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“I will drink plenty of fluids while taking this medication.” Maintaining adequate hydration helps prevent corticosteroid-induced fluid retention and supports overall metabolic function. This is a correct and appropriate self-care measure. No additional teaching is needed for this point.

“I will tell the doctor if I have black, tarry stools.” Black, tarry stools may indicate gastrointestinal bleeding, a potential complication of corticosteroid use. Reporting this symptom promptly allows for early intervention. This statement reflects correct knowledge of warning signs associated with prednisone therapy.

“I will monitor my mouth for canker sores.” Oral ulcers can occur with corticosteroid therapy due to mucosal thinning or immunosuppression. Monitoring the mouth is a preventive and appropriate measure. This demonstrates correct understanding of potential adverse effects.

“This medication can decrease my immune response.” Bronchodilators do not suppress the immune system; this is a side effect associated with corticosteroids. Misattributing immune suppression to bronchodilators indicates misunderstanding of the medication’s mechanism of action. The statement is inaccurate and does not reflect correct teaching.

“I need to take this medication with food.” Bronchodilators can be taken with or without food; timing relative to meals is not critical. Emphasizing food intake is unnecessary and may reflect confusion with other medications like corticosteroids. This statement does not indicate understanding of the drug’s purpose.

“This medication has a slow onset to treat my symptoms.” Rescue bronchodilators, such as short-acting beta₂ agonists, have a rapid onset to relieve acute bronchospasm. Describing the medication as slow-acting is incorrect for acute symptom relief and demonstrates misunderstanding. Knowledge of onset is essential for safe and effective use.

The presence of a pulsus paradoxus. Pulsus paradoxus (a drop in systolic blood pressure >10 mmHg during inspiration) can indicate severe asthma but is less immediately life-threatening than absent breath sounds. It is an important clinical sign but does not replace the urgency of managing critical airflow obstruction.

Use of accessory muscles of respiration and a feeling of suffocation. Accessory muscle use and dyspnea are early indicators of respiratory distress. These signs show increased work of breathing but do not necessarily indicate impending respiratory failure. They are concerning but less critical than a silent chest.

A respiratory rate of 34 and increased pulse and blood pressure. Tachypnea, tachycardia, and elevated blood pressure reflect compensatory responses to hypoxemia and stress. These findings indicate moderate distress but are not as immediately life-threatening as absent breath sounds.

Prepare the client for mechanical ventilation. Mechanical ventilation is reserved for clients showing signs of impending respiratory failure, such as rising PaCO₂, decreased pH, or absent breath sounds. At this early stage, the client is compensating well, and invasive support is unnecessary. Premature preparation could cause unnecessary anxiety and interventions.

Have the client breathe in a paper bag to raise the PaCO₂. Rebreathing exhaled CO₂ is dangerous in asthma, as it can worsen hypoxemia and increase work of breathing. This intervention is not recommended and could precipitate severe respiratory compromise.

Reduce the client’s oxygen flow rate to keep the PaO₂ at the current level. Oxygen should be titrated to maintain adequate oxygenation, not deliberately restricted. Lowering oxygen in a client with borderline hypoxemia could worsen tissue oxygen delivery.

Prednisone orally. Oral corticosteroids reduce airway inflammation but have a delayed onset of action, taking several hours to exert significant effects. They are important for sustained management of an exacerbation but are not effective for immediate relief of bronchospasm. Relying on prednisone alone would leave the client in ongoing respiratory distress.

Ipratropium inhaler. Ipratropium is an anticholinergic bronchodilator that can provide additional relief when combined with SABAs. Its onset is slower and its effect is less potent than albuterol in acute severe asthma. It is considered adjunctive therapy, not first-line rescue therapy.

Fluticasone inhaler. Fluticasone is an inhaled corticosteroid used for long-term airway inflammation control. It does not provide immediate bronchodilation and is not indicated for acute relief. Administering fluticasone during a severe attack would not improve airflow quickly.

Leave the client alone to rest in a quiet, calm environment. Leaving a client in severe respiratory distress alone is unsafe because rapid deterioration can occur, and assistance may be needed immediately. Isolation can increase anxiety and panic, worsening the breathing difficulty. Continuous observation is critical in acute asthma management.

Reassure the client that the attack can be controlled with treatment. Reassurance alone does not address the physiological effects of panic on breathing. Without active intervention to improve ventilation, the client may continue hyperventilating and experience worsening hypoxemia. Reassurance should accompany practical, supportive measures, not replace them.

