Client Profile Case Study Mrs. Hogan is a 38-year-old woman brought to a walk-in health care center by her neighbor. Mrs. Hogan is in obvious respiratory distress. She is having difficulty breathing with audible high-pitched wheezing and is having difficulty speaking. Pausing after every few words to catch her breath, she tells the nurse, "I am having a really bad asthma attack. My chest feels very tight and I cannot catch my breath. I took my albuterol and Vanceril, but they are not helping." Mrs. Hogan hands her neighbor her cell phone and asks the neighbor to dial a telephone number. "That number is my husband's boss. My husband just started working for an asbestos removal company about a month ago. He is usually on the road somewhere. Can you ask his boss to get a message to him that I am here?" While auscultating Mrs. Hogan's lung sounds, the nurse hears expiratory wheezes and scattered rhonchi throughout. Mrs. Hogan is afebrile. Her vital signs are blood pressure 142/96, pulse 88, and respiratory rate 34. Her oxygen saturation on room air is 86%. Arterial blood gases (ABGS) are drawn. Mrs. Hogan is placed on 2 liters of humidified oxygen via nasal cannula. She is started on intravenous (IV) fluids and receives an albuterol nebulizer treatment. Questions 1. What other signs and symptoms might the nurse note during assessment of Mrs. Hogan? 2. In what position should the nurse place Mrs. Hogan and why? 3. Identify at least five signs and symptoms that indicate that Mrs. Hogan is not responding to treatment and may be developing status asthmaticus (a life-threatening condition). 4. Mrs. Hogan states that she took her albuterol and beclomethasone prior to coming to the walk-in health care center. How do these medications work? 5. Briefly discuss the common adverse effects Mrs. Hogan may experience with the albuterol nebulizer treatment. and she appears less anxious. The nurse asks Mrs. Hogan what she was doing when the asthma attack began. Mrs. Hogan says, "Nothing special. I was doing the laundry." What other questions might the nurse ask (and why) to assess the cause of Mrs. Hogan's asthma exacerbation? 10. What are some other questions the nurse might ask to get a better sense of Mrs. Hogan's asthma? 11. The nurse asks Mrs. Hogan to describe step-by- step how she uses her inhalers. Mrs. Hogan describes the following steps: "First I shake the inhaler well. Then I breathe out normally and place the mouth- piece in my mouth. I take a few breaths and then while breathing in slowly and deeply with my lips tight around the mouthpiece, I give myself a puff. 6. Physiologically, what is happening in Mrs. Hogan's I hold my breath for a count of five and breathe out lungs during an asthma attack? 7. In order of priority, identify three nursing diagnoses that are appropriate during Mrs. Hogan's asthma exacerbation. 8. Write three outcome goals for Mrs. Hogan's diagnosis of Ineffective Breathing Pattern. 9. Mrs. Hogan has responded well to the albuterol nebulizer treatment. Her breathing is less labored slowly as if I am blowing out a candle. I wait a minute or two and then I repeat those steps all over again for my second puff." Which step(s) is/are of concern to the nurse and why? 12. Briefly discuss three nursing interventions to help decrease Mrs. Hogan's risk of another asthma exacerbation