Lucinda is 32 yrs old. Allergic asthma

Lucinda is 32 yrs old. Allergic asthma since childhood. She works as a health care assistant in Hobart, Tasmania. She presents with severe dyspnoea, fever and wheezing Family history: Lucinda’s father died of complications from asthma when he was 40 years old. Her mother is in good health, with mild hypertension. Past medical history: Lucinda’s general health is good, with a past history of appendectomy when she was 16 years of age. Weight: 63 kg Height: 145 cm. Physical activity: She swims 2 km three times a week and walks 5 km three times a week on the tracks of kunanyi/Mt Wellington. Diet: She eats a balanced diet, does not smoke and drinks alcohol in moderation. Other: alcohol – less than 5 standard drinks per week; smoking – nil Medications: beclometasone 50mcg: x 1 inhalation morning and night – good effect, asthma well controlled salbutamol 100mcg: according to her asthma plan, used with good effect when she experiences a flare-up, usually due to a cold (upper respiratory tract infection) influenza vaccination: yearly Current presentation: Unwell for three days with dyspnoea and fever (39.5o C). Some wheezing and chest tightness. Enacted her asthma management plan. Brought into Royal Hobart Hospital Emergency Department by mother. Mother reports her own chest infection last week for which she was prescribed oral antibiotics by the GP. Assessment: Vital signs: RR: 32 bpm SpO2: 90% on room air BP: 160/90 mmHg HR: 125 bpm Temp: 38.5o C Respiratory assessment: Inspection: respirations shallow, accessory muscle use, sitting upright in a tripod position, difficulty completing sentences, she is pale Auscultation: decreased breath sounds, inspiratory and expiratory wheeze Venous blood gases: • pH 7.29 (ref range: 7.31 – 7.41) • pO2 25 mmHg (ref range: 30mmHg – 40mmHg) • pCO2 55 mmHg (ref range: 41mmHg – 51mmHg) • Bicarbonate 30 mmol/L (ref range: 23 – 29mmol/L) Consider the impact of dyspnoea on the person, and then consider the impact of that on the respiratory system. Consider all the inputs to the respiratory centres. Why is reassurance so important for Lucinda? How might you evaluate the effectiveness of the reassurance provided? SCIENCE HEALTH SCIENCE NURSING CXA 133

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