Reference no: EM133918923

Question

Melissa Smith is a 30 year old African American female diagnosed with severe persistent asthma as a young child. She presents at her pulmonologist's office at 0900 on Thursday after calling and requesting to be worked in because she is not "getting enough air." As the nurse is working with Ms. Smith pulmonologist, you conduct her client interview and initial assessment when she comes to the clinic. It takes a little time to get through the client interview. Ms. Smith can only speak a few words at a time and appears short of breath. Ms. Smith reports that she came down with bronchitis over the holiday weekend and went to an urgent care clinic to get an antibiotic. The physician Assistant at the clinic prescribed a Z-pack (azithromycin). Ms. Smith states that she has been on 40mg. prednisone since Monday for asthma symptoms and has been using her rescue inhaler 4 times daily in addition to her Flovent Diskus (flaticasone) inhaler. Ms. Smith tells you she woke up in the middle of the night unable to get enough air, and that her nail beds were blue. She used her rescue inhaler and her symptoms improved enough that she decided not to go to the emergency department, but wait and call the office first thing this morning. ou observe that Ms. Smith is holding back tears. She is sitting on the exam table leaning forward with her hands on her knees. Her voice is hoarse, face is pale, and she has dark rings around her eyes. Ms. Smith tells you her voice only gets hoarse when she is ver, very sick. On taking her vitals, you note that Ms. Smith's blood pressure is 152/90, and her respirations are 32 bpm. Her oxygen saturation (SpO2) is 91% on room air. When you auscultate her lungs, you hear decreased breath sounds. The pulmonologist puts her on 4 LPM oxygen by nasal cannula.

What is the priority nursing diagnosis for Ms. Smith at this time?