CNA 252 Assignment 2: Developing Kobi Monterey's Asthma Care Plan

This assignment focuses on developing a comprehensive care plan for Kobi Monterey, a 25-year-old patient experiencing an asthma attack. The assignment begins with a patient scenario detailing Kobi's history, current symptoms, and social context. Students are tasked with collecting cues, interpreting data, relating and inferring findings based on physiology and pathophysiology, and predicting potential outcomes. The core of the assignment involves identifying priority nursing problems, establishing goals, and outlining specific nursing actions, including oxygen therapy and patient education. The rationale for each action is provided, connecting pathophysiological and psychological principles. The assignment also includes an evaluation component, describing how the effectiveness of care will be assessed, and a reflection on the chosen skill performance and its implications for professional practice, referencing the Registered Nurse Standards for Practice and the clinical reasoning cycle. The assignment concludes with a discussion of actions to improve skill performance and how the clinical reasoning cycle has reinforced professional responsibility and informed future learning.

Scenario 2: Kobi Monterey
Consider the patient
situation
Kobi Monterey has grown up with asthma. Diagnosed at a very young age, he has been very diligent in knowing what triggers
his asthma resulting in Kobi experiencing few episodes in recent years. Apart from his asthma, Kobi is a fit and well 25-year-
old. However, this week Kobi has not been feeling well over the past few days and his father brought him to the emergency
department this morning after Kobi experienced an asthma attack whilst at work. Kobi is quite distressed and breathing rapidly
with a notable wheeze on expiration. He is unable to talk to you in full sentences, states he has a tight feeling in his chest and a
continuous cough. You notice that his lips are cyanosed and he appears pale and sweaty.
Collect Cues: Review the existing documentation;
Social History
Kobi is a keen cyclist and rides his bike about 3 times a week with a local cycling group to which he belongs. He enjoys the
social activities and has a good work-life balance. Kobi works as a carpenter with his father. He has aspirations of starting his
own carpentry business and is feeling positive about his future. Kobi is often working in enclosed spaces exposed to fine wood
dust particles, although he complies with all the necessary workplace health and safety regulations.
Medication Use:
Kobi indicates that he has needed to use his puffer more than usual and ceased using the preventer some time ago. When he
runs out of his Ventolin puffer, he orders replacements online that are delivered to his home address for convenience. With

Scenario 2: Kobi Monterey
such a busy schedule, Kobi has found it difficult to find time to schedule an appointment with his GP.
Recall:
Before you continue with this assignment you should recall and apply your existing knowledge to the above situation to ensure
you have a broad understanding of what is/may be occurring.
Process information Interpret:
In the following table, list the data that you consider to be normal/abnormal (not included in word count)
Normal (Subjective & Objective Data) Abnormal (Subjective & Objective)
Participates in cycling, works in enclosed spaces, exposed to
fine wood dust particles, uses his puffer more often, stopped
using preventer, fails to visit a GP.
Wheeze on expiration , a tight cough, rapid breathing , chest
tightness, distress, cyanosed lips and appears pale and sweaty,
difficulty talking and concentrating.
Relate & Infer: (250 words)
 Relate: cluster cues by identifying relationships between them.
• Infer: make deductions as to why a cue, or a cluster of cues may be considered abnormal in this context. Justify by
referring to appropriate anatomy, physiology and pathophysiology.

Scenario 2: Kobi Monterey
Refer to Levett-Jones (2018) Clinical Reasoning p7.
•Based on your interpretation of all the information/cues presented, form and justify an overall opinion on what may be
happening
<insert text here>>
Exposure to fine wood dust particles is one of the ways of introducing foreign particles to the respiratory system during
gaseous exchange. The dust particles are trapped after they are inhaled which is a contributing factor to the narrowness of the
airway and its associated symptoms such as chest tightness. Another cause is failure to use asthma preventer in preventing and
managing asthma. Failure to use it created a room for triggers that lead to the inflammation of the airway and its associated
symptoms Levett-Jones (2018)
Wheezing, rapid breathing is as a result of airway obstruction. the airway is skinnier making it hard for air to move in and out
of their sacks on inhalation and expiration. much of air is trapped inside the lungs making breathing a tough exercise thus
wheezing sounds when breathing. Cough persistence is as a result of exposure the triggers of asthma such as the dust particles
at the place of work. Cough with phlegm is an indication of inflamed airways meaning that the airways are narrower. This also
leads to breathlessness, chest tightness and wheezing as mentioned in this case. Cyanosed lips are as a result of Oxygen
deficiency in the blood (Field, Isaacs, & John Stroobant 2017). There is poor oxygen supply in the lips that has led to cyanosis.
The patient is suffering respiratory distress due to the presence of all the above signs and symptoms. difficulty talking and

