Module 3 Case Study
L.S. is a 7-year-old who has been brought to the emergency department (ED) by his mother. She
immediately tells you he has a history of ED visits for his asthma. He uses an inhaler when he
wheezes, but it ran out a month ago. She is a single parent and has two other children at home
with a babysitter. Your assessment finds L.S. alert, oriented, and extremely anxious. His color is
pale, and his nail beds are dusky and cool to the touch; other findings are heart rate (HR) 136
beats/min, respiratory rate (RR) 36 breaths/ min regular and even, oral temperature 99.1 ° F (37.3
° C), spo2 89%, breath sounds decreased in lower lobes bilaterally and congested with
inspiratory and expiratory wheezes, prolonged expirations, and a productive cough. As you ask
L.S.'s mother questions, you note that L.S.'s RR is increasing; he is sitting on the side of the bed,
leaning slightly forward, and is having difficulty breathing. You are concerned that he is
experiencing status asthmaticus.
1. You check the orders and need to decide which interventions are the priority at this
time. Select all that apply and explain the rationale.
a. Monitor HR and RR every 2 hours
b. Administer oxygen via face mask to keep Spo2 above 90%
Ans: to avoid hypoxia
c. Have L.S. lie flat
d. Administer albuterol (Proventil) and ipratropium bromide (Atrovent) via hand-held
nebulizer (HHN) STAT
Ans: both meds open the airways
e. Reassess in 20 minutes, and if no improvement, administer salmeterol (Serevent Diskus)
via dry-powder inhaler (DPI)
f. Start IV normal saline (NS) at 15 mL/hr and administer methylprednisolone 2 mg/kg IV STAT
× 1 dose g. Have L.S. perform incentive spirometry h. Encourage PO fluids as tolerated
2. Identify the nursing responsibilities associated with giving albuterol.
Ans: Monitor for hypersensitivity for adrenergic amines, assess lung sound, pulse, & BP before
administration, instruct Pt to report any nervousness, restlessness, tremors, chest pain. After
administration of the medication have the Pt rinse his mouth with water & spit (to avoid thrush).
, Case study Progress
You give L.S. the albuterol and Atrovent. His O2 saturation does not improve and remains at
88% with oxygen at 6 L/min via facemask. He says he “does not feel any better.” He is
retracting and RR rate remains 34 breaths/minute. You have started his IV infusion and
administered the methylprednisolone. L.S.'s mother is pacing and tells you she very upset and
worried. You overhead page the attending ed resident to assess, and you notify the patient-family
advocate.
The ED resident, dr. s., arrives within 2 minutes to assess L. and to speak to L.'s mother. New
orders are pending. L.S. is admitted to the pediatric intensive care unit (PICU) for close
monitoring. His condition improves, and 24 hours later is transferred to the floor. Asthma
teaching is ordered. You assess Ms. S.'s understanding of asthma and her understanding of the
disorder.
3. Which of these statements by Ms. S. would indicate a need for further teaching?
a. “He should go to the doctor regularly to make sure his asthma is being treated
correctly.” b. “If he takes medications for a while, he will outgrow his asthma.”
c. “Part of his treatment should be avoiding things that irritate his lungs.”
d. “If I recognize early warning signs, he might be able to take medicine and not go to the ED.”
4. You are educating L.S. and his mother on possible asthma triggers in their environment.
They live in public housing in an apartment without air conditioning. Which of these statements
indicate possible asthma triggers? Select all that apply, and discuss strategies to avoid these
triggers.
a. “The building has copper pipes.”
b. “He coughs when we have cold nights after a warm day.”
c. “We have a pet fish.”
d. “There are hardwood floors.”
e. “L. collects stuffed animals.”
f. “Our visitors smoke outside.”
g. “There are dark stains in our bathroom.”
h. “The housing authority puts a foam down for bugs.”
L.S. is a 7-year-old who has been brought to the emergency department (ED) by his mother. She
immediately tells you he has a history of ED visits for his asthma. He uses an inhaler when he
wheezes, but it ran out a month ago. She is a single parent and has two other children at home
with a babysitter. Your assessment finds L.S. alert, oriented, and extremely anxious. His color is
pale, and his nail beds are dusky and cool to the touch; other findings are heart rate (HR) 136
beats/min, respiratory rate (RR) 36 breaths/ min regular and even, oral temperature 99.1 ° F (37.3
° C), spo2 89%, breath sounds decreased in lower lobes bilaterally and congested with
inspiratory and expiratory wheezes, prolonged expirations, and a productive cough. As you ask
L.S.'s mother questions, you note that L.S.'s RR is increasing; he is sitting on the side of the bed,
leaning slightly forward, and is having difficulty breathing. You are concerned that he is
experiencing status asthmaticus.
1. You check the orders and need to decide which interventions are the priority at this
time. Select all that apply and explain the rationale.
a. Monitor HR and RR every 2 hours
b. Administer oxygen via face mask to keep Spo2 above 90%
Ans: to avoid hypoxia
c. Have L.S. lie flat
d. Administer albuterol (Proventil) and ipratropium bromide (Atrovent) via hand-held
nebulizer (HHN) STAT
Ans: both meds open the airways
e. Reassess in 20 minutes, and if no improvement, administer salmeterol (Serevent Diskus)
via dry-powder inhaler (DPI)
f. Start IV normal saline (NS) at 15 mL/hr and administer methylprednisolone 2 mg/kg IV STAT
× 1 dose g. Have L.S. perform incentive spirometry h. Encourage PO fluids as tolerated
2. Identify the nursing responsibilities associated with giving albuterol.
Ans: Monitor for hypersensitivity for adrenergic amines, assess lung sound, pulse, & BP before
administration, instruct Pt to report any nervousness, restlessness, tremors, chest pain. After
administration of the medication have the Pt rinse his mouth with water & spit (to avoid thrush).
, Case study Progress
You give L.S. the albuterol and Atrovent. His O2 saturation does not improve and remains at
88% with oxygen at 6 L/min via facemask. He says he “does not feel any better.” He is
retracting and RR rate remains 34 breaths/minute. You have started his IV infusion and
administered the methylprednisolone. L.S.'s mother is pacing and tells you she very upset and
worried. You overhead page the attending ed resident to assess, and you notify the patient-family
advocate.
The ED resident, dr. s., arrives within 2 minutes to assess L. and to speak to L.'s mother. New
orders are pending. L.S. is admitted to the pediatric intensive care unit (PICU) for close
monitoring. His condition improves, and 24 hours later is transferred to the floor. Asthma
teaching is ordered. You assess Ms. S.'s understanding of asthma and her understanding of the
disorder.
3. Which of these statements by Ms. S. would indicate a need for further teaching?
a. “He should go to the doctor regularly to make sure his asthma is being treated
correctly.” b. “If he takes medications for a while, he will outgrow his asthma.”
c. “Part of his treatment should be avoiding things that irritate his lungs.”
d. “If I recognize early warning signs, he might be able to take medicine and not go to the ED.”
4. You are educating L.S. and his mother on possible asthma triggers in their environment.
They live in public housing in an apartment without air conditioning. Which of these statements
indicate possible asthma triggers? Select all that apply, and discuss strategies to avoid these
triggers.
a. “The building has copper pipes.”
b. “He coughs when we have cold nights after a warm day.”
c. “We have a pet fish.”
d. “There are hardwood floors.”
e. “L. collects stuffed animals.”
f. “Our visitors smoke outside.”
g. “There are dark stains in our bathroom.”
h. “The housing authority puts a foam down for bugs.”
