Question

Greg, age 20, is an African-American male who comes to the ED complaining "I can’t get my breath." His friend Jamie, who has brought him to the hospital. Nurse Jackie, the triage nurse, quickly escorts them both to a nearby room, where she assesses Greg. She finds his breathing is labored with audible wheezing and notes that he can speak only in short sentences.

Realizing he needs immediate evaluation and treatment, Nurse Jackie positions him in high Fowler’s position. His vital signs are temperature 98.7°, blood pressure 190/88 mm Hg, pulse 122 beats/minute, and respiratory rate 32 breaths/minute. His oxygen saturation is 88%. Nurse Jackie administers oxygen 2 L per nasal cannula and places Greg on a cardiac monitor, which reveals sinus tachycardia. Then she contacts the ED physician.

On arrival, the physician auscultates Greg’s lungs and finds bilaterally diminished lung sounds with expiratory wheezing in the upper and lower fields. He orders an increase in supplemental O2 to 3 L to attain an O2 sat of 93%. As ordered, Nurse Jackie obtains an arterial blood gas sample, chest X-ray, and electrocardiogram. ABG results show a pH of 6.85, partial pressure of arterial oxygen of 62 mm Hg, bicarbonate level of 26 mEq/L, and a partial pressure of arterial carbon dioxide of 48 mm Hg.

1. Based on the ABG, what does the result tell you about the patient? How did you come up with this conclusion? Explain your answer. (2 points)
2. What medication would you anticipate the ED physician to order? How do these medications help your patient? Name two drug classification that the ED physician would order for this patient. Explain your answer. (3 points)
3. What would be a NANDA for this patient? What is your goal (SMART)? (2 points)

Greg was diagnosed with new onset asthma. Greg was getting discharged with inhalers.

4. Based on your answer to question #2, what would you include in your patient teaching? Provide three patient teaching that you would include and the rationale.

Answer 1

Greg's ABG results indicate acute respiratory acidosis, and treatment will likely include bronchodilators and corticosteroids. Education on inhaler use, recognizing exacerbation signs, and avoiding triggers is crucial for his discharge plan.

Step-by-step explanation:

Based on the ABG results provided for the patient, Greg, the pH of 6.85 indicates a significant acidosis, as the normal range for arterial pH is between 7.35 and 7.45. The elevated partial pressure of arterial carbon dioxide (PaCO2) of 48 mm Hg suggests a respiratory cause because it is higher than the normal range of 35-45 mm Hg. His bicarbonate level (HCO3-) at 26 mEq/L is within the normal range (22-26 mEq/L), indicating there may not be significant metabolic compensation. The low pH and high PaCO2 confirm acute respiratory acidosis, likely resulting from impaired gas exchange and ventilation due to asthma.

The ED physician would likely order bronchodilators, such as a beta2-adrenergic agonist (to relax smooth muscles in the airways) and a corticosteroid (to reduce inflammation in the airways), which are commonly used to treat asthma exacerbations. These medications help to improve breathing and oxygenation in asthma patients.

A potential North American Nursing Diagnosis Association (NANDA) diagnosis for this patient could be "Impaired gas exchange related to bronchospasm associated with asthma exacerbation." A SMART goal could be: "Patient's oxygen saturation will reach 95% within 30 minutes after administering bronchodilators and corticosteroids and remain stable for the duration of the ED visit."

For patient teaching upon discharge, education should include the following: The correct technique for using inhalers, recognizing signs of asthma exacerbation and when to seek medical help, and the importance of avoiding triggers, such as allergens or irritants. Understanding these aspects will help Greg manage his new onset of asthma effectively.