A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first?
A. Take a full medication history.
B. Give a bronchodilator by nebulizer.
C. Apply a cardiac monitor to the client.
D. Provide emotional support to the client.
Correct Answer: B. Give a bronchodilator by nebulizer.
The client is having an acute asthma attack and needs to increase oxygen delivery to the lung and body. Nebulized bronchodilators open airways and increase the amount of oxygen delivered. Medical management includes bronchodilators like beta-2 agonists and muscarinic antagonists (salbutamol and ipratropium bromide respectively) and anti-inflammatories such as inhaled steroids (usually beclomethasone but steroids via any route will be helpful).
Option A: First, resolve the acute phase of the attack and how to prevent attacks in the future. During an acute exacerbation, there may be a fine tremor in the hands due to salbutamol use, and mild tachycardia. Patients will show some respiratory distress, often sitting forward to splint open their airways.
Option C: It may not be necessary to place the client on a cardiac monitor because he’s only 19-years-old unless he has a past medical history of cardiac problems. On auscultation, a bilateral, expiratory wheeze will be heard. In life-threatening asthma, the chest may be silent, as air cannot enter or leave the lungs, and there may be signs of systemic hypoxia.
Option D: Measures to take include calming the patient to get them to relax, moving outside or away from the likely source of allergen, and cooling the person. Removing clothing and washing the face and mouth to remove allergens is sometimes done, but it is not evidence-based.
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