P: The patient must be treated aggressively since she is presenting symptoms of life-threatening exacerbations of asthma, including: severe asthma history, poorly controlled asthma, psychological factors/anxiety, previous hospitalization for asthma, and history of intubations with mechanical ventilation. Albuterol must also be stopped as this further aggravates bronchospasm. Hence, the following respiratory care protocol must therefore be administered: (1) 100 percent nonrebreather face mask, (2) continuous SaO2 monitor/pulse oximetry, (3) inhaled short acting beta2-agonist hourly or continuously with the addition of anticholinergic, (4) IV fluid is a must since insensible water losses are increased with the work of breathing. IV hydration also helps in reducing viscosity and mucus plugging; however, urine input and output should be monitored to avoid overhydration, (5) intravenous corticosteroids, (6) CBC, electrolytes, ABG, chest radiograph, EKG, and theophylline level should be obtained (Veteran Health Administration, 2002). Leukotriene modifiers is known for its anti - inflammatory effects and should be added to the aforementioned medications (Louisiana State University database, 2006).
Additionally, ABG revealed that patient has metabolic acidosis (HCO3- 19 mmol/L), an ominous sign of asthma. The patient has metabolic acidosis as a compensatory mechanism of impending respiratory alkalosis. Treating the underlying causes of respiratory alkalosis such as anxiety and asthma per se is a must to avoid further complication. It should be noted that if possible, intubation and mechanical ventilation should be avoided if at all possible, because the “underlying dynamic hyperinflation will worsen with positive-pressure ventilation” (Werner, 2001).
Inspection: high fowler’s position, pursed-lips breathing, cyanotic, using accessory muscles of inspiration,