Patient Profile

Mrs. S., a 30-year-old African American mother of two preschoolers, comes to the emergency department (ED) with severe wheezing, dyspnea, and anxiety. She was in the ED only 6 hours ago with an acute asthma attack.

Subjective Data

? Treated in the ED previously with nebulized albuterol and responded quickly
? Can speak only one- to three-word sentences
? Is allergic to cigarette smoke
? Began to experience increased shortness of breath and tightness in her chest when she returned home
? Used albuterol MDI (without a spacer) repeatedly at home with no relief

Objective Data

Physical Examination

? Uses accessory muscles to breathe
? Has audible wheezing
? Respiratory rate 34/min
? Auscultation reveals no air movement in lower lobes
? Heart rate 126 beats/min

Diagnostic Studies

? ABGs: PaO2 80 mm Hg, Paco2 35 mm Hg, pH 7.46
? PEFR: 150 L/min (personal best: 400 L/min)

Critical Thinking Questions

1. Why did Mrs. S. return to the ED? Explain the pathophysiology of this exacerbation of asthma.

2. What are the nursing care priorities for Mrs. S.?

3. What are the complications the nurse must be ready for based on her assessment of Mrs. S.?

4. What should be included in her discharge plan of care?

5. Based on the assessment data presented, write one or more nursing diagnoses. Are there any collaborative problems?