Scenario

Sept 11

Robert is 32 years old and has been asthmatic since the age of 7. His asthma has

been well managed for the past 3 years with the occasional use of salbutamol

(Albuterol) inhaler: Salamol: 2 puffs (100mcg/puff). He has not had an asthma

attack for a number of years.

Robert is currently in the 3 rd year of his environmental science degree and finding

life generally stressful at the moment. For the past month he has been using his

Salamol inhaler: 2 puffs (100mcg/puff) more frequently: up to three times a day

He has been admitted via the emergency department to a medical ward following

treatment for an acute exacerbation of asthma. He is currently stable and

prescribed the following medications:

Salbutamol (Steri-neb) 5mg four times a day, via oxygen driven nebuliser

Ipratropium bromide (Atrovent) 0.5mg four times a day, via oxygen driven nebuliser

Prednisolone 30mg, once a day, orally for 5 days

His current observations are:

Sa0 2: 97% on 35% humidified oxygen

Pulse: 101 bpm

Blood pressure: 143/80mmHg

RR: 28 breaths per minute

Temperature: 37.2°C

Shaw et al (2009) Chapter 8 & Howell (2010)

Presenter 2: Discuss Howell article: How does ethical theory and anthropocentric views inform how we view the environment? Highlight key arguments around environmental ethics. Comment on how the readings help you in your understanding of business ethics.

It is suggested that you write only one introduction, conclusion and reference list for

this assignment and make reference to part A and part B in your introduction. This

will mean that your word limit will not be reduced too much for each section of the

assignment

A: In reference to the given scenario, critically discuss the relevant pathophysiology

of acute asthma (1500 words)

Part A: topics to read and critically discuss:

1) What is asthma?

2) Incidence of asthma and implications of this

3) What are the common signs and symptoms of asthma?

4) Pathophysiology of asthma: relate this to your scenario

5) Pathophysiology of acute exacerbation of asthma: relate this to your scenario

6) How is an acute exacerbation of asthma defined or diagnosed: BTS guidelines?

7) Treatment guidelines for acute exacerbation of asthma: BTS guidelines: relate this to the

scenario

8) Triggers for asthma: relate this to your scenario and education and information for the

patient in terms of management of asthma

8) You must relate your discussion to the scenario where appropriate

Part B: topics to read and critically discuss:

B: In reference to the given scenario, critically discuss the related pharmacology and

medicines management issues (1500 words)

1) Pharmacokinetics and pharmacodynamics of the 3 identified drugs: what is the action of

these drugs, how do they work, what are the side effects, how are they absorbed,

metabolised, distributed and excreted?

2) Consider some of the points from the introduction to pharmacology session, i.e. specificity

and selectivity of a drug (beta2 agonists) and the implications of this for the patient and

nurse in clinical practice.

3) Consider the onset of action and duration of action of the drugs identified: half-life

4) Why are steroids recommended in all acute exacerbations of asthma: BTS guidelines?

5) Consider how the pharmacology of the 3 drugs impacts on the nursing care of acute

asthma and relate this to the scenario

6) Adverse effects of the medications and relate this to the action of the drug and how we

care for the patient in practice

7) 6 Rs of medicines management: importance of these: WHY? And relate to the scenario

and administration of medication to this patient: Nursing and Midwifery council (NMC)

Standards for Medicines Management 2010)

8) Care and management of nebulisers in practice (equipment and infection control)

9) Patient education regarding nebulisers and specific drug therapy for this patient

10) Education and advice regarding asthma management (particularly important due to

problems highlighted with concordance and asthma): relate this to the scenario

11) Remember that oxygen is also a drug and this is mentioned in your scenario (what is the

importance of prescribing nebulisers via oxygen driven nebuliser?): British thoracic society

guidelines

12) Consider any relevant legal, professional and ethical points related to the medication and

the scenario: NMC Standards for Medicines Management (2010): use the PowerPoint for

guidance on these issues.

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