Video Case Study - Caring for Pediatric Patients With Asthma
Nurse Lin works at a primary care clinic and is caring for Joey, an 8-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 Lin 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.Recognizing and Analyzing Cues First, Nurse Lin recognizes important cues, including Joey’s vital signs which are temperature 98 F or 36.6 C, heart rate 94 beats per minute, respirations 20 breaths per minute, and oxygen saturation 95 percent on room air.
Nurse Lin 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, who’s at the bedside.Nurse Lin: Hi Joey, could you tell me about how your breathing has been?Joey: Sometimes my chest feels a little tight and it's hard to take a deep breath.Nurse Lin: That must be uncomfortable.
When did you start feeling like this?Joey: I don’t know.Angel: 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.Nurse Lin: It’s good you brought Joey in.Next, Nurse Lin 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.
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 the 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 Joey’s 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 Lin 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 Lin and RN Marge then take action to implement these solutions.
RN Marge gathersthe prescribed short-acting beta 2-agonist, a nebulizer, and an inhaled corticosteroid, and they enter Joey’s room with the medications.RN Marge: Hi Joey, the healthcare provider ordered two medicines to help you breathe better.Joey: I don’t wanna have a shot!RN Marge: I know, but these medicines aren’t like a shot.
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 Joey 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 healthcare provider.
She takes Joey’s vital signs which are temperature 98 F or 36.6 C, heart rate 96 beats per minute, respirations 19 breaths per minute, and oxygen saturation 98 percent on room air.
Nurse Lin 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.Alright, as a quick recap…Nurse Lin 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 Lin 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 thirty minutes, they determined that the plan of care was successful. expected outcome since Joey's chest tightness resolved within 30 minutes they determined that the plan
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