Pediatric Asthma FUNDAMENTAL Reasoning - Jared Johnson, 25 years old / Pediatric Asthma History of Present Problem: Jared Johnson is a 25 year-old African-American boy with a history of moderate persistent asthma.(complete answered solution)

Pediatric Asthma FUNDAMENTAL Reasoning - Jared Johnson, 25 years old / Pediatric Asthma History of Present Problem: Jared Johnson is a 25 year-old African-American boy with a history of moderate persistent asthma.(complete answered solution) Pediatric Asthma UNFOLDING Reasoning Jared Johnson, 25 years old Primary Concept Gas Exchange Interrelated Concepts (In order of emphasis) 1. Inflammation 2. Clinical Judgment 3. Patient Education 4. Communication 5. Collaboration UNFOLDING Reasoning Case Study: STUDENT Pediatric Asthma History of Present Problem: Jared Johnson is a 25-year-old African American with a history of moderate persistent asthma. He is being admitted to the hospital from the walk-in clinic with an acute asthma exacerbation. Jared has an increased chest tightness and shortness of breath one day prior to admission. He has been at 50 percent 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 ashen, 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. He has three prior hospitalizations for asthma with one admission to the intensive care unit within the last 5 years. 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 inner city. He is a good college student despite two to three 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. What data from the histories are important and RELEVANT; therefore, it has clinical significance to the nurse? © 2016 Keith Rischer/www.KeithRN.com RELEVANT Data from Present Problem: Clinical Significance: lOMoAR cPSD| - 25 y/o African American History of moderate persistent asthma. - Admitted for acute asthma exacerbation. - He had increased chest tightness and shortness of breath one day prior to admission. - His peak expiratory flow (PEF) is a 50% - -PEF did not improved after him using his albuterol metered dose inhaler (MDI) - Pt alert with speaking and breathing difficulties. - Coarse expiratory wheezesthroughout both lung fields with decreased breath sounds at the right base. - 90% oxygen sat - Colorskin ashen, dark circles under eyes. - Accessory chest muscles and moderate intercostal and substernal retractions, present. - Complains of tightnessin his chest. - Diagnosed with asthma since 6y/o. - 3 hospitalization, 1 ICU admission within the last 5 years - Pt has never been intubated - Chronic asthma state. - Pt is having a flare episode of asthma - Shortness of breath. - Impair gas exchange - Hypoxia - Ineffective health management - Pt is anxious and agitated. - Unable to communicate due to shortness of breath. - Often hospitalizations within 5 years. - Current drug therapy inefficient when pt has asthma crisis. - Pt coughing dry