Scenario 2: Kobi Monterey
concentrating is another severe symptom of asthma. He patient is talking in incomplete sentences an indication that he is
seemingly out of the blue. This is because of the hardness experienced in getting and expelling air and the allergic rhinitis
together with the other symptoms. The flare ups make speaking difficult in asthmatic patients
Predict: (100 words)
Explain what may happen to your patient if no action is taken
<insert text her If quick action is not taken, the presented symptoms may worsen leading to poor response to bronchodilators.
Consecutively, it may lead to life – threatening episodes of asthma. This includes completely damaged lungs and airways. This
may make the patient unable to breath in properly in their entire life time unless by the use of an external aid. The patient can
completely not take part in any exercises or social activities which may lead to increased risk of diabetes, depression and
hypertension. The respiratory failure may lead to complete failure of the respiratory system, hindering breath which may turn
fatal.
e>>
Identify the
Problem/s
List in order of priority at least two key nursing problems (not included in word count)
<insert text here>>
Includes ineffective clearance of the airway and ineffective breathing pattern.

Scenario 2: Kobi Monterey
Establish Goal &
Take Action
For your (ONE) highest priority nursing problem: (300 words)
 Establish one goal
 List the related FOUR (4) actions you would undertake to achieve that goal. Your actions should include ONE (1) skill
only from the following list; 1) 12 Lead ECG and interpretation, 2) Venipuncture and sample handling, 3) Oxygen
therapy, 4) Pulse oximetry.
 Provide a rationale that associates the pathophysiological and psychological principles with each selected nursing action
 Describe how you would evaluate the effectiveness of the care provided (i.e. how will you know that your actions were
beneficial to the patient?).
Problem Goal Related actions Rationale Evaluate outcomes
Rapidly breathing
Impaired gas exchange Position the patient in
high-fowler position
Deliver oxygen
therapy via nasal
prongs
<<insert text here>>
The rationale is to
promote maximum
expansion of the lungs
and helps in breathing.
<<insert text here>>
The patient shall
eventually receive and
maintain the optimal
pattern of breathing.

Scenario 2: Kobi Monterey
Check oxygen
saturation levels every
30 minutes
Educate the patient
about the allergens that
can irritate and factors
which can contribute
ineffective airway
clearance.
Administer medication
like: bronchodilator
(salbutamol puff) and
ipratropium
Deliver oxygen via
oxygen therapy use
pulse oximetry to
identify the oxygen
level in the blood, or
venepuncture and
sample handling to
remove venous blood
and assess it of oxygen
amounts. Monitor
paradoxical pulse
which is a large
abnormal decrease in
systolic blood pressure
and the waves of
pulses amplitude
This shall be proven
through the use of a
relaxed pattern of
breathing, a normal
respiratory pattern or
rate, and the complete
absence of dyspnoea.
The patients
comprehend the
diverse ways of
controlling asthma and
the scenarios to avoid
that may worsen his
situation. He is able to
assess the signs and
symptoms that need an

Scenario 2: Kobi Monterey
during inspiration. The
normal pressure fall
should be less than 10
mmHg. identifying
12mm Hg and above
paradoxical pulse
means severe
obstruction of the
airway. Education
rationale is to help
control asthma
triggers. These
includes allergens,
irritants, certain drugs
and medication
(Lockey & Ledford
emergency and
immediate rush to a
GP (Turner 2012). The
patient knows how to
use the bronchodilators
and various other
asthma medications
given such as the
controller medications
that are delivered
using inhalers. He is
able to assess the
different side effects
that are associated
with the inhaled
steroids, how to

Scenario 2: Kobi Monterey
2014). The patient is
helped in developing a
plan of dealing with
the triggers.
Medication is given as
ordered together with
inhaled
corticosteroids.to
reduce airways
inflammation.
measure the right
quantities and avoid
over dosage.
Ipratropium is used to
treat asthma and its
successful outcome is
opened up airways
after obstruction.
Evidenced based
skill assessment and
Justify and rationalise your choice of skill (not included in word count)
Administer oxygen depending on collected objective data of the patient using oxygen therapy via Nasal prone .To combat the
lack of oxygen as a result of asthma, oxygen therapy provides lungs with extra oxygen.

