L.B. is a 40-year-old woman who is being seen in the clinic with ...

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L.B. is a 40-year-old woman who is being seen in the clinic with complaints of a dry, hacking cough for the past 6 weeks.
 
  As the intake nurse, what routine information do you want to obtain from L.B.?
 
  L.B.'s chief complaint is a cough. What are the main causes of chronic cough, and what
  questions should you ask to elicit information about each cause?

Question 2

You ask B.T. to demonstrate the use of his MDI. He vigorously shakes the canister, holds the aerosolizer at an angle (pointing toward his cheek) in front of his mouth, and squeezes the canister as he takes a quick, deep breath.
 
  What common mistakes has B.T. made when using the inhaler?
 
  You review the proper use of an MDI with B.T and possible side effects he may experience,
  including hoarseness, dry mouth, white spots in the oral cavity, coughing, and headaches.
  What actions can you teach him to prevent or diminish the incidence of these effects? Select
  all that apply.
  a. Decrease his fluid intake.
  b. Use a spacer on the inhaler.
  c. Use the inhaler only as prescribed.
  d. Rinse out his mouth immediately after using the inhaler
  e. Clean the spacer in the dishwasher on hot cycle with heated dry daily.
 
  B.T.'s wife asks about the possibility of B.T. having another attack. How would you respond?
 
  B.T. states that he would like to read more about asthma on the Internet. List three credible
  websites to which you could direct him.

[Jody Vaughn]

Answer to Question 1

 Vital signs (VS), including oximetry
 Personal and family history
 Medications
 Allergies, skin conditions
 Description of her symptoms: location, quality, quantity, timing, setting, factors that aggravate or
relieve them, associated symptoms
 Whether she has ever experienced these symptoms before

Asthma
 Do you have allergies or sinus problems?
 Do you have chronic drainage down the back of your throat?
 Do you have a tickle in your throat?
 Do you clear your throat a lot?
Postnasal Drip
 Do you experience acid reflux (does stomach acid come up into your throat)?
 Is the heartburn worse after you eat certain foods or beverages, go to bed within 4 hours of eating
a meal, exercise too soon after eating, or overeat?
 How often do you take antacids or some type of stomach medication?
 Do the antacids help your cough?
Gastroesophageal Reflux Disease
 Have you ever smoked?
 Do you currently smoke?
 How many packs did you smoke, and how many years have you smoked?
Chronic Bronchitis
 How long have you had this cough?
 Do you cough up anything?
 Have you had a productive cough at least 3 months of the year for 2 consecutive years?
Chronic Bronchitis
 What medications do you take?
 Did your cough begin after starting any medication?
PostRespiratory Infection
 Did your cough begin during or immediately after a respiratory infection?

Answer to Question 2

 Not using the spacer
 Inhaling too fast (he should take a slow, deep breath)
 Lack of coordination between activating the inhaler and initiating the deep breath
 Angling the inhaler to spray the tongue or side of the mouth
 Failing to hold his breath for 10 seconds after inhalation

Answers: b, c, d
Spacers will help him get appropriate doses of his medicine, assisting with controlling symptoms.
An added benefit is that he will not have to worry about timing his breathing with the discharge of
the canister. Caution him against exceeding the prescribed doses, because central nervous system
and cardiovascular symptoms can occur. Rinsing his mouth with water or gargling after each use of
the inhaler will help to prevent mucosal dryness and decrease risk of fungal infections. Increasing
his fluid intake may assist with chronic coughing and hoarseness. Instruct him to clean the MDI and
spacer daily in warm water and place them on a paper towel to air dry.

Yes, it is very likely that B.T. will have another asthma attack in the future. The chance of this
happening can be reduced by avoiding factors, or triggers, that seem to bring on an exacerbation or
attack and properly using the medications prescribed by the doctor.

Credible websites include those maintained by the National Institutes of Health (www.nhlbi.nih.gov);
the Asthma and Allergy Foundation of America (www.aafa.org); the National Library of Medicine
(www.nlm.nih.gov/medlineplus/asthma.html); and the Centers for Disease Control and Prevention
(www.cdc.gov/asthma).

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Correct answers!

[Jody Vaughn]

Great! Please up vote