The second scenario refers to the case of a 12-year-old boy that presents to the emergency department with asthma exacerbation, and, notably, it is the third time he has the same problem in the last three months. The process of collecting the patient’s medical history is simplified in this case since it is not his initial visit, and older health records can be accessed.
As a nurse who has to care for this patient, I would need all information pertaining to the patient’s previous ED visits with the symptoms of asthma exacerbation and subsequent hospitalizations. The required information would include the severity of the previous asthma attacks, the outcomes of lung function tests and assessments conducted before, any adverse reactions to treatment, and other details of previous hospitalizations (Jones et al., 2016).
More than that, I would ask the family to provide information on the total number of exacerbations, including those managed without professional help, and any aggravating factors impacting the child. Such factors would include, for instance, any recent respiratory infections, exposure to allergens at home or outside, changes to indoor climate, new pets, any comorbid diseases, adverse reactions to drugs, emotional stress, deviations from recommended self-management practices, and so on (Indinnimeo, Chiappini, & Del Giudice, 2018; Jones et al., 2016). The presence of an individual asthma action plan would also need to be discussed to provide effective care.
The severity of asthma exacerbation affects the selection of treatment strategies to a large extent. With that in mind, physical examinations and assessment techniques should help to evaluate the severity of an asthma attack. To begin with, it would be necessary to evaluate the pediatric patient for cough (presence, persistence, type, etc.) and establish the presence of tachypnea and wheezing (Children’s Hospital Colorado, 2017).
Next, the patient would need to be evaluated for hypoxemia and increased work of breathing (Children’s Hospital Colorado, 2017). Assessment techniques used for the patient could include the Pediatric Asthma Severity measurement tool designed for children from 2 to 12 years old (Children’s Hospital Colorado, 2017). Additionally, the components of the physical exam that would be helpful for severity assessment would include the patient’s ability to speak in full sentences, current respiratory rate, heart rate, and alertness (Jones et al., 2016).
The specific nursing interventions would depend on information regarding the exact cause of asthma exacerbation and its severity. In general, apart from assessing medical history, including allergic reactions to pharmaceutical drugs, and conducting assessments of the child’s respiratory status, the nurse would be involved in treatment administration. Commonly used interventions in pediatric asthma attacks include the administration of supplemental oxygen (for oxygen saturation <90%), short-acting-beta-agonists, and systemic corticosteroids (Children’s Hospital Colorado, 2017; Indinnimeo et al., 2018).
Next, when caring for preadolescent children, healthcare providers should take these patients’ lack of independence into account and make sure to provide appropriate education to their parents or caregivers. It would be critical to discuss a range of topics with the family. To start with, the family should understand that asthma attacks in children often take place due to poor adherence to self-management recommendations (Indinnimeo et al., 2018).
The boy’s family would need to be educated on the correct use of asthma action plans and the ways to identify specific asthma triggers affecting their child and control them. Moreover, to reduce the risks of further asthma attacks, the boy’s parents would be educated on cold and flu prevention and how to minimize exposure to irritants and allergens. Finally, to support improvement, it would be helpful to provide them with self-assessment tools, such as the Asthma Control Test, and explain how to evaluate the success of asthma management practices they use at home.
References
Children’s Hospital Colorado. (2017). Asthma exacerbation management. Web.
Indinnimeo, L., Chiappini, E., & Del Giudice, M. M. (2018). Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics. Italian Journal of Pediatrics, 44(1), 1-10.
Jones, B. P., Fleming, G. M., Otillio, J. K., Asokan, I., & Arnold, D. H. (2016). Pediatric acute asthma exacerbations: Evaluation and management from emergency department to intensive care unit. Journal of Asthma, 53(6), 607-617.