In vitro studies and in vivo pharmacologic studies have shown that salbutamol has a

preferential effect on beta2-adrenergic receptors compared with isoproterenol. Although

beta2 adrenoceptors are the predominant adrenergic receptors in bronchial smooth muscle
and beta1 adrenoceptors are the predominant receptors in the heart, there are also beta2-
adrenoceptors in the human heart comprising 10% to 50% of the total beta-adrenoceptors
The precise function of these receptors has not been established, but their presence raises
the possibility that even selective beta2-agonists may have cardiac effects. Activation of
beta2-adrenergic receptors on airway smooth muscle leads to the activation of adenyl
cyclase and to an increase in the intracellular concentration of cyclic-3′,5′-adenosine
monophosphate (cyclic AMP). Salbutamol has been shown in most controlled clinical trials
to have more effect on the respiratory tract, in the form of bronchial smooth muscle
relaxation, than isoproterenol at comparable doses while producing fewer cardiovascular
effects. A measurable decrease in airway resistance is typically observed within 5 to 15
minutes after inhalation of salbutamol.

 Check and verify with doctor’s order and Kardex.

 Observe rights in medication administration such as giving the right drug to the
right patient using the right route and at the right time.
 Warn patient about risk of paradoxical bronchospasm and to stop drug
immediately if it occurs.
 Teach patent to perform oral inhalation correctly.
 dvise patient not to chew or crush extended-release tablets or mix them with
food.
 Advise patient to seek assistance in performing activities of daily living because
the risk of feeling weak as well as having vertigo, drowsiness, and headache is
possible.
 Educate client about avoiding stimulus that might precipitate vertigo such as too
much light and too much noise both in forms of talking and loud music and
television.
 Instruct client to rise slowly from bed or when changing positions from lying to
sitting to standing.
 Advise client to have small frequent feedings to avoid increasing risk of vomiting
and heartburn.
 Instruct client to increase oral fluid intake to facilitate drug excretion.
 Instruct client to avoid spicy and oily foods to prevent risk of developing
heartburn.
  Emphasize with the client the importance of gurgling after inhalation to prevent
dry mouth.

 Patient will verbalize understanding of cause and therapeutic

management regimen.
 Patient will maintain airway patency as evidenced by clear breath sounds,
improved oxygen exchange, normal rate and depth of respiration, and
ability to effectively cough out secretions.
Changes in the respiratory rate and rhythm
Assess respiratory rate, depth, and rhythm. may indicate an early sign of impending
respiratory distress.

Cyanosis indicates low oxygenation and that

Assess for color changes in the buccal
breathing is ineffective to maintain
mucosa, lips, and nail beds.
adequate tissue oxygenation.

Wheezes suggest partial obstruction or

Auscultate lungs for adventitious breath
resistance. While rhonchi may indicate
sounds (wheezes and rhonchi).
retained secretions in the lungs.

with dyspneic on exertion, decreased expiratory volume, expiratory

wheezes noted on auscultation, moist lung sound, unproductive cough,
chest tightness, BP; 80/60, ABG reveal pH= 7.30, HCO3= 26 mEq/L, PaCO2=
47 mmHg, peak flow of less than 60% and serum Potassium level is 5.9
mEq/L.

Assessed respiratory rate, depth, and

rhythm. Assessed for color changes in the
buccal mucosa, lips, and nail beds.
Auscultated lungs for adventitious breath
sounds. Monitored and recorded intake and
output (I&O) adequately. Monitored oxygen
saturation using pulse oximetry. Monitored
arterial blood gasses (ABGs).Peak Expiratory
Flow rate done. Provided moderate high
back rest. Administered IV fluids, oxygen,
and medication as ordered. Encouraged
deep breathing and coughing exercises.
Encouraged increased fluid intake of up to
3000 ml/day within cardiac or renal reserve.
Explained the importance of being on a DAT
diet. Demonstrated the proper of using
PEFR

Fully met:
If the patient verbalizes understanding of
cause and therapeutic management
regimen, maintained airway patency as
evidenced by clear breath sounds, improved
oxygen exchange, and normal rate and
depth of respiration and ABG results of pH=
7.37, HCO3= 25 mEq/L, PaCO2= 39 mmHg.

Partially met:
If the patient verbalizes some
understanding of cause and therapeutic
management regimen, maintained airway
patency but ABG results is still abnormal.

Unmet:
If the patient did not understanding the
cause and therapeutic management
regimen and did not maintained airway
patency.

