department, his physical examination reveals a client of 165 cm and 63.5 kg with a harsh non-productive cough. Routine medications at home include theophylline (Theodur) 200 mg twice daily, sodium cromoglycate (Intal) aerosol spray qid, and terbutaline (Bricanyl) inhaler 2 puffs following sodium cromoglycate and prn. He has been asthmatic since age 2. Emergency department treatment includes administration of adrenaline 1:1000 0.6 mL subcutaneously, laboratory determination of theophylline level, which was 7 mcg/mL (normal is 10–20 mcg/mL). He has an intravenous (IV) infusion started. Aminophylline is given in a bolus dose followed by a drip at 30 mg/hour. Solu-Medrol 100 mg IV 4 hourly is prescribed. NURSING CARE PLAN A Client with Asthma Using Sodium Cromoglycate (Intal) and Terbutaline Sulfate (Bricanyl Inhaler) Michael Shanker, a 16-year-old high-school student, is admitted to the emergency department at 1300 hours with shortness of breath and tachycardia. He appears wide-eyed and anxious, with audible expiratory wheezes. Inspiratory wheezes can be heard on auscultation. Mike says shortness of breath and cough began after his routine aerosol inhalation dose of sodium cromoglycate. When he became short of breath, he used the terbutaline inhaler to relieve spasms and cough unsuccessfully. In the emergency Chapter 32 Bronchodilators and Other Respiratory Agents ASSESSMENT NURSING DIAGNOSIS PLANNING/GOALS IMPLEMENTATION EVALUATION Breathing patterns, breath sounds Ineffective breathing pattern related to bronchospasm, secondary to too rapid administration of sodium cromoglycate. Client will have respiratory rate, rhythm, and depth within normal limits. Position client in sitting position. Teach client to rest between activities. Assess ventilation for chest expansion and pursed-lip breathing. Assess breath sounds every hour. Client returns to normal breathing pattern. Breath sounds present and clear. Oxygenation, skin colour, wheezing Impaired gas exchange related to narrowing of bronchial tree. Client will maintain adequate oxygenation as evidenced by blood gases within normal limits. Assess skin colour, temperature, cyanosis. Watch for restlessness, and confusion, which may indicate an oxygen lack. Arterial blood gases as ordered. Client has normal colour with skin that is warm and dry. Respirations and blood gases within normal limits. Breath sounds present and clear. Secretions, coughing Ineffective airway clearance related to increased secretions. Client will have respiratory rate rhythm and depth within normal limits. Breath sounds present and clear. Give fluids to help liquefy secretions. Encourage coughing and expectoration of retained secretions. Assess respirations and breath sounds. Client is taking at least 2000 mL of fluid daily. Secretions are easily expectorated. Breath sounds are improving. Respirations are within normal limits. Appetite, body weight Imbalanced nutrition: less than body requirements related to fatigue, hypoxia, and developmental stage. Client will maintain body weight. Provide well-balanced diet in high- protein liquid form during acute attack. Space feedings throughout day. Between attacks, ensure nutritious diet designed to facilitate growth during this stage of rapid growth. Client is continuing normal growth pattern for this age level. Speech patterns Impaired verbal communication related to inability to breathe. Client will demonstrate ability to communicate needs. Encourage client to use one-word comments when short of breath. Ask yes or no questions. Client is communicating effectively. CONTINUED