Question

Poppy is a 9 year old female, weight 40Kg.

She presented to ED with worsening respiratory symptoms over the past few hours. Her parents state she is unable to

talk in full sentences or undertake a peak flow. In ED Poppy has been given 3 x 20 minutely nebulised Salbutamol with

6LPM of O2, IVF commenced, Stat dose of Prednisone administered, Chest X-ray shows hyperinflation of both lung

fields. She was admitted to ICU due to her deteriorating respiratory function with a diagnosis of acute exacerbation

of asthma.

EXCERPT OF RELEVANT ICU NOTES

Past History

Diagnosed with asthma age 2 (infrequent intermittent asthma).

7

Current medications: - Ventolin PRN.

IUTD (immunisations up to date)

Nursing Assessment

A. Clear, speaking in single words

B. RR 42bpm, SpO2 87% RA, 92% on 6LPM O2 + nebuliser, auscultation decreased AE bibasally, inspiratory and

expiratory wheeze

C. HR 160bpm, ST, peripherally warm

D. GCS 14/15 (E4, V4, M6)

E. Accessory muscle use, shoulder shrugging on inspiration, tracheal tug

F. IVF NaCl 53 ml/hr

G.

a. Mg- low 0.60mmol/L (0.70-1.10mmol/L) all other pathology is normal.

b. BGL 9.0mmol/L

c. Beta-agonist- Salbutamol

d. Anticholinergic - Atrovent

e. IV Hydrocortisone

f. ABG shows respiratory acidosis, (PH 7.32, PaCO2 49, PaO2 70, HCO3 27, BE -2.1, Lactate

1.4)

Plan

- Keep SpO2 92-95%%

- Beta- antagonist Salbutamol continuous via nebuliser

- Anticholinergic Ipratropium bromide (Atrovent) 500ug 4/24

- Hydrocortisone 100mg 6/24

- MgSO4 6.4mmol/20 minutes

- IVF 53ml/hr

- Repeat ABGs in 1hour

- Monitor BGL

- Peakflow /spirometry

QUESTION:

Sit Poppy in a High Fowlers position:

– How does positioning a patient with acute asthma in a High Fowlers position assist to alleviate respiratory distress?

Answer 1

Fowler's position is a standard patient position in which the patient is seated in a semi-sitting position(45-60 degree).Fowler's position facilitates the relaxing of tension of the abdominal muscles, allowing for improved breathing.Variations in the angle are denoted by high Fowler, indicating an upright position at approximately 90 degrees

Body positioning and Breathing techniques are common physiotherapy techniques used to releve dysponea.The total diaphragmatic size varies according to positions and increases during High fowlers position which eases diaghragmatic breathing ans lower symptoms of respiratory distress.