6.12 Learning Activities

Asthma Case Study (Case Study answers are located in the Answer Key at the end of the book.)^[1]

Jeremy, a 13-year-old boy, was brought to the emergency room by his parents after experiencing acute respiratory distress while playing basketball with his friends. He complained of chest tightness, severe shortness of breath, and audible wheezing. Members of Jeremy’s family have experienced a “cold” within the last two weeks. Jeremy attempted to manage his acute symptoms at home by using his salmeterol inhaler. However, he reported that it did not provide any relief.

Assessment findings include wheezing in bilateral upper and lower lungs, current peak flow meter reading: 180 (Personal Best: 425), and pulse oximetry (SpO2): 90% on room air.

1. What is your hypothesis for Jeremy’s current condition and what are two possible causes?

2. How would you teach Jeremy and his parents about his salmeterol inhaler and why did it not offer relief in this situation?

3. Evaluate Jeremy’s peak flow reading. What zone is he currently in? What will you teach Jeremy and his parents regarding his asthma management using peak flow meter readings and the asthma action plan?

COPD Case Study (Case Study answers are located in the Answer Key at the end of the book.)^[2]

Maria, a 65-year-old woman, presents to her primary care physician’s office with complaints of worsening breathing difficulties and a persistent, productive cough that has lasted for several months. She has a history of smoking for over 40 years, averaging one pack of cigarettes per day. She retired last year from her work as a dairy farmer. Her symptoms have progressively worsened over the last two years, limiting her ability to perform daily activities. Her medical history includes hypertension, but she is not on any regular medications.

Physical Assessment: Maria appears fatigued and breathless. She reports the breathlessness increases with activity. She is leaning forward in her chair with her hand on her knees and has an increased respiratory rate. Breath sounds are diminished with occasional wheezing. She reports a chronic cough with thick yellow/green sputum. Her chest is barrel shaped, but no clubbing is noted. She has slight cyanosis in the nail beds.

1. Based upon the information above, what signs and symptoms suggest the client may have COPD?

2. What are potential contributing factors to Maria’s COPD diagnosis?

3. The health care provider prescribes daily fluticasone inhaler use with albuterol inhaler for rapid treatment of dyspnea. What will you teach Maria about these medications?

4. The health care provider recommends Maria to participate in pulmonary rehabilitation. Maria states, “Why should I drive into town to go to pulmonary rehab?” How should the nurse respond to Maria?

Tuberculosis Case Study (Case Study answers are located in the Answer Key at the end of the book.)^[3]

Mrs. Xiong is a 38-year-old woman who presents with a three-week history of fatigue, night sweats, anorexia, weight loss, and a persistent dry cough. She was admitted to the hospital for further evaluation. Mrs. Xiong’s chest X-ray shows cavitary lesions in her right upper lung lobe. She is diagnosed with pulmonary tuberculosis (TB) based on her clinical presentation and imaging findings. The following is an account of her hospital stay, including nursing assessments, interventions, and education.

Upon admission, Mrs. Xiong appears fatigued and malnourished. She has a body temperature of 101°F, pulse 100 bpm, and respirations 24 breaths per minute. Her blood pressure is 120/80 mmHg. Her chest examination reveals reduced breath sounds in the right upper lobe and occasional crackles. She has no apparent respiratory distress. Her skin is warm and dry with no evidence of cyanosis or clubbing. Laboratory tests show an elevated white blood cell count and a positive sputum acid-fast bacilli (AFB) test.

1. What are the key findings in Mrs. Xiong’s physical examination that suggest a diagnosis of pulmonary tuberculosis (TB)?
2. What is the first-line therapy for treating active pulmonary TB, and what are the possible side effects of these medications?
3. What nursing interventions are essential to prevent the spread of TB infection in the hospital setting and ensure Mrs. Xiong’s safety and well-being?
4. What should Mrs. Xiong be educated about regarding her condition, including the importance of medication adherence, infection control measures, and follow-up care?