An Exacerbation of asthma

Johnny is 6 years old, admitted late yesterday with an exacerbation of asthma. Johnny has a history of asthma for 2 1/2 years. He has been admitted to the hospital exacerbation x3, no ICU admission. He was admitted due to coughing, expiratory wheezing, runny nose and increasing shortness of breath that began shortly after a low-grade fever.

Presenting signs: Temp 100.4, HR; 112, RR; 28, 02 Sat 91%

Expiratory wheezing, intercostal, and subcostal retractions; unable to complete a sentence without shortness of breath.

Peak flow meter- 60%.

B-2 Agonists (Bronchodilators)

Albuterol sulfate (Ventolin ®) is a short-acting beta2-agonist (bronchodilator) administered by nebulizer or spacer. This medication is used intermittently, as needed, during acute exacerbations of the disease.  Administered by nebulizer or spacer. This medication is used intermittently, as needed, during acute exacerbations of the disease such as the sudden onset of symptoms or an asthma attack.

Corticosteroids act by reducing swelling and mucus production in the airways. As a result, airways are less sensitive and less likely to react to triggers (Potter, 2010). The Expert Panel (2021) recommends that long-term control medications be taken on a long-term basis to achieve and maintain control of persistent asthma, and that inhaled corticosteroids (ICS) are the most potent and consistently effective long-term control medication for asthma.

Questions:

1. What are the nurse’s priorities for this patient?
2. What symptoms and signs should alert the nurse to potential problems that might need immediate intervention?
3. What instructions would you give a patient in using a MDI?
4. What instructions would you give to perform a peak flow reading?
5. Johnny is unable to use a MDI, what would you suggest to the doctor to order.
6. What would you include in an Asthma Action Plan for Johnny?
7. What are B-2 Agonists and Corticosteroids commonly used in treatment of asthma?