Case Scenario:

Patient history:

32 y/o, male patient arrived at the ER accompanied by relatives with cc of cyanosis, body weakness and
difficulty of breathing. 4 days prior to consultation the patient had cough and cold. 2 days prior to
admission the patient developed fever, cough and cold still persistent. 1 day prior to admission the
patient had difficulty moving around.

According to the relatives the patient has history of asthma since childhood. Last asthma attack was at
the age of 25 y/o. There are no history of travel and the patient is staying at home for work. There is also
no history of travel among the relatives at home. No cases of COVID 19 in the barangay that the patient
is staying.

The patient has difficulty answering the question of the nurse as he is too breathless to talk. Upon
assessment, the nurse noted wheezing, paradoxical thoracoabdominal movement. Temp is 38.7 C, BP is
at 90/60, RR is 27 bpm, o2 sat is at 92%, and pulse is 120 bpm.

Doctors Order: October 18, 2021 at 7 am

Please admit to ROC

Secure consent for admission and Mgt.

Check and Record V/S q2

Position: Semi-fowlers position

Diet: NPO temporarily if RR >30 bpm then shift to Hypoallergenic diet if RR is 12-20bpm

Fluids: D5W 1 L x KVO + Aminophylline 20 ml incorporated

Labs: CBC with PC, Chest x-ray, RT-PCR test

meds:

Hydrocortisone 250 mg IV STAT then hydrocortisone 100 mg IV q6 4 doses

Salbutamol Neb 2.5 mg q 30 with O2 Sat <92% then q6 if O2 sat >96%

Salbutamol + guaifenesin tablet PO q8

Paracetamol 300mg IV q4 PRN for fever >38.5C

Paracetamol 500 mg tablet q4 PRN for fever >37.9-38.5C

Celecoxib 200 mg tab BID PO

Treatment:

O2 continuously 5lpm via nasal cannula

Report signs of respiratory distress.

NPO for RR >30bpm

Admitting diagnosis: BAIAE, bronchial asthma in acute exacerbation

The patient and relatives tested negative in rapid antigen test in the ER, the patient was immediately
laid down in semi-fowlers position, Oxygen was given via nasal cannula at 5 lpm. VS was checked and
recorded, with the doctors order, patient was immediately nebulized with salbutamol neb 2.5 mg and
IVF of D5W I liter with aminophylline 20 cc was aseptically inserted at left metacarpal vein. IV
medications were given: Hydrocortisone 250 mg IV stat at 7:15 am, paracetamol 300 mg IV at 7:30 am.

O2 sat was rechecked at 8 am in the ER, it was 96%. Patient was then transferred to the medical ward
for admission.

Students Task for the day:

1. Describe the severity of asthma attack.

2. Endorsement from ER to ward
3. Without the x-ray result, which part of the ward will you put the patient, describe the ideal
place.
4. Accomplish the chart from ER to ward, then ward for the entire morning shift until 3 pm. (make
sure to create medication card, indicate the time when the meds will be given.)
5. Accomplish complete patient history.
6. What are the important things that the nurse must ask during history taking to avoid future
episode attacks?
7. Make sure medication sheet is updated with all of the medications given from the ER to the
entire AM shift. Take note that: at 10 am the patient insisted to go to CR and collapsed on the
way back to bed, O2 sat fell from 96 in the morning to 89%. Upon assessment the patient was
able to open his eyes when the nurse instructed him to, the patient was oriented to time, and
place, was able to move hand away after pinching. At 10:30 am 02 sat is at 92%. At 11 am o2 sat
is at 94% at 12 nn the O2 sat is at 96%.
8. After the patient collapsed at 10am, explain what the nurses best course of action.
9. At 10:15 am after giving primary interventions to the patient, using ISBAR refer the patient to
the doctor.
10. The doctor decided to order for administration of Oxygen via face mask at 10 lpm with O2 sat
<91%. Why is this so?
11. The doctor asked what is the GCS rate of the client. What is the nurse’s best response?
12. With the patient’s response to the medication, does he needs to move to ICU?
13. Does the patient need to be intubated?
14. The doctor via telephone ordered for single dose of magnesium sulphate 2g with 100 ml 0.9
NaCl to be infused for over 20minutes if the patient suffers from severe respiratory distress.
15. Will you be clarifying the doctors order? Why yes and why not?
16. Describe how you will be giving this medication, elaborate process and computations and what
are the indications of giving this medication and contraindications in giving this medication?
(https://youtu.be/SYNxSOol6tQ)
17. At 12 nn, upon checking the VS, the clients BP is at 100/60, RR is at 20 bpm, PR 98, O2 sat at
96%, temp is 37.5 C.
18. The relative at 12:30nn asked the nurse if the patient can eat and what kind of food can the
patient eat. Explain in detail.
19. Conduct patient teaching: what are the important patient teaching should you include for this
specific patient base on your history taking.
20. The patient is insisting of going to the bathroom again, what is the nurses most appropriate
response.
21. Endorse the patient using ISBAR format.