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.
Concepts (in order of emphasis)
I. Gas Exchange
II. Inflammation
III. Clinical Judgment
IV. Communication
V. 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 5 grade and a good student despite 2-3 absences per
th
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 is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Clinical Significance:
Problem:
1. a history of moderate persistent asthma 1. This is a chronic illness for this child not a new onset
2. increased chest tightness and shortness 2. Patient was already in the yellow zone for asthma action plan
of breath one day prior to admission. the day prior to admission
3. has been at 50% of his personal best for 3. > 50%, patient is in danger (red) zone for his asthma action plan
PEFM did not improve with the use warning that he is in significant distress and rescue medications
of albuterol MDI will not alleviate symptoms.
4. coarse expiratory wheezes throughout 4. Patient is having a hard time moving air with the narrowing of
both lung fields the airways.
5. decreased breath sounds at the right base 5. Decreased or absent lung sounds are a significant finding of
6. room air is SAT 90% respiratory failure which can lead to respiratory arrest also
7. pale and he has dark circles under his patient may have significant mucous buildup over the alveoli
eyes which air trapped in base cannot escape or have gas exchange.
8. using his accessory chest muscles to 6. Patient is having a hard time moving air with the narrowing of
breathe moderate intercostal and the airways and with the mucous buildup causing hypoxia
substernal retractions limited gas exchange is occurring.
9. complaining of tightness in his chest 7. Signs of physical exhaustion
10. 3 prior hospitalizations for asthma 8. Work of breathing has increased to the point where child is
11. never had to be intubated trying to expand his chest due to increased intrathoracic pressure
9. Chest tightness is coming from bronchiole constriction.
10. His asthma has gotten severe enough that he had to be
hospitalized with an admission to the PICU
11. Pertinent negative, asthma has never gotten severe enough to
warrant intubation.
RELEVANT Data from Social History: Clinical Significance:
1. older housing development in the inter- 1. Older home could have triggers within; dust mites, mold, air
city pollution
2. Rides his bike and is the goalie on the 2. Patient lives an active lifestyle; normal activities for his age;
soccer team asthma possibly not induced by his normal daily exercise.
3. Jared and his mother deny tobacco 3. Patient and mother deny smoking which is a trigger for asthma
smoke at home attacks- Sister? Grandmother?
Lab/diagnostic Results:
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.
Concepts (in order of emphasis)
I. Gas Exchange
II. Inflammation
III. Clinical Judgment
IV. Communication
V. 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 5 grade and a good student despite 2-3 absences per
th
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 is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Clinical Significance:
Problem:
1. a history of moderate persistent asthma 1. This is a chronic illness for this child not a new onset
2. increased chest tightness and shortness 2. Patient was already in the yellow zone for asthma action plan
of breath one day prior to admission. the day prior to admission
3. has been at 50% of his personal best for 3. > 50%, patient is in danger (red) zone for his asthma action plan
PEFM did not improve with the use warning that he is in significant distress and rescue medications
of albuterol MDI will not alleviate symptoms.
4. coarse expiratory wheezes throughout 4. Patient is having a hard time moving air with the narrowing of
both lung fields the airways.
5. decreased breath sounds at the right base 5. Decreased or absent lung sounds are a significant finding of
6. room air is SAT 90% respiratory failure which can lead to respiratory arrest also
7. pale and he has dark circles under his patient may have significant mucous buildup over the alveoli
eyes which air trapped in base cannot escape or have gas exchange.
8. using his accessory chest muscles to 6. Patient is having a hard time moving air with the narrowing of
breathe moderate intercostal and the airways and with the mucous buildup causing hypoxia
substernal retractions limited gas exchange is occurring.
9. complaining of tightness in his chest 7. Signs of physical exhaustion
10. 3 prior hospitalizations for asthma 8. Work of breathing has increased to the point where child is
11. never had to be intubated trying to expand his chest due to increased intrathoracic pressure
9. Chest tightness is coming from bronchiole constriction.
10. His asthma has gotten severe enough that he had to be
hospitalized with an admission to the PICU
11. Pertinent negative, asthma has never gotten severe enough to
warrant intubation.
RELEVANT Data from Social History: Clinical Significance:
1. older housing development in the inter- 1. Older home could have triggers within; dust mites, mold, air
city pollution
2. Rides his bike and is the goalie on the 2. Patient lives an active lifestyle; normal activities for his age;
soccer team asthma possibly not induced by his normal daily exercise.
3. Jared and his mother deny tobacco 3. Patient and mother deny smoking which is a trigger for asthma
smoke at home attacks- Sister? Grandmother?
Lab/diagnostic Results:
