Chapter 6

Asthma Case Study Answers

1. What is your hypothesis for Jeremy’s current condition and what are two possible causes?

Hypothesis: Acute asthma exacerbation

Possible Causes:

• Respiratory Infection: The recent “cold” affecting his family members suggests that Jeremy may have contracted a viral respiratory infection, a common trigger for asthma exacerbations.
• Physical Exertion: Playing basketball can be physically demanding and may have triggered his asthma symptoms, especially if he did not use a pre-exercise bronchodilator inhaler, if prescribed.

2. How would you teach Jeremy and his parents about his salmeterol inhaler and why did it not offer relief?

• Explain that Serevent is a long-acting beta-agonist (LABA) bronchodilator, which is primarily used for maintenance therapy, not for immediate relief during an asthma attack.
• Emphasize the importance of using a short-acting beta-agonist (e.g., albuterol) for quick relief during acute symptoms.
• Teach Jeremy and his parents to differentiate between their maintenance and rescue inhalers and when to use each.

3. Evaluate Jeremy’s peak flow reading. What zone is he in? What will you teach Jeremy and his parents regarding his asthma management using peak flow meter readings and the asthma action plan?

Jeremy’s peak flow reading is 180, significantly below his personal best of 425.

Jeremy is in the “Red Zone,” indicating a severe asthma exacerbation.

Teaching will include the following: regularly monitor peak flow measurements because peak flow readings help monitor lung function and assess asthma control and reinforce the three zones (Green, Yellow, Red) in his asthma action plan and actions to take.

• Green Zone (Good Control): No symptoms and peak flow reading 80% or higher compared to his personal best.

• Yellow Zone (Caution): Worsening symptoms. Peak flow reading between 50% and 79%. Follow the asthma action plan in self-administering prescribed medications and contacting the health care provider.

• Red Zone (Medical Alert): Immediate action is required. Administer quick-relief medication and contact the health care provider. Obtain emergency medical care as described.

COPD Case Study Answers

1. Based upon the information above, what signs and symptoms suggest the client may have COPD?

Maria reports chronic cough with sputum production and exertional dyspnea. She has an increased respiratory rate, diminished breath sounds, wheezing, chronic cough with thick yellow/green sputum, barrel chest, and cyanosis in the nail beds. She has assumed a “tripod” position.

2. What are potential contributing factors to Maria’s COPD diagnosis?

Maria’s long-term smoking history is the most likely cause of her COPD. Cigarette smoke is a well-established risk factor for developing the disease. In addition to smoking, occupational or environmental exposures to lung irritants (e.g., dust, chemicals, pollutants) may have contributed to her condition, especially if she had a history of such exposures in her workplace or living environment.

3. The health care provider prescribes daily fluticasone inhaler use with albuterol inhaler for rapid treatment of dyspnea. What will you teach Maria about these medications?

Fluticasone is an inhaled corticosteroid that will reduce inflammation in the lungs. It should be used daily, and Maria should rinse out her mouth after use. Albuterol is a quick-relief medication that Maria should use when she feels short of breath.

4. The health care provider recommends Maria to participate in pulmonary rehabilitation. Maria states, “Why should I drive into town to go to pulmonary rehab?” How should the nurse respond to Maria?

Pulmonary rehabilitation is a supervised program that will help to improve her endurance to physical activity to its optimal level. The staff will also provide teaching on breathing techniques to use when she is feeling short of breath and ways to conserve her energy and manage her fatigue when doing daily activities.

Tuberculosis Case Study Answers

1. What are the key findings in Mrs. Xiong’s physical examination that suggest a diagnosis of pulmonary tuberculosis (TB)?

Mrs. Xiong’s key findings on physical examination include fatigue, night sweats, anorexia, weight loss, a persistent dry cough, and reduced breath sounds in the right upper lobe with occasional crackles. These symptoms, along with a chest X-ray showing cavitary lesions in her right upper lung lobe and a positive sputum AFB test, strongly suggest a diagnosis of pulmonary tuberculosis (TB).

2. What is the first-line therapy for treating active pulmonary TB, and what are the possible side effects of these medications?

The first-line therapy for treating active pulmonary TB consists of a combination of medications, including isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) taken for a minimum of six months. Possible side effects include hepatotoxicity, peripheral neuropathy, flu-like symptoms, and visual disturbances, respectively.

3. What nursing interventions are essential to prevent the spread of TB infection in the hospital setting and ensure Mrs. Xiong’s safety and well-being?

Essential nursing interventions include placing Mrs. Xiong in a negative pressure isolation room, wearing appropriate personal protective equipment (PPE), educating Mrs. Xiong on respiratory hygiene, administering and monitoring her medications, ensuring good nutrition and rest, providing emotional support, and communicating with the multidisciplinary team for coordinated care.

4. What should Mrs. Xiong be educated about regarding her condition, including the importance of medication adherence, infection control measures, and follow-up care?

Mrs. Xiong should be educated about the importance of adhering to her prescribed medications to ensure successful treatment and prevent drug resistance. She should also be taught respiratory hygiene practices to minimize the spread of TB infection to others, including coughing or sneezing into a tissue or elbow, disposing of tissues properly, and wearing a mask if leaving her room. Additionally, she should understand the importance of follow-up appointments to monitor her progress and ensure continued care.

All of the answers to the interactive element are found within the element.