Practicum Case Scenario Study: The Following Outlines Genera ✓ Solved

Practicum Case Scenario Study The Following Outlines General Instruct

Practicum Case Scenario/Study instructions include developing a comprehensive case study of a patient seeking care for an asthma exacerbation, including symptom details, additional medical diagnoses, treatment administered (oral steroids, rescue inhaler, albuterol nebulizer), and corresponding ICD-10 codes. The paper should be at least 500 words, detailed, and include subjective and objective findings, assessment, nursing diagnoses, care plans, potential issues, best practice considerations, and treatment side effects. The case should be written without HIPAA information, and references should follow APA format.

Sample Paper For Above instruction

Introduction

Asthma exacerbations are common yet complex episodes that require prompt assessment and comprehensive management to prevent severe respiratory compromise. This case study explores the clinical presentation, assessment, diagnosis, treatment, and nursing care planning for a patient experiencing an asthma attack, including additional comorbidities, to exemplify best nursing practices aligned with evidence-based guidelines.

Patient Presentation and Subjective Data

The patient, a 32-year-old female, presented to the clinic with complaints of increasing shortness of breath, wheezing, chest tightness, and a non-productive cough lasting for the past three days. She reported increased difficulty breathing during exertion and at rest, especially at night, which has disrupted her sleep. The patient also mentioned experiencing a mild fever and malaise but denied any recent exposure to respiratory infections or allergies. She reported using her rescue inhaler (albuterol) more frequently—approximately every 2 hours over the past 24 hours—with minimal relief. Her medical history reveals a diagnosis of allergic rhinitis and atopic dermatitis, but she has not been hospitalized for asthma previously and has no known drug allergies. Currently, her medications include a nasal spray for rhinitis and OTC antihistamines.

Objective Data and Physical Examination

On examination, the patient's vital signs were notable for tachypnea with a respiratory rate of 24 breaths per minute, pulse of 102 beats per minute, blood pressure of 128/78 mmHg, temperature of 99.1°F, and oxygen saturation of 92% on room air. She appeared mildly using accessory muscles to breathe, with audible wheezing on auscultation throughout all lung fields. Her weight was 65 kg, height 165 cm, with a BMI of 23.9. No cyanosis or nasal flaring was observed. The focused pulmonary examination indicated diffuse wheezing, whereas the examination of other systems was unremarkable.

Assessment and Diagnosis

The clinical presentation and physical findings suggest an acute asthma exacerbation. The increased work of breathing, wheezing, and decreased oxygen saturation corroborate this diagnosis. Additionally, the patient's history of allergic rhinitis points toward allergic triggers exacerbating her asthma.

The primary diagnosis is:

  • Asthma exacerbation (ICD-10 J45.901)

Given her history of allergic rhinitis, a secondary diagnosis could be:

  • Allergic rhinitis (ICD-10 J30.9)

Nursing Diagnoses and Care Planning

The nursing diagnoses include:

- Impaired gas exchange related to airway obstruction secondary to bronchospasm

- Ineffective airway clearance related to mucus production and airway inflammation

- Anxiety related to shortness of breath and respiratory distress

The care plan incorporates the following specific interventions:

  1. Administer nebulized albuterol as prescribed to relieve bronchospasm and improve airflow.
  2. Provide supplemental oxygen therapy to maintain saturation levels above 95%.
  3. Monitor vital signs and respiratory status continuously, including oxygen saturation and work of breathing.
  4. Assess for signs of worsening respiratory status, including increasing wheezing, use of accessory muscles, or decreasing oxygen saturation.
  5. Educate the patient about proper inhaler technique and trigger avoidance.
  6. Encourage fluid intake to help loosen mucus secretions.
  7. Prepare to administer oral corticosteroids to reduce airway inflammation and shorten recovery time.
  8. Provide emotional support and reassurance to alleviate anxiety.
  9. Document all findings, treatments, and patient responses thoroughly.

Potential Challenges and Best Practice Considerations

Achieving comprehensive care requires overcoming challenges such as medication adherence, environmental triggers, and timely recognition of worsening symptoms. Evidence-based guidelines recommend early intervention with inhaled beta-agonists and corticosteroids to stabilize the airway. Continuous monitoring and patient education are essential to prevent hospitalization and future exacerbations.

To optimize outcomes, nursing staff should evaluate the response to initial treatments frequently. Education on trigger management, inhaler technique, and adherence to maintenance therapy plays a vital role in long-term control. Additionally, addressing comorbid conditions such as allergic rhinitis can reduce the frequency of exacerbations.

Possible Side Effects of Medications and Treatments

Short-acting beta-agonists like albuterol may cause tremors, tachycardia, or nervousness. Systemic corticosteroids carry risks such as hyperglycemia, hypertension, mood changes, and secondary infections if used long-term. Nebulizer treatments can cause increased heart rate and jitteriness. Monitoring for adverse effects and adjusting therapy accordingly is critical for safe management.

Conclusion

This case underscores the importance of comprehensive assessment, timely interventions, and patient education for effective management of asthma exacerbations. A multidisciplinary approach, emphasizing both pharmacologic and non-pharmacologic strategies, can significantly improve patient outcomes and reduce the burden of this chronic respiratory condition.

References

  1. Global Initiative for Asthma (GINA). (2023). Global strategy for asthma management and prevention. Retrieved from https://ginasthma.org/gina-reports/
  2. National Heart, Lung, and Blood Institute (NHLBI). (2020). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.
  3. O'Byrne, P. M., & Ferguson, G. T. (2018). Inhaled corticosteroids in asthma: Effects and implications. Expert Review of Respiratory Medicine, 12(11), 909-917.
  4. Barnes, P. J. (2019). Cellular and molecular mechanisms of asthma. Journal of Allergy and Clinical Immunology, 143(1), 41–52.
  5. Reddel, H. K., et al. (2021). Asthma management guidelines. The Lancet, 398(10309), 49–61.
  6. Adams, N., & Smith, R. (2017). Pharmacology of asthma medications. Journal of Respiratory Diseases, 22(4), 599-605.
  7. Oostenbrink, R., et al. (2019). Trigger management in asthma care. Current Opinion in Pulmonary Medicine, 25(1), 66–72.
  8. McCormack, D. (2020). Patient education and self-management strategies. Nursing Clinics of North America, 55(2), 317-331.
  9. Busse, W. W., et al. (2019). Role of comorbidities in asthma management. Journal of Allergy and Clinical Immunology Practice, 7(5), 1480–1488.
  10. Chung, K. F., et al. (2021). Asthma care during exacerbations: Best practices. Respiratory Medicine, 174, 106145.

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