Magazine article American Nurse Today

Asthma Exacerbation: An Accurate History Reduces Risk

Magazine article American Nurse Today

Asthma Exacerbation: An Accurate History Reduces Risk

Article excerpt

YI RONG HUANG, a 55-year-old man who speaks only Chinese, comes to the emergency department (ED) for nonradiating substernal chest pain. His electrocardiogram (ECG) shows a sinus rhythm with no ST changes; his vital signs are blood pressure (BP) 160/92 mm Hg, heart rate (HR) 95 to 100 beats/minute (bpm), respiratory rate (RR) 22 breaths/minute, oxygen saturation ([O.sub.2] sat) 94% on room air, and temperature 100.4[degrees] F (38[degrees] C). Bilateral rhonchi are noted on auscultation. His allergies and medications are unknown.

History and assessment

Because of the language barrier, Mr. Huang's nurse, Peter, is unable to obtain an accurate medical history. Peter requests an interpreter and continues with his assessment. Mr. Huang's complete blood count, metabolic profile, and troponin I level are within normal ranges. After he's placed on 3 L of oxygen by nasal cannula, his [O.sub.2] sat increases to 98%. His BP is 160/92 mm Hg, and his HR is 94 bpm. His chest X-ray is consistent with lobar pneumonia, and the provider orders levofloxacin 500 mg I.V. daily. Before Mr. Huang is transferred to the telemetry unit, he's given 81 mg of aspirin and 6.25 mg carvedilol by mouth for hypertension.

Call for help

The interpreter arrives in the telemetry unit, and Peter fills her in. Shortly after Mr. Huang is connected to the telemetry monitor, Peter hears him wheezing loudly. On auscultation, he notes diffuse wheezing in all lung fields. Mr. Huang is pale, diaphoretic, and lethargic. His vital signs are BP 168/90 mm Hg, HR 100 to 110 bpm with atrial fibrillation, RR 32 breaths/minute, and his [O.sub.2] sat is 90%. Concerned about these sudden clinical changes, Peter calls for the rapid response team (RRT).

On the scene

After Peter updates the RRT leader, a 12-lead ECG, a portable chest X-ray, and an arterial blood gas (ABG) are performed. Mr. Huang is given albuterol nebulizer (5 mg/mL in 3 mL saline) and is placed on a 100% non-rebreather mask. His vital signs are monitored every 5 minutes. Mr. Huang's ABGs reveal compensated respiratory alkalosis, and his ECG shows a new onset of atrial fibrillation with a rate of 120 bpm.

Mr. Huang's English-speaking daughter arrives, and she explains that he has a history of asthma, GI reflux disease, and hypertension. …

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