Included In This Lesson
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Outline
Anthony is a 6-yr-old male patient brought to the pediatric ER with a history of asthma since he came home from the NICU as an infant. He lives with his parents, Bob and Josh, who adopted him after fostering him from age 4 months. They have tried the usual nebulizer treatments but Anthony is not responding as usual, so they brought him for evaluation.
Initial assessment in triage reveals both inspiratory and expiratory wheezes, dyspnea, tachypnea, diaphoresis, and retractions.
BP 70/40 mmHg SpO2 93% on room air
HR 131 bpm
RR 32bpm at rest Temp 38.3°C
Anthony is pale but not gray. His lips do indicate a very faint bluish tinge. He can speak but it appears difficult.
After administration of racemic albuterol, Anthony now has a RR of 22 and O2 saturation
of 95% on room air. However, the provider decides to admit him to the inpatient
pediatric observation unit. His parents ask if there are ways to keep him from continually being admitted to the hospital.
Upon admission to the inpatient unit, Anthony rests quietly without worsening respiratory distress signs. The inpatient unit nurse has assessed the patient and prepares to administer oral prednisolone.
Anthony sleeps during the night shift and the next day, his pediatrician makes rounds and
discusses a change in the severity rating of Anthony’s asthma.
Bob and Josh are interested in meeting with respiratory therapy for assistance with inhalers. They say that Anthony has trouble using inhaler devices.
After lunch, Anthony is ready to be discharged. His parents verbalize gratitude to the staff and thank the team for helping with education.
Transcript
Hey everyone. My name is Abby. We’re going to cover a case study today about pediatric asthma. Let’s get started. Anthony is a six year old male patient brought to the ER with a history of asthma. Since he came home from the NICU as an infant, he has lived with his parents, Bob and Josh, who adopted him after fostering him from the age of four months old. They have tried the usual nebulizer treatments, but Anthony is not responding as usual. So they brought him in for evaluation. Upon initial assessment, Anthony’s lungs had both expiratory and inspiratory wheezes, dyspnea, tachypnea, diaphoresis, and retractions. Let’s take a look at his vital signs:
his blood pressure is 70/40 mmHg heart rate of 131 beats/minute, respiratory rate of 32 beats per minute, oxygen saturation of 93% on room air, with a temp of 38.3 degree Celsius. Now that we’ve looked at this information, let’s look at our critical thinking checks number one and two below.
Great job. Anthony is pale, but not gray. His lips do indicate a very faint, bluish tinge. He can speak, but it does appear difficult. Now that we have these results, let’s take a look at critical thinking checks number three and four below.
Excellent job. After administration of albuterol, Anthony now has a respiratory rate of 22 breaths per minute and an oxygen saturation of 95% on room air. However, the provider does decide to admit him to the inpatient pediatric observation unit. His parents ask if there are ways to keep him from continually being admitted to the hospital. Let’s take a look at critical thinking check number five below.
Great job. Upon admission to the inpatient unit, Anthony rests quietly without worsening respiratory distress signs. The inpatient unit nurse has assessed the patient and prepares to administer oral prednisone. With this in mind, let’s take a look at critical thinking check number six.
Great job looking at those critical thinking checks. Anthony sleeps during the night shift and the next day, his pediatrician makes rounds and discusses a change in the severity rating of Anthony’s asthma. With this in mind, let’s take a look at critical thinking check number seven below.
Great work on those critical thinking checks. Bob and Josh are interested in meeting with respiratory therapy for assistance with inhalers. They say that Anthony has trouble using inhaler devices. With this in mind, let’s take a look at critical thinking check number eight below.
Great job. After lunch, Anthony is ready to be discharged. His parents verbalized gratitude for the staff and thanked the team for helping with education. With this in mind, let’s take another look at the critical thinking checks. This is number nine below.
Great job, everyone! This wraps up our case study on pediatric asthma. Please take a look at the attached study tools and test your knowledge with practice quiz. We love you guys, now go out and be your best self today and as always, happy nursing!
References:
Asthma in children younger than 12 years: Overview of initiating therapy and monitoring control
Authors:Gregory Sawicki, MD, MPHKenan Haver, MD update May, 2021; Patient education: Asthma treatment in children (Beyond the Basics)
Authors:Gregory Sawicki, MD, MPHKenan Haver, MD update Nov 2021; Treatment of intermittent and mild persistent asthma in adolescents and adults
Author:Christopher H Fanta, MD, updated Sept, 2021
Miriam Wahrman, MSN/Ed, RNC-MNN 
Chance Reaves, MSN-Ed, RN 