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
EXCERPT OF RELEVANT ICU NOTES
Diagnosed with asthma age 2 (infrequent intermittent asthma).
Current medications: - Ventolin PRN.
IUTD (immunisations up to date)
A. Clear, speaking in single words
B. RR 42bpm, SpO2 87% RA, 92% on 6LPM O2 + nebuliser, auscultation decreased AE bibasally, inspiratory and
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
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
- 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
– Why your patient is receiving this medication in relation to her symptoms and diagnosis?
– What are the nursing considerations for this medication?
INDICATION OF HYDROCORTISONE IV IN THIS PATIENT:
NURSING CONCIDERATIONS FOR THIS PATIENT:
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