Respiratory assessment helps to determine the adequacy of respiration and enables the

identification of changes to respiratory function. It contributes to the diagnosis and management

of a variety of pathological conditions and helps the practitioner to evaluate therapeutic

interventions. Respiratory assessment to asthma is very much anticipated if complications

happens because problems to airways is a life threatening situation and medica emergency that

may lead to death.

 ducational opportunities that I can
The e

possibly identify for my client would be

related to our current problem today which
is COVID-19. It is very important for my
patients to avoid any factor that can trigger
his condition to avoid recurrence of his
condition as soon. Some people with asthma might be more likely to
have serious symptoms if they get COVID-19. If you have asthma, it's especially
important to take measures to avoid getting sick. This includes staying home as much
as possible and washing your hands often. If you take medications to control your
asthma or treat asthma attacks, it's important to keep taking them as usual. If you have
symptoms of COVID-19, or think you might have been exposed to the virus, call their
health care provider as soon as possible. Another educative interventions that I could
possibly identify are

What my patient can independently do to manage his condition, other alternative

treatment, asthma quick relief medications, and tests to measure lung function such as
spirometry and peak flow

AN I DO ON MY OWN

I will instruct my patient to stand up straight as much as possible

and making sure that the indicator is at the bottom of the meter.
He should take a deep breath, filling his lungs completely then
place the mouthpiece in his mouth, lightly bite with his teeth, and
close his lips on it. Then he should blast the air out as hard and
as fast as possible in a single blow. After that record the number
that appears on the meter and repeat these steps 3 times. As
much as possible compare the readings every day at the same
 time while recording the highest of the 3 readings in an asthma
diary. That reading would be his peak flow.

In the situation where respiratory therapist made a mistake in giving information the client, it is

best to approach first the RT because maybe he/she was just confused or the client is confused.

It always best to maintain a good relationship with the respiratory therapist because RTs and

RNs work together to assess, treat, and support people suspected of having and/or living with

COPD. The RT and RN review health history and risk factors for COPD, medications and ability

to afford the medications, and immunization status as a place to begin the health care

relationship. Continuous collaborating and communicating with them will help clarify things out

and avoid the same mistake that may actually harm the client. In that point, both of us, me and

the respiratory therapist should explain again to the client the proper way of using the peak flow

meter emphasizing salient points to the patient. It is always best to maintain trusting relationship

to the client as well as to all healthcare teams.

30 minutes after taking a blood sample for ABG studies of patient Reyes on his left radial artery

on his arm, he complained that there’s a tingling sensation on the puncture site. Upon

assessment, there was a hemorrhage and hematoma on the area. How are you going to

document these findings on your charting? Write them using only the DATA part. Is there an

ethico/legal principle violated in this situation? Explain Why.

The ethico/legal principle that is being violated in the situation is the principle of

nonmaleficence which talks about doing no harm to the patient as stated in the historical

Hippocratic Oath. Internal bleeding if left untreated might lead to organ

failure, seizures, coma, external bleeding, and eventually death. Another principle that could

also be violated is the principle of veracity if we would not tell the truth to the patient

of some negligence that happened. So it is important to tell the truth to put

immediate interventions as soon as possible and to avoid further complications.

Remember that any bleeding that continues without medical treatment could be fatal. It is

now our responsibility to truthfully document the incident as follows:

Data: Received lying on bed with ongoing IVF of LRS 1Lx8 hours at 1000 mL level infusing

well at left metacarpal vein with dyspneic on exertion, decreased expiratory volume,

expiratory wheezes noted on auscultation, moist lung sound, unproductive cough, chest

tightness, capillary refill of 1-2/min, BP; 80/60, ABG reveals pH= 7.30, HCO3= 26 mEq/L,

PaCO2= 47 mmHg, peak flow of less than 60% and serum potassium level is 5.9 mEq/L, 30

minutes after taking a blood sample patient complains a tingling sensation on the puncture

site, noted with hemorrhage and hematoma on the area.

Patient characteristics
This study included 64 patients (23 men, 41 women; mean age, 55.1 years)
from August 2012 to March 2014 (Table 1). Twenty-five patients (39.1%) were
current or previous smokers. Twenty patients (31.3%) had received influenza
vaccination. ICS was used regularly in 45 patients (70.3%). Forced expiratory
volume in the first second (FEV1.0) was less than 70% in 14 patients (35.0%).
Overall, AEBA occurred at a mean frequency of 1.5 (range, 1–5) times per year;
18 patients (28.1%) had a severe attack, and 15 patients (23.4%) were admitted
to the hospital. The underlying diseases are summarised in Table 1

Pathogens detected using each method

The rate of pathogen detection by real-time PCR in all 64 patients was 76.6%
(49 patients), whereas that of pathogen detection by the conventional methods
was 21.9% (14 patients, p < 0.001; Table 2). H. influenzae was detected by
real-time PCR analysis most frequently in 17 patients (26.6%), followed by RV
in 10 (15.6%), influenza virus in 9 (14.1%), and S. pneumoniae in 6 (9.4%).
All H. influenzae and S. pneumoniae detected by conventional methods were
also detected by real-time PCR. Real-time PCR showed that 39 pathogens
(61.0%) were considered to cause a single-microbe infection, whereas 10
pathogens (15.6%) caused polymicrobial infections.