Let the client know that frequent monitoring is being done using measurement of vital signs and SpO₂. Informing the client about monitoring provides some comfort but does not actively reduce panic or improve oxygenation. Passive observation does not teach coping strategies or actively assist the client in regulating breathing.

Carry the flow meter with the client at all times in case an asthma attack occurs. While convenient, peak flow meters are not designed for emergency use during an acute attack; they are used for routine monitoring. Immediate attacks require rescue inhalers and emergency interventions, not measurement.

Use the flow meter to check the status of the client’s asthma every time the client takes quick-relief medication. Peak flow should be measured at consistent times daily, typically in the morning and evening, not immediately after using a rescue inhaler, because bronchodilation can temporarily mask airway obstruction. This practice would give misleading readings and reduce the effectiveness of monitoring trends.

Use the flow meter by emptying the lungs, closing the mouth around the mouthpiece, and inhaling through the meter as quickly as possible. Peak flow meters measure expiratory flow, not inspiratory flow. The correct technique is to inhale deeply, then blow out as forcefully and quickly as possible, ensuring accurate measurement of airway obstruction. Using inspiration instead of expiration gives invalid results.

“I should exercise every day if my symptoms are controlled.” Regular exercise is encouraged for clients with controlled asthma because it improves cardiopulmonary fitness and lung function. Clients should be educated to use pre-exercise bronchodilators if needed and monitor symptoms, making this statement correct.

“I should inform my spouse about my medications and how to get help if I have a severe asthma attack.” Sharing knowledge with family or caregivers is essential for safety during exacerbations, ensuring timely intervention if rescue therapy is needed. This reflects correct understanding of asthma self-management.

“A diary to record my medication use, symptoms, peak expiratory flow rates, and activity levels will help in adjusting my therapy.” Keeping a detailed diary allows the client and healthcare provider to monitor patterns, detect early exacerbations, and adjust treatment appropriately. This statement demonstrates correct self-management behavior.

“I get a flu shot every year and see my health care provider if I have an upper respiratory tract infection.” Annual influenza vaccination and prompt evaluation of infections are recommended for asthma clients because viral respiratory infections can precipitate exacerbations. This demonstrates correct understanding of preventive measures.

“I use my inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies.” Pre-exposure use of a rescue inhaler and limiting exposure to known allergens is an effective strategy to prevent exercise- or allergen-induced symptoms. This statement reflects appropriate trigger management.

“I walk 30 minutes every day but sometimes I have to use my bronchodilator inhaler before walking to prevent me from getting short of breath.” Using a short-acting beta₂ agonist prior to exercise to prevent bronchospasm is recommended for clients with exercise-induced asthma. This shows proper use of rescue medication as prophylaxis.

Intermittent. Intermittent asthma presents with symptoms less than twice per week and nighttime awakenings less than twice per month. Daily symptoms and frequent nighttime awakenings clearly exceed the criteria for intermittent asthma, so this is incorrect.

Mild persistent. Mild persistent asthma involves symptoms more than twice per week but less than daily, and nighttime awakenings 3–4 times per month. The client’s daily symptoms and multiple weekly awakenings exceed these thresholds, making mild persistent an inaccurate classification.

Severe persistent. Severe persistent asthma is characterized by continuous symptoms, frequent nighttime awakenings often nightly, and limited physical activity. Although the client has daily symptoms, the pattern of 3–4 nighttime awakenings per week does not meet the severe threshold.

Timeline for allergy skin testing. While allergy testing can guide long-term management, it is not part of immediate action planning for symptom control or exacerbation response. An asthma action plan focuses on acute symptom recognition and interventions, not elective testing schedules.

The most direct route when the client drives to the hospital. Directions to the hospital are not relevant to the clinical content of an asthma action plan, which prioritizes symptom monitoring, medication adjustments, and emergency instructions rather than logistics.

The best methods for chest physiotherapy (CPT). CPT is generally used in conditions with excessive mucus production such as cystic fibrosis, but it is not standard for asthma management. Including CPT instructions would not address the acute control and self-management focus of the asthma action plan.

Have the client cough and deep breathe. Coughing and deep breathing are generally supportive measures but do not relieve bronchospasm. Attempting these alone in an impending asthma attack can delay effective treatment, increasing the risk of worsening respiratory distress.

Prepare to intubate the client. Intubation is reserved for life-threatening asthma exacerbations with respiratory failure or exhaustion. Preparing for intubation is premature when wheezing can still be managed with rapid-acting bronchodilators.

Have the client lie on his or her right side. Positioning may offer comfort but does not alleviate airway obstruction or bronchospasm. Upright positioning is generally preferred to maximize lung expansion and ventilation, making lying on the side non-therapeutic.