Bert’s wife drove him to the emergency department when his wheezing

Bert’s wife drove him to the emergency department when his wheezing was unrelieved with his fluticasone/salmeterol inhaler; he was unable to lie down, and he began to use accessory muscles to breath. Bert is immediately started on 4L of oxygen by nasal cannula and intravenous D5W at 75 mL/hr. A set of arterial blood gases is sent to the laboratory. Bert appears anxious and says that he is short of breath.  Bert is a 31-year-old man who lives in a small mountain town in Colorado, is highly allergic to dust and pollen, and has a history of mild asthma.

Vital Signs

Blood pressure (BP) 152/84 mm Hg

Pulse rate 124 beats/min

Respiratory rate 42 breaths/min

Temperature 100.4F (38.4C)

1. Are Bert’s vital signs acceptable? State the nurse rationale.

2. What is the rationale for immediately starting Bert on oxygen (O2)?

3. Keeping in mind Bert’s health history and presenting complaint, what are the most important areas the nurse need to evaluate during physical assessment?

Arterial Blood Gases

pH 7.31

PaCO2 48 mm Hg

HCO3 26 mmol/L

PaO2 55 mm Hg

4. Interpret Bert’s arterial blood gas (ABGs) results.

Medication orders

albuterol 2.5 mg plus ipratroprium 250 mcg nebulizer treatment STAT

albuterol inhaler 2 puff q4h

metaproterenol sulfate 0.4% nebulizer treatment q3h

fluticasone MDI: 220 mcg, 1 puff twice daily

5. What is the rationale for the albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT?

6. Indicate the drug classification and expected outcome Bert should experience with using metaproterenol and fluticasone.

the nurse assess Bert and find that he has diminished lung sounds with inspiratory and expiratory wheezes in all lung fields with a nonproductive cough and accessory muscle use. His skin is pale, warm, and dry. The electrocardiogram (ECG) shows sinus tachycardia without ectopy. He is alert and oriented x4 sphere. He appears anxious and is sitting upright, learning over the bedside table, and continuing to complain of shortness of breath.

7. What is the nurse primary nursing goal at this time?

8. Describe six actions the nurse must implement based on this priority.

9. the nurse will need to monitor Bert closely for the next few hours. What is the most serious complication to anticipate?

10. Identify four signs and symptoms of this complication the nurse will assess for in Bert?