SBAR Select all that applies to "Situation" She does not need supplementary oxygen She has had an acute asthma attack Check vital signs every 15 minutes She has a history of asthma since childhood
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Jenny Smith, a 14-year-old girl with asthma, had been under relatively good control until last night. She slept over at a friend's house and woke up in the middle of the night with severe shortness of breath ("dyspnea") and a cough (unproductive of sputum). She had expiratory wheezing. Unfortunately, she did not take her bronchodilator medication with her to her friend's house. She was taken to the emergency walk-in clinic. On physical exam, she was wheezing quite loudly and using her accessory muscles of respiration to help her breathe. A chest X-ray revealed hyperluscent and over-inflated lungs. Blood testing revealed an arterial blood pH of 7.25 (normal = 7.35-7.45). Pulmonary function testing revealed the graph shown below.
Madhur L.
Twenty-one-year-old Lisa Long has been suffering from asthma and is now experiencing an asthma attack while taking an afternoon walk with her sister. It is a cold, windy, early spring weekend. She complains of acute shortness of breath and has audible wheezing, episodic cough, and chest tightness with itchy red watery eyes and a stuffy, runny, itchy nose. These symptoms become worse within 5 minutes. Her sister called 000 and paramedics promptly attended to Lisa, who was fully conscious, appeared wide-eyed and frightened, and unable to breathe effectively. She was immediately transferred to the nearest hospital for full respiratory function assessment and treatment of acute asthma. A physical test reveals a heart rate (HR) of 120/min, respiratory rate (RR) of 38/min, with signs of accessory muscle use. Chest auscultation reveals decreased breath sounds bilaterally, with inspiratory and expiratory wheezes. Lisa is coughing up small amounts of thin, clear sputum and has an arterial oxygen saturation of 90%. Nebulized salbutamol, oxygen by facial mask, and systemic corticosteroid were administered. A second small-volume nebulizer treatment was ordered 20 minutes later. Chest auscultation revealed diminished wheezes; RR was 24 at this time and HR was 102. Over the next 24 hours, Lisa showed steady improvement and was discharged for follow-up with her local GP to review her asthma action plan and change any medications as needed to help prevent future exacerbations. Question 3/1. List two factors that could have triggered Lisa's acute asthma attack and explain the link between the named factors and her asthma. (4 marks) Question 3/2. Explain the pathophysiological steps leading to an acute asthma attack. In your answer, you are expected to link type 1 hypersensitivity reaction to the role of histamine in acute asthma. (4 marks) Question 3/3. Briefly explain the mechanisms of action of (i) salbutamol and (ii) corticosteroids in the treatment of acute asthma and describe their benefits in Lisa's condition. (4 marks) Question 3/4. Explain the mechanism of action of anticholinergic/anti-parasympathetic medications and their potential benefit(s) in asthma treatment. (3 marks).
Sri K.
Asthma Case Study Assignment History Ms. B is a 19-year-old competitive bronco rider seen in the emergency room because of shortness of breath. The dyspnea began during a particularly hard ride, which culminated in modest dust inhalation on the rodeo floor. She states that the tightness in her chest and shortness of breath were so severe that she had to eventually leave the rodeo and seek medical help. She is now very uncomfortable, even at rest. During the past week, she has had a cough productive of greenish-yellow sputum, mild fever, malaise, and fatigue, but she did not feel seriously ill until the onset of dyspnea at the rodeo earlier in the day. She denies previous lung problems except for mild "wheezing" in her chest, which has occurred off and on during the past several years. She denies the use of any prescription medications or any previous episodes of dyspnea, chest pain, leg pain, hemoptysis, sinusitis, or allergies. Her family history is negative for lung disease. Physical Examination General: 19-year-old, 66 inches tall, and 140 lbs. Patient alert but restless and in moderate respiratory distress, mildly diaphoretic, sitting up on the edge of the bed leaning forward with her arms braced on her knees; cough frequent and productive of small amounts of greenish sputum. Vital Signs: Temperature 101.1 F, Respiratory Rate 38/min, Blood Pressure 170/95 mmHg, Heart Rate 140/min, Paradoxical Pulse 25 mmHg. HEENT: Sinuses not tender to palpation; nasal flaring with inspiration. Neck: Trachea midline and mobile to palpation; no stridor; carotid pulsations ++ and symmetrical bilaterally with no bruit; no lymphadenopathy, thyroidomegaly, or jugular venous distention; sternocleidomastoid muscles tensed during inspiration. Chest: Increased anteroposterior diameter with decreased expansion during breathing and mild abdominal paradox with respiratory efforts. Lungs: Rapid respiratory rate with prolonged expiratory phase and polyphonic wheezing heard over the entire chest during inhalation and exhalation. Heart: Regular rhythm at 140/min; no murmurs, gallops, or rubs; point of maximum impulse in normal position. Abdomen: Soft, nontender; bowel sounds present; no masses or organomegaly. Extremities: No clubbing, cyanosis, or edema; pulses ++ and symmetrical in all areas. Questions: What infection control guidelines would you institute for this patient? List all of the protective gear you would use and state the rationale for your decision.
Supreeta N.
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