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- GOAL: This issue is about Trina, a 12-year-old girl who has had asthma since her tender age. Trina has developed a nasty cough and persistent wheezing, and not responding to her usual Salbutamol. In addition, Trina is becoming increasingly breathless and somewhat distressed. Because of her condition, she is brought in by ambulance to the local Emergency Department (ED).
- Nursing intervention: A nurse is to administer the following medication prescribed by a medical officer:
- Oxygen: 4L Oxygen via Hudson mask.
- Intravenous fluids: N/2 saline commenced at 70mL/hr
- Medications: 12 puffs of Salbutamol via pressurised metered dose inhaler (pMDI) plus spacer every 20mins for the first hour (i.e 3 doses).
- Medications: 4 puffs of Ipratropium via puffer and spacer every 20mins for the first hour.
- Medications: Prednisolone, po, 1mg/kg daily for three days.
- Rationale: This is to provide comfort for Trina as well as to ameliorate her condition.
Assessment of nursing care of Trina case
- Goals: To help Trina to improve her physical condition, verbal communication, and remember words.
- Nursing intervention: Monitoring the height of Trina by taking her height and weight regularly. Essentially, with age of Tina, there is need to perform spirometry for the rational objective assessment of lung function. Thus, to confirm exercise-induced asthma in Tina, there is need to perform bronchial hyperactive responsiveness test. Meanwhile, the symptom of Tina asthmatic case is essential acute asthma, because of inability of Tina to speak a long sentence, thus, a nurse should provide immediate oxygen on Tina before performing the full assessment. (National Asthma Council Australia, 2006, (NATIONAL INSTITUTES OF HEALTH1995). Typically, from the description of Tina’s case, the child has shown sign of significant airflow limitation. Thus, a nurse needs to perform peak expiratory flow on Tina in order to ensure that there is bronchodilator response and assessment of lung function. In addition, the effective nursing intervention relevant to Trina’s need is to perform Chest X-ray for Tina for effective diagnosis if there is no response on the therapeutic treatment recommended.
- Rationale: To ensure that Trina take her medication as prescribed by medical officer. Because poor medication can cause growth suppression and this is a sign of poorly controlled asthma.
Trina’s respiratory problem
- Goal: To improve the Trina’s respiratory problem caused by Asthma.
- Nursing intervention: Administering 4L Oxygen via Hudson mask, and there is need to administer this on Trina before completing full assessment. A nurse should also collect adequate data on the respiratory function, and regularly listen to Tina’s sound of breath for respiratory monitoring. In addition, a nurse should ensure that there is medication of 4 puffs of Ipratropium via puffer and spacer for Tina at every 20mins for the first hour. This should be administered on Tina in order to ensure that each puff is administered separately for full assessment of Tina‘s condition that include systemic corticosteroids. (National Asthma Council Australia 2006).
- Rationale: To ensure that Tina does not have the respiratory problem.
Taking of record during nursing intervention
- Goal: Taking record of Trina’s medication, behaviour, and record to ascertain whether she is responding to treatment. There is also need to note Trina’s degree of dehydration.
- Nursing intervention: In the course of treatment, a nurse should monitor the behaviours of Tina and note whether the Tina behaviours are normal or different from unusual. In addition, the adequate appetite of Tina should be recorded, and the nurse should identify activities of Tina whether she is responding to treatment. The angle by which Tina is sitting should be recorded to note whether the Tina is responding to treatment, and a nurse needs to take regular test between 15 and 30 minutes of Tina’s temperatures, and her level of level of consciousness, which include depression and excitation. (NATIONAL INSTITUTES OF HEALTH, 1995, Nursing care). Finally, a nurse intervention of Tina’s case should assess the degree of dehydration to asses the percentage of weight loss , and there should be review of Trina’s oral fluid in every 4 hours, and if the child is severely or moderately dehydrated, a nurse should intervene by calling a medical officer. (Primary Clinical Care Manual, 2007).
- Rationale: Taking record is necessary because there is need to make adequate record on Trina’s medical history and note level she is responding to treatment.
National Ashtma Council Australia, (2006), Asthma Management Handbook, Revised and Updated, Melbourne, Australia.
NATIONAL INSTITUTES OF HEALTH, (1995), NURSES: PARTNERS IN ASTHMA CARE, NIH PUBLICATION NO. 95-3308.
Nursing care, (nd), General Nursing© ASTHMA. Web.
Primary Clinical Care Manual, (2007), Acute Gastroenteritics, and dehydration vomiting and Diarrhoea, Royal Flying Doctor Service (Queensland Section), Queensland Health.