Stabilisation
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Stabilisation:
- Thankfully, while magnesium was being drawn up for intravenous infusion, she begins to settle and is breathing more comfortably
- Her chest still exhibits wheeze but air entry is unequivocally better
- Critical care reviewed her and agreed that she would be a candidate for the intensive care unit, but that it was not yet required
- She is transferred to the respiratory ward for observation and further management
Preparing for discharge:
- Thanks to your quick thinking and supportive care, her use of nebulisers gradually dwindles and her need for supplemental oxygen falls
- She was "off oxygen" on day 2 and did not need any nebulisers on day 5
- She is very keen to go home, though a bit nervous
Question:
Feedback:
There is lots to ask here and it would be good to structure your questions in terms of:
- Overall control of asthma prior to admission
- Think of the "three asthma questions": frequency of day time symptoms, night time symptoms, and effects on normal daily activities
- You also got an impression of this in the acute history in terms of previous admissions, critical care admission, use of steroids etc.
- Current therapy
- Does she understand how to use her inhalers and the difference between the reliever and preventer?
- Is she compliant with her inhalers?
- Is her technique good with the inhalers?
- How often is she needing to use her reliever inhaler?
- Environmental triggers
- Does she smoke?
- Does she have any pets that are contributing to symptoms or an occupation that is contributing to asthma?
- Is she taking any medications such as NSAIDs?
- Future exacerbations
- This patient should have follow-up arranged with the respiratory team and be discharged with rescue steroids to use at home if needed and an asthma action plan that will let her know when to use them and who to call if she is feeling symptomatic
Incorrect use of inhalers is very common
This list is not exhaustive
Most respiratory departments have asthma nurses that are excellent at this discharge planning and will help you out as there is a lot to think about
