Patient Scenario: A college student, arrives at the emergenc…
Patient Scenario: A college student, arrives at the emergency department with shortness of breath, wheezing, and chest tightness that began about an hour ago after exposure to dust while cleaning their apartment. Pt. states, “I used my rescue inhaler twice, but it’s not helping much.” Vital Signs on Admission: BP: 132/86 mm Hg HR: 110 bpm RR: 24/min, labored Temp: 99.0°F (37.2°C) O₂ Sat: 88% on room air Nurse’s Note: Patient sitting upright, anxious, using accessory muscles to breathe. Audible expiratory wheezes in all lung fields. Speaking in short phrases. Rescue inhaler used prior to arrival. Oxygen applied at 2 L/min via nasal cannula. Provider notified. Provider’s Note: Diagnosis: Acute asthma exacerbation Orders: Continue oxygen 2 L/min Administer albuterol nebulizer treatment STAT Obtain peak expiratory flow rate (PEFR) Monitor lung sounds and oxygen saturation Reassessment (30 minutes later): RR: 22/min HR: 104 bpm O₂ Sat: 94% on 2 L Breath sounds: Wheezing persists but less intense PEFR: 55% of predicted value Provider’s Note (Update): Order: Administer IV methylprednisolone (Solumedrol). Continue bronchodilator treatments as needed. Monitor for changes in lung sounds and respiratory effort. Next Assessment (1 hour later): Patient reports breathing is easier. RR: 20/min O₂ Sat: 97% on 2 L Mild expiratory wheezing persists. Which finding indicates an improvement in oxygenation?