Salbutamol (Ventolin) Classification: Indication: Assessment required: Contraindication:

Salbutamol (Ventolin) Classification: Indication: Assessment required: Contraindication: Tiotropium (Spiriva) Classification: Indication: Click or tap here to enter text. Assessment required: Click or tap here to enter text. Contraindication: Click or tap here to enter text. Budesonide and formoterol (Symbicort) Classification: Indication: Assessment required: Contraindication: NovoRapid insulin Classification: Indication: Assessment required: Contraindication: Prednisone Classification: Indication: Assessment required: Contraindication: Sandra, a 64-year-old female, presents in the emergency department with acute onset of shortness of breath. Sandra states symptoms began “about 2 days ago” and have progressively worsened. She states “it feels like it did last time my COPD got bad.” Sandra discloses that she was hospitalized about a year ago with and acute exacerbation of her COPD. Sandra denies fever, chills, chest pain, abdominal pain, nausea, vomiting or diarrhea. She states that she is SOB even at rest, and she’s feeling more forgetful and tired. Sandra states she feels weak and is worried about getting up out of bed. In addition to COPD, Sandra has a history of congestive heart failure, hypertension, diabetes mellitus, and has a history of smoking cigarettes for 40 years. She recently quit smoking 2 years ago due to increased SOB. Sandra uses oxygen at home, usually 1 LPM via NP, but states that over the past could days, she has needed to increase her oxygen “much more”. Initial physical assessment reveals the following findings: Vitals: 36.7- 98- 27-147/89-87% on 2LPM via NP Sandra appears pale, diaphoretic, has difficulty sitting still or resting comfortably. Sandra is frail and her gait is unsteady. She uses a 4-wheel walker to ambulate. Clubbing is noted in her fingers, and she is breathing through pursed lips. A chest x-ray indicates increased air trapping in her lungs. There is an area of consolidation present on the x-ray that is suggestive of pneumonia. A sputum sample is pending. Sandra brough her bag of medications with her, and she is currently prescribed the following: ï‚· Salbutamol (Ventolin) 2-4 puffs every 2-4 hours PRN ï‚· Tiotropium (Spiriva) 2 puffs daily ï‚· Ramipril (Altace) 10 mg PO daily ï‚· Metformin 500 mg PO BID ï‚· Tylenol #3 1-2 tabs Q4H PRN for pain Sandra states that her main concern is to get back home as quickly as possible because she doesn’t have anyone to care for her cat. Assignment Questions 1. a) As the nurse assuming care for Sandra, what are your priority assessments? (1 mark) b) What would be an appropriate nursing diagnosis for Sandra? (1 mark) After revieing the chest x-ray, the physician decides to start Sandra on IV Prednisolone x 24 hours and IV Ceftriaxone x 5 days. 2. a) What is the purpose of the IV Prednisolone? (1 mark) b) What teaching points would you provide to Sandra about IV prednisolone? (2 marks) 3. In reviewing Sandra’s health history, which of her comorbidities could be exacerbated during an acute exacerbation of COPD and treatment? (1 mark) Sandra tells you that she has needed to use her “blue inhaler a lot lately”. She finds when she does, her heart starts to race a lot. She’s worried that her heart is giving out too. What can you teach Sandra about this? (1 mark) The following day, the physician has ordered Sandra’s blood glucose levels to be checked QID. She has also been started on NovoRapid insulin with a sliding scale TID with meals. The physician also orders a new inhaler- Symbicort and discontinued the IV prednisolone. 5. Sandra is upset to hear that the physician has started her on insulin. She states “I’ve never been on insulin before- why now? It’s my breathing that’s bothering me, not my sugars!” How would you respond to Sandra’s concerns? (1 mark) 6. Sandra had already been prescribed two inhalers prior to admission. What is the rationale for adding this one to her regime? (1 mark) You enter Sandra’s room with her new inhaler, and she states that “puffers don’t work anyway, why bother with a new one?” You ask Sandra if anyone has shown her how to use her inhalers before, and she replies, “oh yeah, years ago.” You ask Sandra to show you how she been using her inhalers in the past and discover that she has not been using her inhalers effectively. 7. a) What teaching would you provide to Sandra about inhaler use? (2 marks) b) Who else would be helpful to provide this teaching? (1 mark) After 5 days of treatment, Sandra’s condition finally seems to be improving. Her SpO2 is 95% on 2 LPM via nasal. She is reporting less dyspnea, you note a significant decrease in accessory muscle use and Sandra’s respiratory rate is 20. As per the physician’s order, you go to titrate Sandra’s oxygen so that her SpO2 is 88-92%. Sandra is alarmed that you are reducing her oxygen. She is concerned that she will end up in respiratory distress again without it. 8. What teaching would you provide to Sandra about oxygen use? (1 mark) 1. Did the mini drug card preparation assist you in critically thinking through COPD management for this patient? Why or why not? If not, how could you better prepare yourself for medication administration and teaching? (1 mark) 2. What are two pieces of learning that you will take away from this case study? (1 mark)

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