Pediatric Asthma

Jared, 10 years old Overview This scenario is a rich application of the priority setting required by the nurse to rescue a child with an acute asthmatic exacerbation. Please make sure your answers are peds appropriate. I. II. III. IV. V. Concepts (in order of emphasis) Gas Exchange Inflammation Clinical Judgment Communication Collaboration Pediatric Asthma I. Clinical Relevance/Significance History of Present Problem: Jared is a 10 year-old African-American boy with a history of moderate persistent asthma. He is being admitted to the pediatric unit of the hospital from the walk-in clinic with an acute asthma exacerbation. Jared started complaining of increased chest tightness and shortness of breath one day prior to admission. He has been at 50% of his personal best measurement for his peak expiratory flow (PEF) meter reading which did not improve with the use of albuterol metered dose inhaler (MDI) (per his written asthma management plan). In the walk-in clinic Jared is alert, speaking in short sentences due to breathlessness at rest. He has coarse expiratory wheezes throughout both lung fields with decreased breath sounds at the right base. His oxygen saturation on room air is 90%. His color is pale and he has dark circles under his eyes. He is sitting upright and using his accessory chest muscles to breath and has moderate intercostal and substernal retractions. He is complaining of tightness in his chest. Jared was diagnosed with asthma at age 6 years and has 3 prior hospitalizations for asthma with one admission to the pediatric intensive care unit. He has never had to be intubated with these episodes. Personal/Social History: He is accompanied by his mother and 16-year-old sister. Jared lives with his mother, maternal grandmother and sister in an older housing development in the inter-city. He is in the 5th grade and a good student despite 2-3 absences per school year for his asthma. He likes to ride his bike and is the goalie on the soccer team. He says that he has lots of friends at school and likes his teacher Mr. Bates who is also his soccer coach. Both Jared and his mother deny tobacco smoke at home