Scenario 2: Kobi Monterey
reflection
Watch the video of the clinical skill performance which you have chosen from the list provided above. Analyse and critically
reflect on skill performance in the video you have chosen, using the skill checklists in (Tollefson 2019). Discuss 1 (ONE)
strength and 1 (ONE) weakness that you have identified in the skill performance. Discuss in relation to the Registered Nurse
Standards for Practice. (150 words)
Strength Weakness
<<insert text here>> Oxygen has been stored in a special
tank which has been used to generate oxygen through a
carriable bag and a Nasal Oxygen Cannula. The
practitioner describes her theoretical knowledge verbally
by explaining the procedure she is doing. She then
performs it practically meaning she really understands
what she is doing. The patient has been set psychologically
for oxygen therapy and cooperative (Smith, Loftus, &
Levett-Jones 2013).
<<insert text here>> The nasal cannula has been improperly
placed. The right position for a nasal Cannula during oxygen
therapy is around the ears and under the chin. This prevents
the patient from strangulation in case the patient becomes
unconscious. The patient’s head should not be tapped as
witnessed in the video. . We did not see the practitioner attach
humidifiers as well.
Reflecting on the video performance, discuss what two (2) actions you will take to address their performance in the promotion

Scenario 2: Kobi Monterey
of positive health outcomes. Reflecting on the clinical reasoning cycle, how has this reinforced your professional responsibility
as a beginning level practitioner and informed your future learning? (200 words)
<<insert text here>>
The actions I would take in place includes the positioning of the Nassal Cannula and the positioning of the patient. When doing
Oxygen therapy, first it will need me to calibrate the patient’s oxygen supply to know the proper level of the Oxygen they need
(Hawkins 2012). In the nasal cannulas, I can attach warming humidifiers that prevents the patient’s nasal dryness. The proper
Oxygen levels of oxygen should be administered to avoid too much of it which may turn dangerous.
Positioning of the patient and the Cannula is of great importance in this case. The cannula should be placed by making sure the
nasal prongs are placed in the nostrils and passing the tubbing along the nasal areas to the chin. The patient should be placed in
a prune position to ensure proper respiration and opening up of the patient’s airway. A practitioner is supposed to ensure
continuous contact with the patient until they are fully respired.
In my clinical cycle, this shall help me put theory into practice and always carryout research for clarification of issues to enable
evidence based practice (Hall & Roussel 2012).

Scenario 2: Kobi Monterey
References
Field, D. J., Isaacs, D., & John Stroobant, F. (2017). Pediatric Differential Diagnosis - Top 50 Problems. MO: Elsevier (Singapore) Pte.
Hall, H. R., & Roussel, L. A. (2012). Evidence-Based Practice. Burlington, MA: Jones & Bartlett Publishers.
Hawkins, M. (2012). Use of tracheostomy tubes with removeable inner cannula to prevent ventilator associated pneumonia
(VAP). http://isrctn.org/>. doi:10.1186/isrctn48260748
Levett-Jones, T 2018, Clinical reasoning: learning to think like a nurse, 2nd ed, Pearson Australia
Lockey, R. F., & Ledford, D. K. (2014). Asthma: Comorbidities, Coexisting Conditions, and Differential Diagnosis. Oxford, MO: Oxford
University Press (UK).
Smith, M., Loftus, S., & Levett-Jones, T. (2013). Teaching Clinical Reasoning. Educating Health Professionals, 269-276. doi:10.1007/978-94-
6209-353-9_23
Turner, J. (2012). Thoracic Emergencies, An Issue of Emergency Medicine Clinics - E-Book. St. Louis, MO: Elsevier Health Sciences.