Case Study 106 Asthma (002) PDF

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Student _Megan Pulkkinen__________________________ Date __12/17/2020________

Instructor __Teresa Hardman___________________ Ivy Tech Community College Pediatric Case Study Asthma

Directions: Please insert your typed answers on this case study form using Times New Roman, 12 pt. font with proper spelling and grammar. Case study is due on the day of clinical. Submit on Canvas or email completed case study to the instructor. No late work will be accepted. Scenario L.S. is a 7-year-old who is being directly admitted to your unit from his pediatrician’s office. His mother has brought him directly to the unit without stopping to admit him. She immediately tells you that she is a single parent and has 2 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 136 beats/min, respiratory rate 36 breaths/min regular and even, oral temperature 37.3° C, SaO2 92%, breath sounds decreased in lower lobes bilaterally and congested with inspiratory and expiratory wheezes, prolonged expirations.

1.

As you ask Mrs. S. questions, you note that L.S.’s respiratory rate is increasing; he is sitting on the side of the bed, leaning slightly forward, and is having difficulty breathing. What should your immediate nursing care include? Immediate nursing care would include administering supplemental oxygen and establishing and maintaining a patent airway. You would also want to put him in a high fowler’s position to help with breathing effort.

2.

Prioritize the following orders from the most to the least important, and be prepared to explain your order of priority. A. Vital signs (VS) q2h B. Cardiac and respiratory monitor C. Continuous pulse oximeter D. IV fluids, D5.45NS at 78 ml/hr E. Chest x-ray (CXR) STAT F. Arterial blood gases (ABGs) STAT G. Give a loading dose of aminophylline 240 mg IV over 30 minutes, then maintain an aminophylline drip of 0.9 mg/kg/hr H. Methylprednisolone (Solu-Medrol) 40 mg IV q6h I. Albuterol 2.5 mg inhaled now and q3-4h prn

I, H, G, C, A, B, D, F. I prioritized them in this order because you would want to establish and maintain a patent airway and proper oxygenation prior to any further interventions.

3.

Identify the nursing responsibilities associated with giving aminophylline and albuterol. You would want to verify that there is not a patient history of allergy to either medication and explain what the medication is and why it’s being used. Educate the patient on using a MDI with a spacer if being used for administration. You would also want to explain the side effects of the medications and signs and symptoms of complications. As the nurse you would also monitor for signs and symptoms of complications and assess if the medication is helping.

4.

Asthma education is ordered for L.S. and his mother. You call her to arrange a schedule. You find out that the phone number she has provided is no longer in service. What should be your next nursing action? The next action would be to get in contact with social services or the primary care provider and see if there are any alternative numbers for the patient or the parent.

CASE STUDY PROGRESS Mrs. S. arrives to visit L.S. later that day, and you begin to discuss the education plan and to arrange when Mrs. S. can participate. You learn that Mrs. S. works 12 hours a day, the family is not covered by insurance, and she is worried about how she will pay for the hospitalization and medications for her son.

5.

What will be your next step, and how might this information influence your discharge planning? My next step would be to collaborate with social services for the patient in regards to financial assistance. My discharge teaching would change because I would want to include resources for the mother for paying for care and brochures or handouts for them about asthma that they can give to friends, family, schools or babysitters.

6.

L.S. tells you that he loves to play basketball and football and asks you if he can still do these activities. How should you respond? I would respond by advising him that he can still participate in sports if he wants, as long as he is adhering to his medication schedule and he understands to seek help from an adult if he starts having breathing problems. I would also advise the mother to notify any coaches of his condition, where emergency inhalers are and how to use them.

7.

What information should be included in your discharge teaching regarding how to prevent acute asthmatic episodes and to manage symptoms of exacerbation of asthma? Discharge teaching would include monitoring and identifying triggers for acute asthmatic episodes and how to avoid them. I would also include taking daily medications as prescribed, when to use emergency medications and how each are to be administered. Signs and symptoms of worsening conditions and when to seek emergency care would need to be explained. Finally, the patient and mother would need to be advised to follow up with a primary care provider regularly to monitor the condition....