College

Ismail, a 19-year-old, is brought into the Emergency Department by his parents with breathlessness, wheezing, and coughing. For the past three days, Ismail has been experiencing mild exacerbation of his asthma on exertion. His inhalers have been ineffective, and he has a productive cough of thick whitish sputum and a "runny nose." According to Ismail, he has been experiencing high levels of stress due to his impending examinations. He shared that many of his classmates are also "down with flu."

**Past Medical History:**
- Asthma, last hospitalization 2 years ago, and last course of oral corticosteroids a year ago.

**Social History:**
- Lives with mother, father, and two siblings, both of whom have asthma.
- They have two cats at home.
- Father is a smoker, but states that he tries to smoke outside and not around the kids.

**Nursing Assessment:**
- **Neurological:** Alert and oriented to time, place, and person, appears anxious and scared. Pupils equal and reactive to light (PEARL).
- **Respiratory:** RR 36 breaths per minute, SpO2 89% on room air, audible wheeze heard bilaterally.
- **Cardiovascular:** BP 110/64 mmHg, HR 120 beats per minute, Temperature 37.1ºC.
- **Gastrointestinal:** No nausea/vomiting, bowel sounds normoactive.
- **Renal:** Has difficulty passing urine.
- **Integumentary:** Dry and pale in color.
- **Other:** Chest x-ray normal, sputum c/s negative.

**Doctor’s Orders:**
- O2 at 3 LPM nasal cannula if SpO2 ≤ 90%.
- Hourly vital signs.
- Medications:
- Nebulization with salbutamol, ipratropium bromide, sodium chloride 2:1:2, every 4-6 hours or as needed.
- PO prednisolone 30 mg in the morning.
- PO augmentin 500 mg twice daily.
- PO acetylcysteine 600 mg in the morning.

**Discharge Medications:**
- MDI salbutamol, 2 puffs three times daily or as needed.
- MDI budesonide/formoterol (Symbicort) 160/4.5 mcg, 2 puffs twice daily or as needed.

Which prescribed medications are only needed for the patient in this case?

Answer :

Nebulisation Salbutamol: Ipratropium Bromide: Sodium Chloride 2:1:2 4-6 hourly/PRN, PO Prednisolone 30 mg OM, PO Augmentin 500 BD, and PO Acetylcysteine 600mg OM are the prescribed medications that are needed for the patient in this case.

According to the given case, the patient Ismail, 19-year-old, is brought into the Emergency Department by his parents with breathlessness, wheezing, and coughing. Ismail has been suffering a moderate aggravation of his asthma on exertion for the previous three days. His inhalers haven't worked, and he also has a "runny nose" and a strong cough that produces thick, white-colored phlegm.

Based on the nursing assessment, the patient has a respiratory rate (RR) of 36 breaths per minute, SPO2 of 89% on room air, and audible wheeze heard bilaterally. Therefore, the prescribed medications that are needed for the patient in this case are Nebulisation Salbutamol: Ipratropium Bromide: Sodium Chloride 2:1:2 4-6 hourly/PRN, PO Prednisolone 30 mg OM, PO Augmentin 500 BD, and PO Acetylcysteine 600mg OM.

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