L.S. is a 7-year-old who has been brought to the emergency department (ED) by his mother. She immediately tells you he has a history of ED visits for his asthma. He uses an inhaler when he wheezes, but it ran out a month ago. She is a single parent and has two other children at home with a babysitter. Your assessment finds L.S. alert, oriented, and extremely anxious. His color is pale, and his nail beds are dusky and cool to the touch; other findings are heart rate 136 beats/min, respiratory rate 36 breaths/min regular and even, oral temperature 37.3°C (99.1°F), SaO2 89%, breath sounds decreased in lower lobes bilaterally and congested with inspiratory and expiratory wheezes, prolonged expirations, and a productive cough.

Questions:

1. As you ask Ms. S. questions, you note that L.S.'s respiratory rate is increasing; he is sitting on the side of the bed, leaning slightly forward, and is having difficulty breathing. What interventions are appropriate at this time and rationalize it?

2. Identify the nursing responsibilities associated with giving bronchodilators.

3. He improves and 24 hours later is transferred to the floor. Asthma teaching is ordered. You assess Ms. S.'s understanding of asthma and her understanding of the disorder. L.S. tells you that he loves to play basketball and football and asks you whether he can still do these activities. How will you respond?

4. What additional information should be included in your discharge teaching regarding how to prevent acute asthmatic episodes and how to manage symptoms of exacerbation of asthma?

Administer supplemental oxygen, position L.S. upright, provide reassurance, and administer a short-acting bronchodilator to alleviate respiratory distress. Assess respiratory status, educate on medication use, monitor for adverse effects, and document bronchodilator administration.

With proper asthma management, L.S. can still participate in physical activities, emphasizing the need for control, medication use, and symptom monitoring. Discharge teaching should include trigger avoidance, inhaler use, asthma action plan, recognizing worsening symptoms, managing asthma in different environments, and educating family members.

As L.S.'s respiratory rate is increasing and he is experiencing difficulty breathing, immediate interventions are required. Administering supplemental oxygen helps improve oxygenation, while positioning L.S. upright helps optimize lung expansion. Providing reassurance helps alleviate anxiety, and administering a short-acting bronchodilator, such as albuterol, helps relax the airway smooth muscles and relieve bronchoconstriction, improving L.S.'s breathing.

Nursing responsibilities associated with giving bronchodilators include assessing respiratory status before and after administration, monitoring vital signs and oxygen saturation, documenting the medication administration, educating the patient and family on proper inhaler technique, and monitoring for any adverse effects or allergic reactions.

When L.S. asks about participating in basketball and football, it is important to respond positively and encourage his involvement in physical activities. Emphasize that with proper asthma management, including regular use of prescribed medications, monitoring symptoms, and having an asthma action plan, he can still engage in sports while minimizing the risk of exacerbations.

In discharge teaching, additional information should be provided on avoiding triggers that may precipitate acute asthmatic episodes, such as allergens or irritants. Educate L.S. and his family on proper inhaler use, including correct technique and timing of medication administration. Provide an asthma action plan outlining steps to manage worsening symptoms or exacerbations. Emphasize the importance of regular follow-up with healthcare providers and the need for ongoing monitoring and adjustments to the treatment plan as necessary.

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