Case scenario:

Maria, a 55-year-old patient, was recently diagnosed with bronchial asthma. Her mother and three brothers also have asthma. In the past year, Maria has had three asthmatic attacks that were treated with prednisone and an albuterol inhaler. At a clinic visit today, prednisone is prescribed for 4 weeks and the order is written as follows:

Day 1: 1 tablet four times a day

Day 2: 1 tablet three times a day

Day 3: 1 tablet two times a day

Day 4: 1 tablet in the morning

Day 5: ½ tablet in the morning

QUESTIONS:

1. Explain the purpose for the use of prednisone during the asthmatic attack. Explain why the dosage is decreased (tapered) over a period of 5 days.
2. Can Cromolyn sodium be substituted for prednisone during the asthmatic attack? Explain your answer.
3. Maria is prescribed Albuterol. What effect does albuterol have in controlling asthma?
4. For each drug dose, Maria is to take two puffs of albuterol administered by inhaler. What instructions should she be given concerning the use of inhaler?

To minimize the frequency of Maria’s asthmatic attacks, the doctor prescribes aminophylline 1200 mg/day in divided doses. The albuterol inhalation is to be taken as needed. Nursing interventions include patient history of asthmatic attacks and physical assessment.

QUESTIONS:

1. When taking the patient’s history, what should the nurse include concerning asthmatic attacks? What physical assessment would suggest an asthmatic attack?
2. What type of drug is aminophylline? Why should the nurse asks Maria if she smokes?
3. What are the side effects, adverse reaction, and drug interactions related to aminophylline?
4. What nonpharmacologic measures can the nurse suggest that may decrease the frequency of asthmatic attacks?
5. Which are appropriate rescue medications used for acute asthmatic attack? Which drugs are used as preventive medications?

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