Final answer:
A 36-year-old male with asthma is presenting with signs of an exacerbation and requires emergency treatment, physical examination, diagnostic testing, targeted therapy, and may need hospitalization depending on the severity of the symptoms. The treatment should focus on relieving the immediate symptoms and also address long-term management including smoking cessation.
Step-by-step explanation:
Managing an Asthma Exacerbation
The 36-year-old male patient with a history of asthma presenting in the emergency department (ED) with symptoms of an asthma exacerbation requires immediate attention. Emergency orders should begin with assessing the patient's airway, breathing, and circulation (ABCs) and might include supplemental oxygen to maintain SpO2 >90%, nebulized short-acting β-2 agonists such as albuterol, and possibly anticholinergics like ipratropium. The physical exam should focus on respiratory assessment including auscultation to check for wheezing or other abnormal breath sounds.
Diagnostic tests for this patient may involve a chest X-ray to rule out pneumonia, an arterial blood gas (ABG) to assess gas exchange, and a complete blood count (CBC) to look for signs of infection or inflammation. Therapy should be guided by the severity of the exacerbation and may include systemic corticosteroids to reduce airway inflammation.
The location for the treatment depends on the patient's response to initial interventions; he may be managed in the ED or require admission to a hospital unit for further care. The final order, after stabilization, should include arranging follow-up care, advising smoking cessation, and possibly updating his asthma action plan. The differential diagnosis (Dx) includes an acute asthma attack potentially complicated by a respiratory infection or pneumothorax.