Detection of pathogens using both methods

The respective percentages of detected pathogens by comprehensive real-time
PCR and conventional methods are shown in Fig. 1. By the use of both
methods, 62 pathogens were detected in 50 patients (78.1%). The infectious
etiology was viral only in 20 patients (31.3%) and both viral and bacterial in 8
patients (12.5%). In addition, the most common single bacterial pathogen
was H. influenzae, which was detected in 10 patients (15.6%), followed by S.
pneumoniae in 4 patients (6.3%), and M. pneumoniae in 2 patients (3.1%).

Relationship between the development of influenza infection and influenza

vaccination
Among the 44 patients who had been not vaccinated against the influenza
virus, 9 patients (20.5%) developed influenza infection, whereas none of the
20 patients (0%) who received the vaccination developed influenza infection
(p = 0.047 by Fisher’s exact test).

Risk factors associated with severe AEBA

The results of univariate and multivariate analyses of AEBA risk factors are
shown in Tables 3 and 4, respectively. Infection caused by influenza virus was
significantly associated with severe exacerbation (OR 7.107; 95% CI 1.511–
33.43; p = 0.013). Other respiratory viruses, H. influenzae, and S.
pneumoniae were not significant variables affecting the severity of AEBA.

Monthly distribution and pathogens in AEBA

The monthly distributions of frequencies and characteristic pathogens of
AEBA are shown in Fig. 2. AEBA clearly followed a seasonal pattern, with the
highest monthly rates occurring from November to January, during which
14.5 instances (38.7%) of exacerbation were observed.
In relation to my patient’s case which is
bronchial asthma in acute exacerbation, I
wanted to explore more on how to detect
this kind of condition so I come up with the
journal entitled Detection of pathogens by real-time PCR
in adult patients with acute exacerbation of bronchial asthma.
Respiratory tract infection is really a major cause of acute exacerbation of
bronchial asthma (AEBA). Although other findings suggest that common
bacteria are causally associated with AEBA, a comprehensive epidemiologic
analysis of infectious pathogens including common/atypical bacteria and
viruses in AEBA has not been performed so this journal attempted to
detect pathogens during AEBA by using real-time polymerase chain reaction
(PCR) in comparison to conventional methods. Bronchial asthma is a common
chronic inflammatory disease of the airways characterized by variable and
recurring symptoms, reversible airflow obstruction, and bronchospasm. Acute
exacerbation of bronchial asthma (AEBA) is the acute worsening of clinical
symptoms caused by various factors, including respiratory infections, which
are associated not only with the deterioration of lung function but also with
hospitalization or death. In the journal, I am greatly amazed and sad at the
same time on how they conduct the journal by gathering volunteers with the
same condition as my patients proving that AEBA is a condition that is
prevalent. Base on the findings, it is found out that real-time PCR was more
useful than conventional methods to detect infectious pathogens in patients
with AEBA. This journal will surely be very helpful for an accurate detection of
pathogens with real-time PCR that may enable the selection of appropriate
anti-bacterial/viral agents as a part of the treatment for AEBA.

Write a thoughtful reflection about this

virtual clinical experience and link them to
your values as a person, and the values of a
future Filipino Louisian professional nurse.

In our current situation today in which we

are experiencing this kind of pandemic,
there are a lot of problems that we are able
to encounter and this online class is one of
them. I will be very honest that adjustment
to this new kind of learning is not easy and
is very difficult. But as a student of Saint
Louis University and as Louisian nurse, we
are aiming for quality education. Even
though we are in this kind of situation our
school did not fail to give the quality
education that I need. I can feel this now
especially by studying our major courses like
the MS LAB that requires a more complex
concepts and difficult skills. Despite this I am
thankful to have modules that I can study in
the comfort of my home with my family
near me. There are also a lot of activities
which helped me to adjust and learned
more. Even though online class is very
difficult with our course requiring skills, I
think this will still help me on my future
career as a professional nurse. Saint Louis
University is always ensuring that being
competitive, creative, socially involved and
especially Chistian-spirited is still applied in
our community. So in our part, we really
have to do our very best to strive and reach
our goal.