Allira Nantuwara Case Study Based Questions

Case study

Allira Nantuwara, is a 14-year-old girl who identifies as a Ngadjuri woman. She is attending Mentone Girls' Grammar on an academic and sporting scholarship. She has a keen interest in human biology as she has plans to study physiotherapy once she completes school. Her mother Brooke has attended the hospital with Allira.

Complaints: SOBOE, SPO2 93% RA, RR 28, HR 130, BP 140/85, temp 36.8oC

Expiratory wheeze and cough

Allira states that she has hayfever (she notes that grass pollen seems to be the cause but has not seen a specialist)

Allira is talking in short sentences as she is struggling to catch her breath.

The attending doctor, Dr. Ling, prescribes a Salbutamol nebulizer. The preliminary diagnosis is acute asthma. Dr. Ling also organizes an Aboriginal Liaison Officer to come and discuss the situation with the family.

Allira and her mother want to understand Asthma. Allira asks, Does asthma constrict the alveoli?

1. Explain the changes that occur in the respiratory system and the effect this has on breathing. Note which clinical signs indicate that Allira has asthma and link them to the respiratory changes.

Allira commences the salbutamol and you check her SPO2 to see that it has risen to 96%. Allira asks if that is good and what does salbutamol do?

2. Explain the action of nebulized salbutamol. Include in your answer 4 potentially relevant side effects and 4 nursing considerations.

Allira is discharged with a Ventolin inhaler (Metered dose inhaler type) and spacer. The Aboriginal The liaison officer offers to attend the follow-up appointment as well. Allira has never used an inhaler before and is unsure how to correctly use it.

3. Explain the correct use of an inhaler medication, noting why correct use is important. You can include diagrams to help illustrate your response (all diagrams need to be appropriately referenced)

18 months later Allira (now 16 years old) is attending an appointment with her mother and the Aboriginal Liaison Officer to discuss her asthma management. Dr Ling has commenced Allira on a preventer medication, Flixotide Junior Accuhaler (Fluticasone propionate). However, this is only for winter, (June?August) when Allira's asthma seems to be worse. Allira wants to know why she needs prevention.

4. Explain the changes that asthma can have on the respiratory physiology if left untreated.
5. Discuss the action of the preventor. Include in your answer 4 potentially relevant side effects and 4 nursing considerations. Include when to take which medication (reliever or preventor) and why

Allira is planning to travel with her family to South Australia in a month to visit her family's traditional land. She wants to be able to manage her medication independently while away.

6. Explain what the teach?back method is. Discuss how you would apply it in Allira's circumstances.

Allira returns from South Australia, and is seeing her regular General Practitioner (GP) for review. Allira, who is on a sporting scholarship at her school, has been experiencing regular generalised muscle cramping. She is concerned about this, as it is affecting her ability to perform well in her sports. Allira has noticed that, when she is playing her sport, she needs to use her salbutamol inhaler daily as she gets short of breath on exertion. Allira sometimes then experiences generalised muscle cramps, especially in her legs and arms.