the nurse include in the instructions about nebulization? 1. Sit in an upright position during the treatment. 2. Hold the inspiration for 10 seconds. 3. Breathe rapidly between forced breaths. 4. Do not cough after the nebulization treatment.

1. Sit in an upright position during the treatment. Nebulization involves administering drug solution as mists produced by small machines called nebulizers. An upright position allows for efficient breathing that ensures adequate penetration and deposition of the aerosolized medication. The patient should hold the inspiration for two to three seconds to ensure penetration of the medication. The patient should practice deep breathing in between the forced breathing to prevent alveolar hypoventilation. The patient should be encouraged to cough effectively after the nebulization to mobilize the secretions.

The nurse is teaching a patient how to use a hand-held nebulizer. Which guideline is correct? 1. Sit in an upright position during the treatment. 2. Take short, shallow breaths while inhaling the medication. 3. Rinse the nebulizer equipment under running water once a week. 4. During the treatment, breathe in and hold the breath for five seconds.

1. Sit in an upright position during the treatment. The patient is placed in an upright position that allows for most efficient breathing to ensure adequate penetration and deposition of the aerosolized medication. The patient must breathe slowly and deeply through the mouth and hold inspirations for two or three seconds. Deep diaphragmatic breathing helps ensure deposition of the medication. Instruct the patient to breathe normally in between these large forced breaths to prevent alveolar hypoventilation and dizziness. After the treatment instruct the patient to cough effectively. An effective home-cleaning method is to wash the nebulizer equipment daily in soap and water, rinse it with water, and soak it for 20 to 30 minutes in a 1:1 white vinegar-water solution, followed by a water rinse and air drying.

The nurse determines that a patient is not experiencing the beneficial effects of ipratropium after noting which finding in the patient? 1. Hypoactive bowel sounds 2. Expiratory wheezing 3. Elevated blood pressure 4. Increased low back pain

2. Expiratory wheezing Ipratropium, a bronchodilator, decreases wheezing; if wheezing persists, the medication has not been effective. Ipratropium will have no effect on bowel sounds, blood pressure, or pain of any kind.

The patient has a prescription for albuterol 5 mg via nebulizer. Available is a solution containing 2 mg/mL. Calculate how many mL the nurse should use to prepare the patient's dose. Fill in the blank using one decimal place. __ mL

2.5 5 mg ÷ 2 mg/mL = 2.5 mL

In which position is it most appropriate for the nurse to place a patient experiencing an asthma exacerbation? 1. Supine 2. Lithotomy 3. High-Fowler 4. Reverse Trendelenburg

3. High- Fowler The patient experiencing an asthma attack should be placed in high-Fowler position and may need to lean forward to allow for optimal chest expansion and enlist the aid of gravity during inspiration. The supine, lithotomy, and reverse Trendelenburg positions will not facilitate ventilation.

The nurse administering beclomethasone to a patient can help reduce side effects by instructing the patient to perform which action? 1. Use this medication only as needed 2. Avoid use of a spacer to increase the amount of medication absorption 3. Rinse mouth thoroughly after each use 4. Use the inhaler at the onset of an asthma attack

3. Rinse mouth thoroughly after each use The side effects of the glucocorticoid include oral candida, which can be prevented through rinsing the mouth with water or mouthwash after each use. This medication should be used on a schedule, not as needed, a spacer is encouraged, and it will not be helpful at the onset of an asthma attack because it is not an abortive medication; it is a preventative medication.

The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate what as the most likely next step in treatment? 1. Intravenous (IV) fluids 2. Biofeedback therapy 3. Systemic corticosteroids 4. Pulmonary function testing

3. Systemic corticosteroids Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient. IV fluids may be used, but not to improve ventilation. Biofeedback therapy and pulmonary function testing may be used after recovery to assist the patient and monitor the asthma.