Question

Case scenario:

Maria, a 55 year-old patient, was recently diagnosed with bronchial asthma. Her mother and three brothers also have asthma. In the past year, Maria has had three asthmatic attacks that were treated with prednisone and an albuterol inhaler. At a clinic visit today, prednisone is prescribed for 4 weeks and the order is written as follows:

Day 1: 1 tablet four times a day

Day 2: 1 tablet three times a day

Day 3: 1 tablet two times a day

Day 4: 1 tablet in the morning

Day 5: ½ tablet in the morning

To minimize the frequency of Maria’s asthmatic attacks, the doctor prescribes aminophylline 1200 mg/day in divided doses. The albuterol inhalation is to be taken as needed. Nursing interventions include patient history of asthmatic attacks and physical assessment.

5. When taking the patient’s history, what should the nurse include concerning asthmatic attacks? What physical assessment would suggest an asthmatic attack?

6. What type of drug is aminophylline? Why should the nurse asks Maria if she smokes?

7. What are the side effects, adverse reaction, and drug interactions related to aminophylline?

8. What nonpharmacologic measures can the nurse suggest that may decrease the frequency of asthmatic attacks?

9. Which are appropriate rescue medications used for acute asthmatic attack? Which drugs are used as preventive medications?

Answer 1

1 . when taking patient history what should the nurse include the concerning asthmatic attack?

Patient is having asthma.asthma is a respiratory system disorder which is listed as chronic one.during history taking nurse should enquire about all the participating factor that can cause asthma .genetic inheritance is a common cause of asthma so she should ask the client about other family members having any type of asthma.she should ask about clients occupation,habits of smoking or other substances, time of breathing difficulties,intensity of breathing problem etc.

2. What physical assessment would suggest an asthmatic attack?

Asess Bp,pulse,respirations, lung sounds and character of secretions before and during.patientscwhich cardiovascular history should be monitored with ECG changes and chest pain, administer around the clock for therapeutic levels.

3. What type of drug is aminophylline? Why should the nurse asks maria if she smokes?

Aminophylline is a bronchodilator with mild antiinflammatory effects.they are used only as an alternative therapy for mild persistent asthma.nurse enquires about smoking habits because smoking causing intensifying adverse effects.the main problem with aminophyline are the relatively high incidence of interaction with other drugs and the side effects ,which include,nausea,headache,insomnia,GI distress,tachycardia,dysrhythmias and seizure.

4. Why are the side effects , adverse reactions and drug interactions related to aminophylline?

Side effects aminophylline

* upset stomach

* restlessness

* insomnia

* irritability

Adverse effects aminophylline

* nausea

* vomiting

* headache

* insomnia

* irritability

* increase urine volume

* shakiness

Drug interaction aminophylline

* Acetylsalicylic acid ( aspirin)

* activated charcoal ( charcoal)

* adenosine

* adrenaline

* albuterol

* allopurinol

* benadryl ( diphenhydramine)

* caffeine

* cipro ( ciprofloxacin)

5. What non pharmacologic measures can the nurse suggest that may decrease the frequency of asthmatic attack?

* dealing with triggers :- one of the first things Ricky had to do when he got diagnosed was to determine what triggers his asthma and asthma attacks.eg, airbone allergens,food allergies,milk from cows, and cold air

Help the patient to identify what triggers the asthma

Herbal and supplemental remedies :- certain vitamins seem to decrease asthma. symptoms.it always seems that vitamin c take care of everything and there is no exception here! Ricky decides to take vitamin c as Well as B vitamins..these vitamins have been shown help to decrease the inflammation in the body to include the inflammation in the airways of asthma sufferers.

Other supplement may help Ricky are omega - 3 fatty acid and antioxidant as they reduce inflammation in the body.

Educate the patient follow good diet

Exercise :- educate the patient to do daily exercise as per doctors order.

6 .which are appropriate rescue medications used for acute asthmatic attack? Which drug used as preventive medications?

Rescue medications :-

1. Bronchodilators : shirt- acting- Beta- adrenergic agonists

( albuterol), antichilinergics ( inhaled- ipratropium)

2. Antiinflammatory drugs: corticosteroids (systemic - prednisone)

Preventive medications:-

1. Bronchodilators: long acting inhaled Beta- adrenergic agonists (salmeterol), long acting oral beta- adrenergic agonists ( albuterol), methylxanthines ( theophylline).

2. Antiinflammatory drugs : corticosteroid- oral (prednisone)

Inhaled ( fluticasone), leukotriene modifiers (montelukast), anti- IgE ( omalizumab).