A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, what action should the nurse take to initiate care of the client?
A. Initiate oxygen therapy and reassess the client in 10 minutes.
B. Draw blood for an ABG analysis and send the client for a chest x-ray.
C. Encourage the client to relax and breathe slowly through the mouth.
D. Administer bronchodilators.
Correct Answer: D. Administer bronchodilators.
In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, intravenous corticosteroids, and possibly intravenous theophylline.
Option A: Administering oxygen and reassessing the client 10 minutes later would delay needed medical intervention. A favorable response to initial treatment of status asthmaticus should be a visible improvement in symptoms that sustains 30 minutes or beyond the last bronchodilator dose and a PEFR greater than 70% of predicted.
Option B: Drawing an ABG and obtaining a chest x-ray would be a delay. The absolute value of PEFR less than 120 L per minute and FEV1 less than 1 L corresponds with the proportional reduction. These absolute numbers should prompt an assessment of arterial blood gas (ABG) immediately. Initial blood gas results indicate respiratory alkalosis with hypoxemia.
Option C: It would be futile to encourage the client to relax and breathe slowly without providing necessary pharmacologic intervention. An initial aggressive treatment trial of beta-agonists, corticosteroids, and anticholinergics has to be tried, followed by adjunct measures, which may not be based on robust guidelines but evidence.
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