NGN case study
Pediatric Asthma Exacerbation
An 8-year-old arrives with cough, wheezing, and increased work of breathing. Setting: Emergency department.
Client record
Assessment
- Speaks in short phrases.
- Intercostal retractions present.
- Expiratory wheezes bilaterally.
Vital Signs
- HR 132, RR 34, SpO2 90% room air.
- Peak flow 45% of personal best.
Medication History
- Albuterol inhaler used every hour today.
- No controller medication for 2 weeks.
Questions
Question 1 of 3
Take action. Which intervention is the priority?
Answer and rationale
A. Apply oxygen and administer prescribed short-acting bronchodilator.
The child has respiratory distress and low oxygen saturation; airway and breathing come first.
Treat hypoxemia and bronchospasm first.
Question 2 of 3
Prioritize hypotheses. Complete the bow-tie for this child.
Complete the diagram: 1 condition, the actions to take, and the parameters to monitor.
Actions to take
Condition
Parameters to monitor
Answer and rationale
- Condition: Severe asthma exacerbation
- Actions to take: Apply oxygen, Give prescribed albuterol
- Parameters to monitor: SpO2 and work of breathing, Peak flow after treatment
The bow-tie connects respiratory distress with immediate therapies and objective reassessment.
Severe asthma exacerbation requires oxygen, bronchodilator, and close respiratory reassessment.
Question 3 of 3
Evaluate outcomes. Complete the evaluation statement.
Choose the option that best completes each blank.
Improvement: . Oxygenation: .
Answer and rationale
Improvement: decreased retractions and RR 24/min. Oxygenation: SpO2 96%.
Asthma evaluation requires reassessment of ventilation, oxygenation, and distress.
Less work of breathing and better SpO2 show improvement.