Case Scenario – Pulmonary and Cardiovascular Purpose As a nurse you will be required to think critically about patient data and make informed decisions. In this case scenario you will apply what you’ve learned in the previous modules to the following concepts (if applicable):
Clinical decision making Safety Considerations Collaboration Patient assessment Pathophysiology Nutrition Medication Administration
Instructions: Read the assignment rubric to understand how you will be graded. Download the case scenario download and concept map answer document download. Answer the case scenario questions using your textbook and scholarly, recent (within the last five years) nursing articles. Be sure to address any of the above concepts that apply to the scenario. Complete the concept map according to the case scenario. A concept map template is provided for you, but you can edit it to fit the case scenario as you see fit. Be sure map all medications and show relationships between the concepts listed above if it’s applicable to the scenario.
Case Scenario: Proventil is the best for the patient at the moment because it is given to exercise-induced bronchospasm. Beclomethasone Dipropionate is a schedule medication and it does not work right away. It is not be used to relieve an asthma attack. The difference between two inhalers is that Beclomethasone is a steroid used to prevent an asthma attack and does not treat an asthma attack that has already begun. Proventil on the other hand is a bronchodilator used to treat or prevent bronchospasm in people with reversible obstructive airway disease.
Instructions about the sequence of the inhalers include: Proventil should be administered before the glucocorticoid drug. In other words, use Proventil first then after 5 minutes, use Beclomethasone Dipropionate. Administering the Proventil first allows the airway to dilate, letting the second drug, beclomethasone, to reach farther into the lungs during inhalation. Proventil is a beta 2 agonist and when caring for a patient taking a beta 2 agonist, we need to monitor for tachycardia, heart palpitations, and any chest pain since these drugs mimics the action of the sympathetic system. Patient teaching include advising the client to avoid caffeine and let the provider know if they are experiencing tremors that interfere with performing their activities of daily living. For Beclomethasone Dipropionate, the medication should be given on regular schedule rather than as needed because they are not beneficial as a rescue drug for acute asthma attack.
When instructing the client about this medication, the provider can encourage the patient to use a spacer during administration so less of the drug is deposited in the mouth and oropharynx. They should also encourage the patient to rinse their mouths and to gargle after using the inhaler to help prevent the medication to go systemic and prevent candidiasis of the oral structures. Patient on Beclomethasone Dipropionate, should be monitored closely because as a corticosteroid, it suppresses the immune system, making them more prone to infection. Possible side effects of Beclomethasone Dipropionate include palpations, nervousness, nausea, vomiting, and a white coating in the mouth. Advise patient not to eat or drink until signs and symptoms of asthma attack subsides (ATI testing, 2021).
References ATI Testing: Nursing Education: NCLEX Exam Review: TEAS Testing. Main (2021).https://atitesting.com/.Molimard, M., & Colthorpe, P. (2015). Inhaler devices for chronic obstructive pulmonary disease: insights from patients and healthcare practitioners. Journal of aerosol medicine and pulmonary drug delivery, 28(3), 219-228. doi: 10.1089/jamp.2014.1142Scullion, J. (2018). The nurse practitioners’ perspective on inhaler education in asthma and chronic obstructive pulmonary disease.
Canadian respiratory journal, 2018. https://doi.org/10.1155/2018/2525319.
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