David is a 12 y/o male with a history of asthma. His mother, who is a Labor and Delivery nurse, is accompanying him. He has presented to the ER after being seen by the school nurse and being told that he needs further evaluation. His mother states that he had not been feeling well after hunting in the desert with his father over the weekend. Monday he rode his bike to school with no complaints but did not return promptly when school was out. She states that he told his father that he was short of breath and couldnt ride his bike. She reports that he did use his rescue inhaler that day but does not know how many times. The following day, David asked for a breathing treatment before school, which included only albuterol. After school he did not return for an hour and finally called his mother at work and said he needed a ride home. He sounded short of breath at that time and his mother instructed him to take another breathing treatment. His father picked him up. This morning, the mother reports that David had another treatment at home, but would not eat and seemed sluggish. David shakes his head yes after being asked if the treatment helped this morning. The mother reports that he has had a total of 4 treatments this morning between the home treatment and three treatments at a local urgent care.
David appears pink in color, labored breathing, with no lung sounds in lower lobes bilaterally and minimal breath sounds with wheezing in upper lobes bilaterally. He is breathing through his mouth at this time and sitting slumped in the gurney. He does not answer questions when asked, only shakes or nods his head. He appears to be in distress.
You note his vital signs to be the following: HR 127, BP 131/90, SPo2 82% on room air, RR 26. After an x-ray of the chest, during which he became light headed and fell to the floor, it is determined that David is having an asthma exasperation secondary to a pneumonia infection. He is prescribed a STAT bronchodilator and steroid via nebulizer, admitted to the childrens ward for antibiotics, and he is placed on 02 via nasal cannula at 3 L/min.

    What bronchodilators should the nurse anticipate giving David? List two and your rationale as to why these medications are to be prescribed.
    What steroid should the nurse anticipate giving David?
    Why are these medications being given via nebulizer rather those other possible routes of administrations?
    What antibiotics should the nurse anticipate being ordered for David?
    What lab work should be ordered for this patient? Explain why these are important. How may the lab results affect this patients care?
    What are the possible/actual contraindications to administering these medications at this time?
    What education should be provided to both the patient and his mother? How does the age of the patient change how you are going to present this information?
    What are the possible triggers and risk factors David has for future attacks and complications?

–    Must identify and demonstrate a sophisticated understanding of the main issues/problems in the case study.
–    Must present an insightful and thorough analysis of all identified issues/problems
–    Must Support diagnosis and opinions with strong arguments and well-documented evidence; presents a balanced and critical view; interpretation is both reasonable and objective.
–    Make appropriate and powerful connections between identified issues/problems and the strategic concepts studied in the course readings and lectures; supplements case study with relevant and thoughtful research and documents all sources of information.
–    Demonstrate clarity, conciseness and correctness; formatting is appropriate and writing is free of grammar and spelling errors.

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