Question

CASE STUDY:

Poppy is a 9 year old female, weight 40Kg.

She presented to ED with worsening respiratory symptoms over the past few hours. Her parents state she is unable to

talk in full sentences or undertake a peak flow. In ED Poppy has been given 3 x 20 minutely nebulised Salbutamol with

6LPM of O2, IVF commenced, Stat dose of Prednisone administered, Chest X-ray shows hyperinflation of both lung

fields. She was admitted to ICU due to her deteriorating respiratory function with a diagnosis of acute exacerbation

of asthma.

EXCERPT OF RELEVANT ICU NOTES

Past History

Diagnosed with asthma age 2 (infrequent intermittent asthma).

7

Current medications: - Ventolin PRN.

IUTD (immunisations up to date)

Nursing Assessment

A. Clear, speaking in single words

B. RR 42bpm, SpO2 87% RA, 92% on 6LPM O2 + nebuliser, auscultation decreased AE bibasally, inspiratory and

expiratory wheeze

C. HR 160bpm, ST, peripherally warm

D. GCS 14/15 (E4, V4, M6)

E. Accessory muscle use, shoulder shrugging on inspiration, tracheal tug

F. IVF NaCl 53 ml/hr

G.

a. Mg- low 0.60mmol/L (0.70-1.10mmol/L) all other pathology is normal.

b. BGL 9.0mmol/L

c. Beta-agonist- Salbutamol

d. Anticholinergic - Atrovent

e. IV Hydrocortisone

f. ABG shows respiratory acidosis, (PH 7.32, PaCO2 49, PaO2 70, HCO3 27, BE -2.1, Lactate

1.4)

Plan

- Keep SpO2 92-95%%

- Beta- antagonist Salbutamol continuous via nebuliser

- Anticholinergic Ipratropium bromide (Atrovent) 500ug 4/24

- Hydrocortisone 100mg 6/24

- MgSO4 6.4mmol/20 minutes

- IVF 53ml/hr

- Repeat ABGs in 1hour

- Monitor BGL

- Peakflow /spirometry

QUESTION:

Salbutamol via nebuliser

– What clinical response you expect from this medication?

– What continuing clinical observations will you need to undertake?

Answer 1

It works by relaxing the muscles of the airways into the lungs, which makes it easier to breathe.Nebulizer will help the child to breath in the medication as as a mist, using a mask or a mouthpiece.Salbutamol,act as bronchodilator , through its effects of relaxing airway smooth muscle and increasing airflow, provides rapid relief of acute asthma symptoms. Treatment's effects begin in about 10-15 minutes and peak effect is usually within 30 minutes.Here the child will breath easily ,and expected his respiratory rate will come down from 44bpm to 18-30bpm.

Continuing clinical observations will you need to undertake

• Vital signs 5-30 minutely P,R,SpO2
• Temperature 2-4/24 as clinically indicated
• Description of indicators such as mental state, general appearance, air entry, breath sounds, respiratory effort (ie: degree and type of recession), nasal flaring must be documented at least 30 minutely.
• Close observation for 30 minutes after cessation of continuous nebulisers (to monitor for signs of hypoxaemia).