AUSTRALIAN MEDICAL OR NURSING PROFESSIONAL WRITER REQUESTED DUE TO THE NATURE OF THE ASSESSMENT REQUIREMENTS. • Word count: 1250 [-/+ 10% (reference list excluded)] • Short answer format • 3 cm left and right margins, double spaced. • Font: Arial or Times • Referencing Style: APA 7th ed. • References articles to be within the last 5 years (minimum of 12) • Australian academic grammar, vocabulary, Australian medical equipment and units to be used. Medical terminology should be used throughout the assessment. • High Distinction assessment criterion Aim of assessment The aim of this assessment is to: 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 pathophysological 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. Details The answers each question related to the case study provided. Your answers must be directly related to the clinical manifestations that the patient presents with. Every bit of information and assessment result provided in the case study MUST be articulately and meticulously featured due to the words limit restraints. Case study Peter is a 10 year old male, weight 45Kg. He presented to ED with worsening respiratory symptoms over the past few hours. His parents state he is unable to talk in full sentences or undertake a peak flow. In ED Peter 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. He was admitted to ICU due to his deteriorating respiratory function with a diagnosis of acute exacerbation of asthma. EXCERPT OF RELEVANT ICU NOTES Past History Diagnosed with asthma age 3 (infrequent intermittent asthma). Current medications: – Ventolin PRN. IUTD (immunisations up to date) Nursing Assessment AIRWAY: Clear, speaking in single words BREATHING: RR 43bpm, SpO2 87% RA, 92% on 6LPM O2 + nebuliser, auscultation decreased AE bibasally, inspiratory and expiratory wheeze CIRCULATION: HR 162bpm, ST, peripherally warm DISABILITY: GCS 14/15 (E4, V4, M6) EXPOSURE: Accessory muscle use, shoulder shrugging on inspiration, tracheal tug FLUIDS: IVF NaCl 54 ml/hr GLUCOSE a. Mg- low ( all other pathology is normal. b. BGL c. Beta-agonist- Salbutamol d. Anticholinergic – Atrovent e. IV Hydrocortisone f. ABG shows respiratory acidosis, (PH , PaCO2 49, PaO2 70, HCO3 27, BE , Lactate ) Plan – Keep SpO2 92-95% – Beta- antagonist Salbutamol continuous via nebuliser – Anticholinergic Ipratropium bromide (Atrovent) 500ug 4/24 – Hydrocortisone 100mg 6/24 – MgSO4 4mmol/20 minutes – IVF 53ml/hr – Repeat ABGs in 1hour – Monitor BGL – Peak flow /spirometry Question 1 Explain the pathogenesis causing EACH of the clinical manifestations with which Peter presents (refer to the case study, every. Question 2 1. Sit Peter in a High Fowlers position; – How does positioning a patient with acute asthma in a High Fowlers position assist to alleviate respiratory distress? 1. 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 Peter? Question 3 For each medication below explain – 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 should you expect? – What continuing clinical observations will you need to undertake? Medication: Salbutamol via nebuliser Hydrocortisone IV Ipratropium Bromide via nebuliser
