Reference no: EM133446040
Sharon Taylor is a 6 year-old girl who presents to your clinic today. She has a past medical history of allergic rhinitis, moderate persistent asthma, eczema, obesity, GERD in infancy. Her parents bring her in today because she has a "cough lasting longer than normal," fatigue and shortness of breath at bedtime. Since the start of the school year, she has missed 8 days of school due to episodes of coughing and wheezing. She has tested negative for covid19 several times and has received the appropriate childhood vaccines. Her parents describe that the coughing spells are intermittent and usually accompanied by wheezing. When you talk to the child, she is meeting developmental goals but she tells you when her parents fight, it makes her angry to the point of coughing.
You note that she is speaking in short sentences due to breathlessness at rest. She has coarse expiratory wheezes throughout both lung fields with decreased breath sounds at the right base. Her oxygen saturation on room air is 89%. Her color is ashen and she has dark circles under his eyes. She is sitting upright and using his accessory chest muscles to breath and has moderate intercostal and substernal retractions. She is complaining of tightness in his chest at this time.
You reviewed her past medical record and noted that last year; her pediatrician had diagnosed her with asthma and has since had three prior hospitalizations with one of the admission leading to transfer to the pediatric intensive care unit. She has never had to be intubated with these episodes. Sharon tells you that she uses her "inhaler" almost every day but sometimes twice a day.
You are her LPN supervisor for the day and due to her complexity have taken on her case. You collect some information about her household. The family tells you that they have dog name ruby that sheds. Sharon recently was treated for diarrhea related to E.Coli and was given doxycycline. . Her last diarrhea episode was yesterday. Both parents are smokers but only smoke outside of the house and when driving with the windows down. When you inquired about her performance at school, her mother tells you that she likes to play soccer but sometimes unable to play during the spring from having "allergies" and chest pain during "running."
The mother reported that at the last visit, she was given a peak flow meter but has misplaced it and cannot afford another one. As you talking to the mother, you noted that Sharon becomes tachypnea and sweating. You quickly assess her lung fields and note that she has "silent chest." On exam, you noted that her breathing has become labored and her pulse ox reads 71%. Her bp is 80/51 pulse 130. She is rushed to the intensive care unit for intubation.
1. What the physiology of asthma? Describe what happens on a cellular level. How is asthma different from Cystic Fibrosis?
2. List all the risk factors Sharon Taylor has in this scenario. Identify which ones are modifiable and which ones are not.
3. What nursing action would you take the mother not having a peak flow meter? What specific would you teach her about how a peak flow meter is used? How is a peak flow meter different from a incentive spirometer? How is an incentive spirometer used.
4. What nursing action should have been priority when Sharon came in?
5. What could you have done better? Why?
6. What are the diagnostic tests for asthma?
7. Identify 3 (prioritize) nursing diagnoses and 4 nursing interventions for this patient.
8. Identify 3 nursing outcomes that are specific.
9. What specific category per EPR3 guideline would you say her asthma is? What are these categories
10. What medications does she need now? What is name of the position she is sitting in? Why is that beneficial?
11. What medications do you suspect the provider will start her on based on her history? Why?
12. As you are talking to her mother, her condition changes. What do you think happened? What are 4 specific strong nursing actions and interventions?
13. Before discharge, what 7 things would you teach the mother and Sharon herself?
14. Should she get her vaccinations follow up vaccines when discharged? Why or why not?
15. What other inter-professional care disciplines would you refer her to?
16. What are the classes of medications used to manage asthma. Even 2 examples of each (generic name only)
17. What would you expect Sharon's Abg to be during asthma exacerbation? Explain.