![]() ![]() Healthcare providers should ask patients questions that focus on asthma severity and control with regard to impairment and risk. These guidelines direct healthcare providers to the latest evidence-based practice guidelines to support accurate asthma diagnosis and management. In 2007, The National Heart, Lung, and Blood Institute and National Asthma Education and Prevention Program released evidence-based guidelines, called the Third Expert Panel Report (EPR-3). Healthcare providers don’t always ask patients the right questions, which can hinder development of an appropriate treatment plan and care. He admits to occasional alcohol use and smoking half a pack of cigarettes per day for the past 2 years. Marcus states he awakens during the night two or three times a week with asthma symptoms. She is concerned because his asthma has limited his activity level he recently had to quit playing recreational college softball. Olivia reports this is his second ED visit for asthma exacerbation in the past year, but states he hasn’t been admitted to the hospital since childhood. He admits he ran out of his inhaled corticosteroid months earlier and hasn’t refilled the prescription. Further questioning reveals Marcus had been using his albuterol inhaler almost daily, but only once a day. Marcus is in college and has been getting his inhaler refilled from a healthcare provider back home. She states his asthma seemed to be getting worse over the past 6 months, but he has refused to see his primary care provider. ABG results show an partial pressure of arterial oxygen (PaO 2) of 62 mm Hg (below the normal range) and a partial pressure of arterial carbon dioxide (PaCO 2) of 42 mm Hg.ĭuring the history and physical exam, Olivia reports Marcus has been healthy except for asthma, which came on during childhood. As ordered, Gina obtains an arterial blood gas (ABG) sample, chest X-ray, and electrocardiogram. corticosteroid to decrease inflammation and ease airway obstruction. ![]() He orders an increase in supplemental O 2 to 3 L to attain an O 2 sat of 93%, along with a bronchodilator nebulizer breathing treatment and an I.V. On arrival, the physician auscultates Marcus’s lungs and finds bilaterally diminished lung sounds with expiratory wheezing in the upper and lower fields. Gina administers oxygen 2 L per nasal cannula and places Marcus on a cardiac monitor, which reveals sinus tachycardia. His vital signs are temperature 98.7° (37° C), blood pressure 190/88 mm Hg, pulse 122 beats/minute, and respiratory rate 32 breaths/minute. Realizing he needs immediate evaluation and treatment, Gina positions him in high Fowler’s position. She finds his breathing is labored with audible wheezing and notes that he can speak only in short sentences. Gina, the triage nurse, quickly escorts them both to a nearby room, where she assesses Marcus. Marcus, age 20, is an African-American male who comes to the ED complaining “I can’t get my breath.” His friend Olivia, who has brought him to the hospital, reports he has a history of asthma. Between asthma attacks, lung sounds may be clear. As the attack subsides, the patient may have thick mucus secretions. (See the box below.) Recognizing asthma quicklyĬonfusion and fatigue may indicate respiratory failure. Whether the patient presents to the ED or is admitted to the hospital, all nurses should be able to recognize asthma symptoms readily. ![]() Treatment must be quick and effective to relieve symptoms and prevent further deterioration. Patient assessmentĪs asthma progresses, the patient may experience shortness of breath, cough, chest tightness, and wheezing. Asthma incidence has risen in the last 20 years, resulting in more emergency department (ED) visits, hospitalizations, and deaths. African-Americans are more likely than whites to be hospitalized and die from asthma. Each year, 500,000 people are hospitalized with asthma and 4,000 people die. What’s more, an asthma attack can cause fear and anxiety, which can worsen symptoms.Īpproximately 22 million people in the United States have asthma 6 million are children. Asthma signs and symptoms range from mild to severe and may proceed to life-threatening complications, including respiratory failure and even death. In asthma, airway inflammation leads to airway obstruction, which may be chronic or arise as an acute symptom exacerbation.
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