PEDIATRIC NURSING (NCM 104)

STATUS ASTHMATICUS
A Case Study

Azores, Mae Ann A.

BSN 4A1-4

Ms. Led Erika R. Paez, RN

Professor
CASE SCENARIO:

A 3 year-old child was brought to the emergency room and exhibited apparent central cyanosis. She breathed labouredly and rapidly.
Upon interview, the mother verbalized that the child has had asthma attack from exposure to burning sulfur dioxide when she neglect to
watch the child while playing in the neighbor’s yard. The attack was unable to be halted even in upright position and by using her inhaler.
Vital signs were taken as follows: RR: 68cpm PR:137bpm BT:37.1 °C.

RELATED QUESTIONS:

1. Asthma attacks are triggered by?

-exposure to allergens, wheather changes, exacerbations from other RTI, pollutants, cold air, exercise

2. What is status asthmaticus?

-It is a medical emergency usually occurring with complicating conditions with continued display of RDS despite vigorous therapeutic
measures.

3.What are the signs of asthma?

Signs of asthma may include:

• Coughing
• Wheezing
• Shortness of breath
• Chest tightness
4. At what age do people get asthma?

Some people get asthma as children. Asthma may or may not go away as children grow up. Other people get asthma later in life.

5. Lab findings may include which of the following

a. macrocytopenia b. O2 sat of 40% c. eosinophilia d. chronic alkalosis

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective: Risk for STG: After 30 mins 1. Administer 1. To maintain STG: After 30 mins
suffocation r/t of nsg intervention, humidified O2 by tent, satisfactory of nsg intervention,
Verbalization of bronchospasm, the pt will facemask or cannula. oxygenation. the pt experienced
patient’s exposure mucus secretions experience cessarion cessarion of
to sulfur dioxide and edema. of bronchospasm, 2. Closely monitor O2 2. To detect early or bronchospasm, the
the patient will sat and ABG via pulse impending hypoxia. patient breathes
breathe more easily oximetry. more easily and does
Objective: and will not not suffocate.
suffocate. 3. Closely monitor 3. High levels may
Tachypnea percentage of O2 depress respirations. LTG: After 8 hrs of
Tachycardia LTG: After 8 hrs of delivered. nsg intervention, the
Central cyanosis nsg intervention, the patient exhibits
Inability to halt patient will exhibit 4. Establish IV infusion. 1. For administration normal respiratory
attack even in normal respiratory of meds and function. Child’s
upright position function. Child’s hydration. respirations are
and by using respiration will be unlabored and within
inhaler unlabored and within 5. Position patient high 5. This position is normal limits.
normal limits. fowlers, provide more comfortable
overbed table pillows on for a child. Promotes
which to lean. lung expansion.

6. Closely monitor vital 6. To promote

signs before, during and maximum efficacy
after drug and minimal side
administration. effects.

7. Interview the parent 7. To avoid possible

 to determine overdose.
medications given
before admission.

8. Have emergency 8. To prevent delay

equipment and in tx.
medications readily
available.
Dependent:
1. Administer 1. To relieve
aerosolized bronchospasm.
bronchodilators and
either oral/IV
costicosteroids as
prescribed.

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective: Risk for fluid STG: After 30 mins 1. Maintain IV infusion 1. Liquid therapy will STG: After 30 mins
volume deficit r/t of nsg intervention, at appropriate rate ( IV enhance liquefaction of nsg intervention,
Verbalization of difficulty taking the patient’s @2/3 to ¾ to minimize of secretions. the patient’s
patient’s exposure fluids, insensible condition will be risk of pulmonary condition was
to sulfur dioxide loses from maintained and devt edema because of high maintained and devt
hyporventilation of dehydration will inspiratory pressure). of dehydration was
and diaphoresis. be controlled. controlled.
Objective: 2. Monitor I and O. 2. To correctly
LTG: After 8 hrs of monitor for true fluid LTG: After 8 hrs of
Tachypnea nsg intervention, the volume deficits or nsg intervention, the
Tachycardia patient will exhibit other underlying patient exhibits
Central cyanosis adequate hydration. disorder. adequate hydration.
Inability to halt
attack even in 3. Correct dehydration 3. Overhydration can
upright position slowly. increase pulmonary
and by using fluid leading to
inhaler increased airway
obstruction.

4. Encourage oral fluids 4. To decrease risk

when ARD subsides. for aspiration.

5. Avoid cold liquids. 5. They can trigger

reflex
bronchospasm.
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION
Subjective: Risk for injury STG: After 30 mins 1. Closely monitor blood 1. Blood pH <7.25 STG: After 30 mins
(resp. acidosis, of nsg intervention, pH. impairs systemic, of nsg intervention,
Verbalization of electrolyte the patient’s pulmonary and the patient’s
patient’s exposure imbalance) r/t condition will be coronary blood flow. condition was
to sulfur dioxide hypoventilation maintained and devt Normal ph enhances maintained and devt
and dehydration. of acidosis will be effect of of acidosis was
controlled. bronchodilators. controlled.
Objective:
LTG: After 8 hrs of 2. Maintain IV infusion. 2. For administration LTG: After 8 hrs of
Tachypnea nsg intervention, the of emergency meds nsg intervention, the
Tachycardia patient will not and to prevent DHN. patient does not
Central cyanosis experience acidosis. experience acidosis.
Inability to halt 3. Prevent vomiting and 3. Initially child will
attack even in subsequent DHN. experience alkalosis
upright position but if vomiting
and by using becomes severe/
inhaler uncontrolled it can
lead to acidosis.

4. Implement measures 4. Hypoventilation

to improve ventilation. may cause an
accumulation of CO2
which will decrease
pH.

Dependent:

1. Administer sodium 1. To prevent/

bicarbonate as ordered. correct acidosis.