Online Case Studies Learning Activity: Respiratory Illness and Management
Assignment Outline
This assignment will give you the opportunity to apply your knowledge related to respiratory illness and related medications. You will be asked to complete preparation work prior to reviewing the case study and complete the ensuing knowledge application questions. To complete this activity, please download this worksheet and complete the fillable spaces. Please submit your completed document to Dropbox by midnight Friday April 14th. You will be evaluated based on your responses on the worksheet. This assignment is worth 5% of your overall theory mark.
Case Study Preparatory Work- Mini Drug Cards (5 marks)
| Salbutamol (Ventolin) | Classification: adrenergic bronchodilator |
| Indication: used to treat asthma, Copd or prevent exercise induced bronchospasms | |
| Assessment required: Monitor respiratory rate, oxygen saturations and lungs sounds prior to and after administration | |
| Contraindication: contraindicated in patients with high blood pressure during pregnancy, uterine infection, miscarriage, heart disease and hypersensitivity. | |
| Tiotropium (Spiriva) | Classification: anticholinergic bronchodilator |
| Indication: prevent bronchospasms in patiens with COPD, emphysema or bronchitis | |
| Assessment required: Assess Heart rate, ECG, and heart sounds. Monitor for adverse effects and obstructive lung disease progression | |
| Contraindication: contraindicated in patients with Hypersensitivity (urticaria, angioedema, rash, bronchospasm, anaphylaxis, itching) to tiotropium and ipratropium. | |
| Budesonide and formoterol (Symbicort) | Classification: Corticosteroid |
| Indication: prevents exacerbations of Copd and Asthma | |
| Assessment required: Assess for theraupetic reactions and adverse effects | |
| Contraindication: Allergy or Hypersensitivity | |
| NovoRapid insulin | Classification: Fast acting insulin |
| Indication: use for hyperglycemia, diabetes or prevention of high blood glucose levels directly after eating | |
| Assessment required: Assess for adverse reactions and hypoglycemia | |
| Contraindication: Allergy, hypoglycemia or Hypersensitivity | |
| Prednisone | Classification: corticosteroids |
| Indication: low corticosteroids or inflammatory reactions in the body | |
| Assessment required: theraupetic reactions and adverse effects | |
| Contraindication: Allergy, diabetes, tuberculosis, fungus caused infection or Hypersensitivity |
Case Information
Sandra, a 64-year-old female, presents in the emergency department with acute onset of shortness of breath. Sandra states symptoms began “about 2 days ago” and have progressively worsened. She states “it feels like it did last time my COPD got bad.” Sandra discloses that she was hospitalized about a year ago with and acute exacerbation of her COPD.
Sandra denies fever, chills, chest pain, abdominal pain, nausea, vomiting or diarrhea. She states that she is SOB even at rest, and she’s feeling more forgetful and tired. Sandra states she feels weak and is worried about getting up out of bed.
In addition to COPD, Sandra has a history of congestive heart failure, hypertension, diabetes mellitus, and has a history of smoking cigarettes for 40 years. She recently quit smoking 2 years ago due to increased SOB. Sandra uses oxygen at home, usually 1 LPM via NP, but states that over the past could days, she has needed to increase her oxygen “much more”.
Initial physical assessment reveals the following findings:
Vitals: 36.7- 98- 27-147/89-87% on 2LPM via NP
Sandra appears pale, diaphoretic, has difficulty sitting still or resting comfortably. Sandra is frail and her gait is unsteady. She uses a 4-wheel walker to ambulate. Clubbing is noted in her fingers, and she is breathing through pursed lips. A chest x-ray indicates increased air trapping in her lungs. There is an area of consolidation present on the x-ray that is suggestive of pneumonia. A sputum sample is pending.
Sandra brough her bag of medications with her, and she is currently prescribed the following:
- Salbutamol (Ventolin) 2-4 puffs every 2-4 hours PRN
- Tiotropium (Spiriva) 2 puffs daily
- Ramipril (Altace) 10 mg PO daily
- Metformin 500 mg PO BID
- Tylenol #3 1-2 tabs Q4H PRN for pain
Sandra states that her main concern is to get back home as quickly as possible because she doesn’t have anyone to care for her cat.
Learning Resources
Please review the following resources to assist you in completing the assignment:
- Sealock, K., Seneviratne, C. (2020). Lilley’s pharmacology for Canadian health care practice (4th edition). Elsevier. Chapter 38.
