Reference no: EM133953383

Question

L.S. is a 7-year-old who has been brought to the emergency department (ED) by his mother. She immediately tells you he has a history of ED visits for his asthma. He uses an inhaler when he wheezes, but it ran out a month ago. She is a single parent and has 2 other children at home with a babysitter. Your assessment finds L.S. alert, oriented, and extremely anxious. His color is pale, and his nail beds are dusky and cool to the touch; other findings are heart rate 136, respirations regular and even, rate 26, oral temperature T 37.3 C (99.1 F), Spo2 89%, breath sounds decreased in lower lobes bilaterally and congested with inspiratory and expiratory wheezes, prolonged expirations, and a productive cough. As you ask L.S.'s mother questions, you note that L.S.'s respiratory rate is increasing; he is sitting on the side of the bed, leaning slightly forward, and having difficulty breathing. You are concerned that he is experiencing status asthmaticus.

1. You check the orders and need to decide which intervention are the priority at this time. Select all that apply and explain the rationale.

a. Have L.S. lie flat.

b. Have L.S. perform incentive spirometry.

c. Administer oxygen via face mask to keep his Spo2 above 90%.

d. Administer albuterol (Proventil) and ipratropium bromide (Atrovent) via hand-held nebulizer (HHN) STAT.

e. Reassess in 20 minutes, and if no improvement, administer salmeterol (Servant Diskus) via dry-powder inhaler (DPI)

f. Reassess in 20 minutes, and if no improvement, administer albuterol (Proventil) and ipratropium (Atrovent) via hand-held nebulizer again.

g. Start IV normal saline (NS) at 15mL/hr and administer methylprednisolone 2 mg/kg IV STAT x 1 dose.