B.T., a 31-year-old man who lives in a small mountain town in Colorado, is highly allergic to dust and pollen and has a history
of mild asthma. B.T.'s wife drove him to the emergency room when his wheezing was unresponsive to his fluticasone/salmeterol (Advair) inhaler, he was unable to lie down, and he began to use accessory muscles to breathe. B.T. is immediately started on 4 L oxygen by nasal cannula and intravenous (IV) D5W at 75 mL/hr. A set of arterial blood gases is sent to the laboratory. B.T. appears anxious and says that he is short of breath.
Vital Signs
Blood pressure (BP) 152/84 mm Hg
Pulse rate 124 beats/min
Respiratory rate 42 breaths/min
Temperature 100.4 ° F (38.4 ° C)
1. Are B.T.'s vital signs acceptable? State your rationale.
2. What is the rationale for immediately starting B.T. on O2?
3. Keeping in mind B.T.'s health history and presenting complaint, what are the most important areas you need to evaluate during your physical assessment?
Arterial Blood Gases
pH 7.31
Paco2 48 mm Hg
HCO3 26 mmol/L
Pao2 55 mm Hg
Interpret B.T.'s arterial blood gas results.
Medication Orders
Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT
Albuterol (Ventolin) inhaler 2 puffs q4h
Metaproterenol sulfate (Alupent) 0.4% nebulizer treatment q3h
Fluticasone (Flovent HFA) MDI: 220 mcg, 1 puff twice daily
4. What is the rationale for the albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment
STAT (immediately)?
Indicate the drug classification and expected outcome B.T. should experience with using metaproterenol sulfate (Alupent) and Fluticasone (Flovent).
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