Let's Look at the Goal Statement
Review the criteria for a proper goal statement: (1) Is the goal statement clearly related to the problem? Yes (2) Is it patient focused (i.e., not a nursing action in disguise)? Yes, it is patient focused. (3) Is it in a time context? Yes (4) Is it measurable or binary (yes/no)? Yes (Caveat: "normal" may be a word that sounds wishy-washy and inexact. However, since there are established ranges for "normal" ABG's it is OK to use this term.)
Look at the Nursing Actions:
1. Increase O2 to 4L/min. This might actually be pretty low ball. The patient cannot be over oxygenated. So, this increase in FiO2 (fraction or % of inspired oxygen) is probably not going to be enough. But it's something.
2. Start IV stat and begin replacement fluids: As mentioned previously, the patient's labs indicate she's dehydrated. In addition, part of the pathophysiology of asthma is that goblet cells near the lumen of the airways are producing thick, difficult to mobilize sputum. So hydrating the patient may facilitate thinning the secretions somewhat, thus opening her airways a bit.
3. Methylprednisolone 62.5 mg IV q6h: Asthma is an inflammatory condition. Glucocorticoids can inhibit leukocyte infiltration at the site of inflammation, interfere with mediators of inflammatory response, and suppress humoral immune responses.
4. Albuterol 5 mg/hour by nebulization: Infammatory mediators in asthma are causing airway smooth muscles to contract, reducing the diameter of airways throughout the lung. Albuterol is a beta-2 agonist that acts by relaxing smooth muscle. Giving it by nebulization puts it where it needs to be thus minimizing some systemic side effects.
5. Magnesium sulfate 2G IV now: Muscle cells need a flux of increased intracellular Ca2+ in order to contract. Mg2SO4 appears to block calcium entry into airway smooth muscle cells. It is also thought to block histamine (a major chemical mediator in inflammation) release from mast cells in airway tissues. It may also synergistically increase the bronchodilator action of albuterol.
6. Independent nursing actions: These are predominantly aimed at prescribing very frequent and intense monitoring of this patient. The overbed table (or any support the patient wants) may reduce the fatigue associated with maintaining the tripod position.
2. Start IV stat and begin replacement fluids: As mentioned previously, the patient's labs indicate she's dehydrated. In addition, part of the pathophysiology of asthma is that goblet cells near the lumen of the airways are producing thick, difficult to mobilize sputum. So hydrating the patient may facilitate thinning the secretions somewhat, thus opening her airways a bit.
3. Methylprednisolone 62.5 mg IV q6h: Asthma is an inflammatory condition. Glucocorticoids can inhibit leukocyte infiltration at the site of inflammation, interfere with mediators of inflammatory response, and suppress humoral immune responses.
4. Albuterol 5 mg/hour by nebulization: Infammatory mediators in asthma are causing airway smooth muscles to contract, reducing the diameter of airways throughout the lung. Albuterol is a beta-2 agonist that acts by relaxing smooth muscle. Giving it by nebulization puts it where it needs to be thus minimizing some systemic side effects.
5. Magnesium sulfate 2G IV now: Muscle cells need a flux of increased intracellular Ca2+ in order to contract. Mg2SO4 appears to block calcium entry into airway smooth muscle cells. It is also thought to block histamine (a major chemical mediator in inflammation) release from mast cells in airway tissues. It may also synergistically increase the bronchodilator action of albuterol.
6. Independent nursing actions: These are predominantly aimed at prescribing very frequent and intense monitoring of this patient. The overbed table (or any support the patient wants) may reduce the fatigue associated with maintaining the tripod position.