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Nursing QUESTION #9239
Question 1
A Charge Nurse is managing a patient with status asthmaticus who is deteriorating despite bronchodilators. SpO\(_2\) is \(85\%\) on high-flow oxygen. The patient is becoming drowsy. What is the MOST appropriate next step?
  • Increase ipratropium nebulization frequency to every 15 minutes
  • Administer IV magnesium sulfate 2g over 20 minutes
  • Prepare for emergency intubation and contact intensivist immediately✔️
  • Position the patient supine and increase oxygen flow rate
Correct Answer Explanation
Correct Answer: C — Prepare for emergency intubation

Indicators of impending respiratory failure in status asthmaticus (Intubation threshold):
  • Declining GCS / drowsiness / confusion
  • Exhaustion — patient too tired to breathe
  • SpO\(_2 < 90\%\) despite high-flow O\(_2\)
  • Silent chest on auscultation (no wheeze = no airflow)
  • PaCO\(_2\) rising (normal or elevated CO\(_2\) in asthma = danger sign — patient normally hyperventilates, so rising CO\(_2\) means fatigue)
  • Pulsus paradoxus \(> 25 \text{ mmHg}\)
Progressive management of status asthmaticus:
  1. Short-acting \(\beta_2\) agonists (Salbutamol) — continuous nebulization
  2. IV/oral corticosteroids (Hydrocortisone/Methylprednisolone)
  3. Ipratropium bromide
  4. IV Magnesium Sulfate \(2 \text{ g}\) over 20 min
  5. IV Aminophylline
  6. Intubation (last resort — high risk, use RSI)