NR411 Nursing


Mort Gilligan is a 27 year old man who lives in a small mountain town in British Columbia. He is the youngest in a family of six, and has five sisters. He was diagnosed with Asthma at 12 years of age. Mort is highly allergic to dust and pollen. Anxiety also contributes to the exacerbation of his asthma attacks. Mort is very active and participates in various outdoor sports activities and works in the local mill. You are working in the local hospital and are admitting Mort to your unit for observation. Mort’s sister had to rush him to the emergency this morning as he was wheezing and unresponsive to the Atrovent and Vanceril (Beclomethasone) inhalers.  

What is the underlying pathophysiology of asthma?
What are the mechanisms involved in the inflammatory response during asthma?
Identify the drug classifications and actions of Vanceril and Atrovent
What are the modes of pharmacokinetics and pharmacodynamics of the Atrovent and Vanceril (Beclomethasone) inhalers?
Are Vanceril and/or Atrovent appropriate for use during an asthma attack? Explain…
What would you teach Mort about asthma, so that he can be more prepared to prevent an asthma attack in the future?

Scenario 2

Mr. Gordon Needaire is a 69 year old widower who has been admitted with extreme fatigue. During the second day of his hospital stay he complains that his chest hurts and he is unable to stop coughing. He develops a fever and starts getting shaking chills. His cough is productive with a consistency of yellowish thick sputum. He is unable to lie down to sleep/rest. The physician asks you to perform a head-to-toe routine assessment and to call with your findings.

Identify the four most critical elements in your physical assessment of Mr. Needaire.

Your assessment findings include these vital signs: BP 155/82, pulse 106, temp. 39.4C, oxygen saturation is 84% on room air. Upon chest auscultation, you discover decreased breath sounds in the LLL, anterior and posterior aspect of his chest. You can also hear coarse crackles in the LUL. His nail beds are dusky on fingers and toes. Mr. Needaire has never smoked in his life, has not been sexually active in over 15 years, and was monogamous with his wife. He denies allergic reaction to any medications. He has type 2 diabetes and is on Metformin.

Which of the findings above concern you most and why?
The physician write an order to maintain oxygen saturation levels >90%. What is the rationale for ordering his level of oxygen level?
The physician orders a C&S test for sputum. Why is this important?
The physician orders a specimen to be drawn for blood culture. Why would this be performed in a patient who spikes a fever?
Why would blood cultures be drawn from two different sites?
The physician orders a chest x-ray. What general information can be discovered from a chest X-ray?
What nursing plan would be most appropriate based on the above case study so far?
Mr. Needaire recovers from his pneumonia and is preparing for discharge from the hospital. As his nurse, what four prevention strategies in relation to the increased risk for pneumonia will you be discussing with him?
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