8.14 Clinical Reasoning and Decision-Making Learning Activities V2

Let’s apply what you have learned in the respiratory unit.

Asthma Scenario

An adult patient presents to the emergency department with complaints of shortness of breath and increased difficulty breathing. The patient is alert and oriented x 3, skin is pink, warm and dry, BP 148/88, T 98, P92, R 24, pulse oximetry 91% on room air. Assessment of the lung reveals expiratory wheezing throughout the lung fields. The client has a medical history of asthma, hypertension, and diabetes.

1. The nurse anticipates which of the following medications will be initially administered to the client?
   1. Theophylline
   2. Montelukast
   3. Salbutamol
   4. Salmeterol
2. List the steps the nurse should take to safely administer the medication.
3. What assessments should the nurse plan to complete after administering the medication?
4. The nurse plans on teaching the client about using the salbutamol inhaler at home. What information should be included?
5. What is the best method for the nurse to use to ensure that the client is correctly using an inhaler?

Allergy Scenario

A pediatric client presents to the emergency department with complaints of shortness of breath, increased difficulty breathing, and a cough. The client is alert and oriented x 3, skin is pink, warm and dry, BP 112/68, T 99, P106, R 32, pulse oximetry 90% on room air. Assessment of the lung sounds reveals diminished lung sounds throughout all lung fields. The client has a medical history of a peanut allergy. The client’s mother tells you that they were at a birthday party and after the client consumed a cupcake, the symptoms started.

6. The nurse anticipates that which of the following medication likely will be ordered for this client?

1. 1. Diphenhydramine
   2. Epinephrine
   3. Cetirizine
   4. Guaifenesin

Review Questions

1. Which of the following is an important client education point for someone prescribed a leukotriene modifier like montelukast?
   1. Take the medication only during periods of respiratory exacerbation.
   2. Monitor for symptoms of oral thrush and report them immediately.
   3. Take the medication regularly, even when symptoms are not present.
   4. Discontinue the medication immediately if mood changes occur.
2. What is the most appropriate nursing intervention for a patient taking a theophylline (methylxanthine) medication for long-term asthma management?
   1. Monitor for blood levels to avoid toxicity.
   2. Instruct the patient to stop the medication immediately if they experience dizziness.
   3. Increase the dosage if the patient is not feeling relief.
   4. Assess for visual disturbances related to the medication.

Note: Answers to the Clinical Reasoning Activities and Critical Thinking questions can be found in the Chapter 8: Respiratory Medications Answer Key V2 – Fundamentals of Nursing Pharmacology – 2nd Canadian Edition section at the end of the book.