A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air
The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug? a. Four puffs of albuterol, oxygen, and intravenous theophylline
b. Intramuscular glucocorticoids and salme-terol by metered-dose inhaler
c. Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen
d. Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg
C
Patients using inhaled glucocorticoids should be given IV or oral glucocorticoids for acute ex-acerbations. During asthma flares, nebulized albuterol with ipratropium may be better tolerated and more effective. Oxygen is indicated, because oxygen saturations are low despite the in-creased work of breathing. Increasing the dose of albuterol and giving theophylline are not indi-cated. Salmeterol is a long-term beta agonist and is not useful in an acute attack.
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