Case study - Asthma (pediatric): Nursing

Nurse. Lyn works at a primary care clinic and is caring for Joey an eight year old who's had a cough for two months and mild chest tightness over the last week.

In collaboration with the registered nurse, RN Marge. Nurse Lynn goes through the steps of the clinical judgment measurement model to make clinical decisions about Joey's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse Lynn recognizes important cues including Joey's vital signs which are temperature 98 °F or 36.6 °C, heart rate, 94 BPM, respirations, 20 breaths per minute and oxygen saturation.

95% on room, air nurse, Linn auscultates Joey's lungs and hears mild wheezes in all lobes upon expiration, which is consistent with RN Marge's previous assessment.

She gathers additional information from Joey and his aunt, Angel whos at the bedside. Hi, Joey.

Could you tell me about how your breathing has been? Sometimes my chest feels a little tight and its hard to take a deep breath that must be uncomfortable.

When did you start feeling like this? I don't know he's had a nagging cough for a while.

Now, at first I thought it was just the change in the weather making his allergies flare up, but his allergies don't normally affect his breathing.

That's why I made the appointment. It's good.

You brought Joey in next nurse Lyn analyzes these cues. She reviews the electronic health record or EHR and notes that Joey has no relevant medical history other than seasonal allergies, she assists Joey to a sitting position while RN Marge performs the ordered spirometry testing by having Joey breathe into a mouthpiece connected to a device that measures how much air he's able to breathe in and out.

They note that Joey can't expel all the air after taking a deep breath. RN Marge then speaks to the healthcare provider who diagnoses Joey with asthma.

Nurse. Lynn understands that asthma is an inflammatory condition that causes airway narrowing and obstruction of airflow.

She recognizes that asthma can be stimulated by environmental triggers like pollution, cigarette smoke, dust and pollen.

As the triggering substance travels into the airway immune cells release chemical mediators that cause smooth muscles in the bronchioles to spasm and goblet cells to produce mucus.

The combination of mucus and bronchospasm narrows the airway making it harder to breathe leading to joeys symptoms like wheezing, chest tightness and cough nurse.

Lin recognizes that Joey needs effective respiratory management. Now, using the information she's gathered along with Joey's medical history.

Nurse Lynn reports her findings to RN Marge and together they develop a priority hypothesis of ineffective breathing pattern.

Then they generate solutions to address Joey's ineffective breathing pattern and establish the expected outcome that after intervening Joey's chest tightness will improve within 30 minutes.

Nurse Lynn and RN Marge then take action to implement these solutions. RN Marge gathers the prescribed short acting beta two agonist, a nebulizer and an inhaled corticosteroid and they enter Joey's room with the medications.

Hi, Joe, the healthcare provider ordered two medicines to help you breathe better. I don't want to have a shot.

I know, but these medicines aren't like a shot. Instead you'll breathe them in through your nose and mouth.

Will it hurt? Not at all?

In fact, theyll make your chest feel better? Ok.

Nurse Li then administers the nebulized medication according to the principles of safe medication administration. While the medication flows through the mask.

RN Marge teaches Angel about how to use Joey's nebulizer at home. Once the nebulizer treatment has finished.

RN Marge shows Angel and Joe how to use the inhaler and spacer to administer the corticosteroid. RN Marge also provides Angel with an asthma action plan to prevent and control asthma attacks.

And she teaches them how to avoid asthma triggers and how to recognize symptoms that warrant a call to the health care provider.

After RN Marge leaves the room. Nurse, Lynn reinforces the teaching and answers questions that Joey and Angel have 30 minutes later.

Nurse Lyn evaluates the outcomes of her actions she takes Joe's vital signs which are temperature 98 °F or 36.6 °C heart rate, 96 BPM respirations, 19 breaths per minute and oxygen saturation.

98% on room air nurse, Linn auscultates, Joey's lungs and notes that the expiratory wheezes are present but they're less audible than before.

Joey also reports that his chest tightness is resolved. All right, as a quick recap nurse Lynn recognized and analyzed cues related to Joey's ineffective breathing pattern.

And in collaboration with RN Marge prioritized hypotheses and generated solutions to address this problem. Nurse Lynn and RN Marge then implemented measures and evaluated Joey's outcomes and compared them to the expected outcome.

Since Joey's chest tightness resolved within 30 minutes, they determined that the plan of care was