Managing Acute Asthma Exacerbation in Adult Nursing | Emergency Care and Clinical Reasoning Guide
Introduction
Acute asthma exacerbation is one of the most time-critical presentations a nurse will encounter. Knowing how to assess, prioritise and respond quickly is not just an academic exercise, it is the difference between a patient who recovers and one who deteriorates.
This clinical learning guide walks you through a real-world acute asthma scenario, applying the Levett-Jones Clinical Reasoning Cycle to demonstrate evidence-based decision-making and person-centred care.
Clinical Scenario: Rahman-Okoro, 21
You are the nurse taking over the ongoing care of Rahman-Okoro, a 21-year-old university student who identifies as non-binary (they/them). In line with NMC privacy standards, patient anonymity has been maintained throughout this case.
Rahman-Okoro has been brought into the emergency department after collapsing outside the university campus.
Patient’s Background
Rahman-Okoro is in their second year of a nursing degree and holds two part-time jobs to support themselves and contribute to their younger siblings' living costs. They became estranged from their parents after starting gender-affirming hormone therapy six months ago and currently live alone in shared student accommodation. They report feeling constantly stressed and fatigued ahead of upcoming end-of-year exams.
They have a known history of moderate persistent asthma, diagnosed at age 8, alongside eczema.
Current medications include:
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Salbutamol inhaler (100 micrograms/dose) PRN
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Budesonide/formoterol (Symbicort 200/6) twice daily, although doses have been missed in the past week due to exhaustion and financial pressure.
No known drug allergies. Non-smoker, minimal alcohol use, no history of illicit drug use. A GP review one month ago noted an increasing night-time wheeze and recommended a step-up in preventer therapy, which had not yet been actioned.
Presenting Situation
While running late for an in-person exam after finishing a night shift, Rahman-Okoro experienced sudden shortness of breath and chest tightness, became dizzy and collapsed. Paramedics found them tachypnoeic with an audible wheeze.
Peak Expiratory Flow on arrival was 35%.
They received nebulised salbutamol 5mg, oxygen at 4 L/min via nasal cannula and 40mg of oral prednisolone en route. On arrival at ED Resus, the confirmed diagnosis was acute severe asthma exacerbation. They have since been transferred to Majors for ongoing care and monitoring.
Current Observations
|
Parameter |
Reading |
Reference Range |
|
Respiratory Rate |
28 breaths/min |
12-20 breaths/min |
|
Oxygen Saturation (4L O₂) |
90% |
94-98% |
|
Heart Rate |
112 beats/min |
60-100 beats/min |
|
Blood Pressure |
118/76 mmHg |
90/60-120/80 mmHg |
|
Temperature |
37.2°C |
36.1-37.2°C |
|
Peak Expiratory Flow |
250 L/min |
Based on predicted |
|
ABG (on 2L/min O₂) |
pH 7.33, PaCO₂ 5.0 kPa, PaO₂ 7.0 kPa, HCO₃⁻ 22 mmol/L |
See reference ranges |
|
Serum Potassium |
3.4 mmol/L |
3.5-5.0 mmol/L |
|
Serum Sodium |
139 mmol/L |
135-145 mmol/L |
|
WBC |
9.5 × 10⁹/L |
4.0-11.0 × 10⁹/L |
|
CRP |
5 mg/L |
< 10 mg/L |
Current Clinical Status
Rahman-Okoro remains tachypnoeic with expiratory wheeze audible throughout both lung fields. They are unable to complete a sentence in one breath and report feeling "panicky and light-headed." Nebulised bronchodilators are continuing every 20 minutes as prescribed.
Oxygen is running at 4 L/min via nasal cannula, maintaining saturations between 93 and 95%. IV access is secured with normal saline running at 75 mL/hr and IV hydrocortisone 100mg administered.
No antibiotics have been prescribed. The registrar plans to review after the next nebuliser cycle.
Rahman-Okoro's friend KK, a fellow nursing student, is present at the bedside providing emotional support. KK reports that Rahman-Okoro has barely slept or eaten properly for days.
KK becomes visibly tearful when discussing the family situation and finances, expressing fear of "failing everything" and "ending up in hospital again."
Clinical Learning Objective
Using this scenario, apply the Levett-Jones Clinical Reasoning Cycle to demonstrate clinical decision-making and person-centred care across the following steps:
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Consider the patient's situation
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Collect cues and information
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Process the information
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Identify the problem
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Establish goals
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Take action
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Evaluate outcomes
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Reflect on the process
Featured Institutions Using This Guide
This clinical scenario has been used as a learning reference by nursing students across leading institutions, including the:
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University of Essex
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Birmingham Newman University
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University of Winchester
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Wrexham University
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Deakin University
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Auckland University of Technology
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University of Canterbury
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Griffith University.
How UKNurses Can Help You
Struggling to apply clinical reasoning frameworks to complex patient scenarios like this one? The good news is that you are not alone.
At UKNurses, our team of experienced nursing professionals provides expert academic guidance to BSN and MSN nursing students across the UK, Australia, New Zealand, Ireland, Scotland and Wales.
Whether you need help understanding clinical frameworks, preparing for nursing exams or navigating advanced nursing modules, our expert guidance is here to support you every step of the way.
Connect with a nursing expert at UKNurses today and take the next step in your nursing journey.