The patient is a 16-year-old college student

The patient is a 16-year-old college student who has had asthma since childhood. She is prescribed fluticasone (Flovent) 50 mcg/puff, 2 puffs twice daily; salmeterol (Serevent) 1 puff twice daily; albuterol (Ventolin) 1-2 puffs every 4-6 hours as needed for wheezing. She reports that she is using the fluticasone and salmeterol as prescribed but needs to use the albuterol about every 2 hours. She also tells you that she is having difficulty sleeping and feels “like my heart is skipping some beats.” Her vital signs are BP, 136/88; P, 96 and irregular; R, 30, with slight wheezing on exhalation. Her oxygen saturation is 92%, and you notice that she has a slight tremor in both hands. 1. What additional physical manifestations should you assess? 2. What questions should you ask the patient? 3. Should you administer oxygen? Why or why not? 4. What guidelines are available to support her current asthma management? 5. At what “step” is her current asthma management? What information indicates this step is effective or ineffective? 6. What teaching may be needed and how would you best teach this content given the age of the client?

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