Question

A PN 200 Fundamentals of Nursing IT Case Study Bronchial Asthma Michael y dinosed with bronchial asthma. His mother her have to the past year, Michael has had three asthma attacks that ne trend th e and autol Preventi inhaler. At the office visit today. pod prethod for a week and the order is written as follows: 7 tablet by mouth four times a day Day? Day 2 Day 3 Day - Table by mouth three times a day tablet by mouth two times a day 1 tablet by mouth in the morning 6 tablet by mouth in the moming 1. Explain the use of prednisone during an asthma attack. Explain why the dosage is decreased tapered) over a period of 5 days. Day 3 2. Can Cromolyn sodium (Nasal Crom) be substituted for prednisone during an asthma attack? Explain your answer. 3. Michael is prescribed albuterol (Proventil, Ventolin). What effect does albuterol have on controlling asthma? 4. For each drug dose, Michael is to take two puffs of albuterol administered by an inhaler What instructions should be given to the patient concerning the use of an inhaler? minimize the frequency of Michael's asthma attacks, the health care provider prescribes phylline (Elixophyllin) 200 mg. twice a day. The albuterol inhaler is to be taken as need Eng interventions include patient history of asthma attacks and physical assessment. When taking the patient's history, what should the nurse include concerning asthm attacks? What type of drug is Elixophyllin? Why should the nurse ask if Michael smokes

Answer 1

1. Prednisone is a corticosteroid, which is an anti-inflammatory or an immunosuppressant medication. The medicine prevents the release of substances in the body that cause inflammation. In the patient with asthma, the airways get inflamed during an acute asthmatic attack. The airway become puffy, irritated, making it difficult to breathe. Prednisone helps to reduce the body’s inflammatory response after the asthma attack. When a patient takes Prednisone, the body thinks it is a steroid hormone (Cortisol). These hormones enter the body’s cells, and create chemical reaction, which in turn stop the inflammatory process. As a result, the patient is able to breath more easily. The airways also create less mucus, making it easier to br eath. Tapering Prednisone: Prednisone is similar to cortisol, a hormone naturally made by the adrenal glands. Cortisol is a steroid hormone, which regulates the metabolism and immune responses. As discussed earlier, Prednisone work by imitating the effects of cortisol. If Prednisone is taken for more than a few weeks, the adrenal glands will decrease the natural production of cortisol. One can experience withdrawal symptoms if Prednisone is stopped before the natural production of cortisol is restored. The medication should be gradually reduced in dose according the prescription by the doctor to avoid withdrawal symptoms.

2. Cromolyn sodium is also used to prevent the symptoms of asthma, by reducing the inflammation in the lungs when used regularly. Cromolyn inhalation works by acting on certain inflammatory cells in the lungs to prevent them from releasing substances that cause asthma symptoms. However, Cromolyn will not help an asthma or bronchospasm attack if it has already started. Therefore, Cromolyn sodium cannot be used as a substitute for prednisone during an asthma attack. Cromolyn can be used alone or with other asthma medicine such as bronchodilators or corticosteroids.

3. Albuterol is a bronchodilator. Patients with asthma often experience bronchoconstriction, where the airways become narrowed, making it difficulty to breathe enough air. This causes wheezing and shortness of breath. Albuterol acts on the beta2 receptors in the smooth muscles of the bronchi, thereby relaxing the smooth muscle of the bronchi. The airways become clear and allow more air to flow into the lung.

4. Using the inhaler: When using the inhaler for the first time, shake the inhaler for five seconds. Press down the canister with the index finger to release the medication. Hold the inhaler away from your face to prevent the mediation getting into your eyes. Wait a few seconds, shake the inhaler, and press the canister down again.

   General instructions: Remember to take the cap off the mouthpiece; be sure there is medication in the canister; shake the inhaler vigorously for five seconds before each puff; inhale through the mouth when breathing in the medication, not the nose; keep the tongue under the mouthpiece so that it does not block the opening of the mouthpiece; take a slow, deep breath at the same time as the patient press down on the medication canister; hold breath for as long as comfortable (5-10 sec) and then exhale.

   Cleaning the inhaler: remove the medication canister and cap from the mouthpiece, do not wash the canister or immerse in water; run warm tap water through the top and bottom of the plastic mouthpiece for 30 to 60 seconds. Use a soft cloth to remove any crusting of medication around the mouthpiece; shake off excess water, and allow the mouthpiece to dry completely.

5. The nurse should include the following while taking the history of the patient:

   Usual prodromal signs or symptoms

   Rapidity of the onset

   Associated illness

   Number of asthma attacks in the last year

   Need for emergency department visits/hospitalization/ICU admission

   Missed days from work or school or activity limitation

6. Elixophyllin is a bronchodilator that is used to treat symptoms of asthma, bronchitis, emphysema or breathing problems. The patient should not start or stop smoking without consulting the doctor while taking Elixophyllin. Smoking changes the way our body uses Elixophyllin, and dosage alteration would be needed. The drug clearance is increased by 58-100% and its half-life is decreased by 63% in smokers compared to non-smoker.