- Canadian Lung Association. (November 19, 2019). Chronic Obstructive Pulmonary Disease (COPD) [Video]. YouTube. https://www.lung.ca/copd
- MDI Use
- o Canadian Lung Association. (Aug 24, 2020). How to use MDI with spacer [Video]. YouTube. https://www.youtube.com/watch?v=JPm10-ExQsA
You are encouraged to procure any additional resources that you find useful for completing the worksheet.
Assignment Questions
- a) As the nurse assuming care for Sandra, what are your priority assessments? (1 mark)
Full set of Vitals, such as chest sounds, respiration, Spo2
- b) What would be an appropriate nursing diagnosis for Sandra? (1 mark)
Risk for impaired gas exchange as evidenced by shortness of breath and O2 stats
After revieing the chest x-ray, the physician decides to start Sandra on IV Prednisolone x 24 hours and IV Ceftriaxone x 5 days.
- a) What is the purpose of the IV Prednisolone? (1 mark)
The purpose of the medication being delivered Intravenously is for prednisone to be delivered faster. The medication is given to reduce inflammation to the lungs.
- b) What teaching points would you provide to Sandra about IV prednisolone? (2 marks)
I would advice to keep a closer eye on her blood glucose as prednisone can increase it.
As well to report weight gain, swelling, black or tarry stools, fever or prolonged sore throat
- In reviewing Sandra’s health history, which of her comorbidities could be exacerbated during an acute exacerbation of COPD and treatment? (1 mark)
With Sandras history congestive heart failure when experiencing shortness of breath due to the heart’s weakness, snadras heart could fail to pump blood fast enough leading to backup of blood, increasing the shortness of breath.
- Sandra tells you that she has needed to use her “blue inhaler a lot lately”. She finds when she does, her heart starts to race a lot. She’s worried that her heart is giving out too. What can you teach Sandra about this? (1 mark)
The inhaler is used to relieve symptoms and shouldn’t be used more than 4 times a day, as it can lead to overuse. An increased heart reate is also a sign that the condition may br getting worse and she may need to see her physician.
The following day, the physician has ordered Sandra’s blood glucose levels to be checked QID. She has also been started on NovoRapid insulin with a sliding scale TID with meals. The physician also orders a new inhaler- Symbicort and discontinued the IV prednisolone.
- Sandra is upset to hear that the physician has started her on insulin. She states “I’ve never been on insulin before- why now? It’s my breathing that’s bothering me, not my sugars!” How would you respond to Sandra’s concerns? (1 mark)
I would explain that the insulin has been ordered due to her history and the fact that the corticosteroid medication can increase blood sugar.
- Sandra had already been prescribed two inhalers prior to admission. What is the rationale for adding this one to her regime? (1 mark)
The new prescribed inhaler acts as a replacement for the prednisone and acts to assist with inflammation to the lungs and help with breathing
You enter Sandra’s room with her new inhaler, and she states that “puffers don’t work anyway, why bother with a new one?” You ask Sandra if anyone has shown her how to use her inhalers before, and she replies, “oh yeah, years ago.” You ask Sandra to show you how she been using her inhalers in the past and discover that she has not been using her inhalers effectively.
- a) What teaching would you provide to Sandra about inhaler use? (2 marks)
rinse mouth, shake puffer, sit up straight, take cap out breath out all the way, breath all the way out, place lips around mouth area, slowly inhale while pressing down on the button, remove inhaler, hold breath for 5-10s, slowly exhale.
- b) Who else would be helpful to provide this teaching? (1 mark)
respiratory therapist
After 5 days of treatment, Sandra’s condition finally seems to be improving. Her SpO2 is 95% on 2 LPM via nasal. She is reporting less dyspnea, you note a significant decrease in accessory muscle use and Sandra’s respiratory rate is 20. As per the physician’s order, you go to titrate Sandra’s oxygen so that her SpO2 is 88-92%. Sandra is alarmed that you are reducing her oxygen. She is concerned that she will end up in respiratory distress again without it.
- What teaching would you provide to Sandra about oxygen use? (1 mark)
The use of oxygen is to help keep O2 stats within a safe range wich would be 88-92% for Sandra. Also stress the importance of staying away from smoking while on the oxygen or anything like fire or electrical equipment to avoid the oxygen catching fire.
Reflection and Application of Learning
- Did the mini drug card preparation assist you in critically thinking through COPD management for this patient? Why or why not? If not, how could you better prepare yourself for medication administration and teaching? (1 mark)
Yes, they helped with critically thinking by providing useful information to answetr questions
- What are two pieces of learning that you will take away from this case study? (1 mark)
- Effect on glucose from corticosteroids
- Effects on a person with COPD and Cardiac Heart failure
Total /20 marks