department, his physical examination reveals a client of 165 cm and 63.5 kg with a harsh non-productive cough.

Routine medications at home include theophylline (Theodur) 200 mg twice daily, sodium cromoglycate (Intal) aerosol spray qid, and terbutaline (Bricanyl) inhaler 2 puffs following sodium cromoglycate and prn. He has been asthmatic since age 2. Emergency department treatment includes administration of adrenaline 1:1000 0.6 mL subcutaneously, laboratory determination of theophylline level, which was 7 mcg/mL (normal is 10–20 mcg/mL). He has an intravenous (IV) infusion started. Aminophylline is given in a bolus dose followed by a drip at 30 mg/hour. Solu-Medrol 100 mg IV 4 hourly is prescribed.

NursiNg Care PlaN A Client with Asthma Using Sodium Cromoglycate (Intal) and Terbutaline Sulfate (Bricanyl Inhaler)Michael Shanker, a 16-year-old high-school student, is admitted to the emergency department at 1300 hours with shortness of breath and tachycardia. He appears wide-eyed and anxious, with audible expiratory wheezes. Inspiratory wheezes can be heard on auscultation. Mike says shortness of breath and cough began after his routine aerosol inhalation dose of sodium cromoglycate. When he became short of breath, he used the terbutaline inhaler to relieve spasms and cough unsuccessfully. In the emergency

Chapter 32 Bronchodilators and Other Respiratory Agents

Assessment nursing diAgnosis PlAnning/goAls imPlementAtion evAluAtion

Breathing patterns, breath sounds

Ineffective breathing pattern related to bronchospasm, secondary to too rapid administration of sodium cromoglycate.

Client will have respiratory rate, rhythm, and depth within normal limits.

Position client in sitting position. Teach client to rest between activities. Assess ventilation for chest expansion and pursed-lip breathing. Assess breath sounds every hour.

Client returns to normal breathing pattern. Breath sounds present and clear.

Oxygenation, skin colour, wheezing

Impaired gas exchange related to narrowing of bronchial tree.

Client will maintain adequate oxygenation as evidenced by blood gases within normal limits.

Assess skin colour, temperature, cyanosis. Watch for restlessness, and confusion, which may indicate an oxygen lack. Arterial blood gases as ordered.

Client has normal colour with skin that is warm and dry. Respirations and blood gases within normal limits. Breath sounds present and clear.

Secretions, coughing Ineffective airway clearance related to increased secretions.

Client will have respiratory rate rhythm and depth within normal limits. Breath sounds present and clear.

Give fluids to help liquefy secretions. Encourage coughing and expectoration of retained secretions. Assess respirations and breath sounds.

Client is taking at least 2000 mL of fluid daily. Secretions are easily expectorated. Breath sounds are improving. Respirations are within normal limits.

Appetite, body weight

Imbalanced nutrition: less than body requirements related to fatigue, hypoxia, and developmental stage.

Client will maintain body weight.

Provide well-balanced diet in high-protein liquid form during acute attack. Space feedings throughout day. Between attacks, ensure nutritious diet designed to facilitate growth during this stage of rapid growth.

Client is continuing normal growth pattern for this age level.

Speech patterns Impaired verbal communication related to inability to breathe.

Client will demonstrate ability to communicate needs.

Encourage client to use one-word comments when short of breath. Ask yes or no questions.

Client is communicating effectively.

CONTINUED

32 BROYLES NCP 1ed SB 9780170193009 TXT 1pp.indd 1 8/17/12 11:51 AM

Assessment nursing diAgnosis PlAnning/goAls imPlementAtion evAluAtion

Knowledge of factors that cause attacks

Deficient knowledge related to disease process.

Client will verbalise understanding of disease and precipitating factors of attacks.

Assess client’s understanding that asthma is precipitated by stress, fatigue and specific allergens such as dust, pollen, etc. Teach ways to conserve oxygen. Inform client that evening exercise may be better than morning, as pollens and moulds are at lower level then.

Client is able to list causes of attacks.

Client’s response to attack

Ineffective individual coping related to acute process.

Client will be able to identify methods of disease management and prevention of future attacks prior to discharge.

Ensure that client and family understand disease. Remind them that his teen growth has probably changed his medication dosage needs.

Client can describe changes that will be made in his usual routine.

Knowledge of drug therapy

Deficient knowledge related to drug therapy and sodium cromoglycate inhaler.

Client will verbalise understanding of drug therapy routines and signs or symptoms of side effects to report.

Client understands that sodium cromoglycate may irritate throat and should be followed with water. Report promptly rapid heart rate, headache, dizziness, increased blood pressure. Ensure that he knows proper use of inhaler.

Client adheres to medication routine and has demonstrated proper inhaler use. Reports adverse reactions promptly.

Knowledge of special health and hygiene measures

Ineffective health maintenance related to chronic illness and risk-taking lifestyle.

Client will verbalise understanding of lifestyle changes.

Client teaching includes avoiding stress, heavy exercise, colds, smoking, infections. Stay indoors on high humidity or high pollution days. Eliminate dust, house-plants, pets.

Client understands and can describe lifestyle changes he is making.

32 BROYLES NCP 1ed SB 9780170193009 TXT 1pp.indd 2 8/17/12 11:51 AM