2. Definition of Asthma
› Asthma is a condition in which your airways
narrow and swell and produce extra mucus.
This can make breathing difficult and trigger
coughing, wheezing and shortness of
breath.
› For some people, asthma is a minor
nuisance. For others, it can be a major
problem that interferes with daily activities
and may lead to a life-threatening asthma
attack.
› Asthma can't be cured, but its symptoms
can be controlled.
4. subjective
› DEMOGRAPHICS : Terri Collins is an 8-year-old African-American girl and her
weight 22.7 kg.
› CC : My daughter has had a bad fever, and now she is having trouble breathing
and albuterol doesn’t help.
› HPI : she presents to the emergency department with a 2-day history of
fevers, malaise, and nonproductive cough. The mother gave acetaminophen
and ibuprofen to help control the fever. Terri started having trouble breathing
the morning of admission, and the mother gave her albuterol, 2.5 mg via
nebulization twice within an hour. Terri still sounded wheezy to the mother
after the albuterol, and Terri stated it was “hard to breath.” Terri was
previously well controlled regarding asthma symptoms. Previous clinic notes
reported symptoms during the day only with active play at school or at home
and rare nighttime symptoms. She uses PRN albuterol to help with symptoms
after playing. Her assessment in the emergency department revealed Terri to
have labored breathing, such that she could only complete four- to five-word
sentences. She had subcostal retractions, tracheal tugging with tachypnea at
54 breaths/min. Her other vital signs were a heart rate of 160 beats/min,
blood pressure of 115/59, temperature of 38.8°C. The initial oxygen saturation
was 88%, and she was started on oxygen at 1 L/min via nasal cannula. A chest
x-ray revealed a right lower lobe consolidation consistent with pneumonia and
possible effusion. After receiving three albuterol/ipratropium nebulization's,
her breath sounds and oxygenation did not improve; so she was started on
albuterol via continuous nebulization at 10 mg/h, and her oxygen was titrated
to 3 L/min. She was also given a dose of 25 mg IV methylprednisolone and a
› PMH : Asthma, last hospitalization 4 years ago, and
last course of oral corticosteroids over a year ago.
› FH: Asthma on father’s side of the family.
› SH :Lives with mother, father, and two siblings, both
of whom have asthma. There are two cats and a dog
in the home. Father is a smoker, but states that he
tries to smoke outside and not around the kids. She is
in the second grade and is very active on the
playground.
› Meds :
1. Albuterol 2.5 mg nebulized Q 4–6 h PRN
wheezing
2. Fluticasone 44 mcg MDI two puffs BID
3. Acetaminophen 160 mg/5 mL—10 mL Q 4 h PRN
fever
4. Ibuprofen 100 mg/5 mL—10 mL Q 6 h PRN fever
› All : NKA
5. Objective
Physical Examination:
1. ROS: (+) Fever, cough, increased work of breathing.
2. GEN: Alert and oriented but in mild distress with
difficulty breathing.
3. VS: BP 125/69, P 120, T 37.9°C, R 40, O sat 94% on 3
L/min nasal cannula.
4. CHEST: Wheezes throughout all lung fields, still with
subcostal retractions.
Lab result:
A. K 3.1 mEq/L (Hypokalemia)
B. WBC 34.2 × 10 /mm (leukocytosis)
C. Neut 91% (Neutrophilia)
D. Lymph 5% (Lymphocytopenia)
E. Respiratory viral panel nasal swab: positive for
influenza A (probably H1N1 strain)
6. Respiratory viral panel nasal swab
› To determine whether you have a respiratory infection due to
certain bacteria or viruses; to help guide management of a
respiratory infection.
› Not everyone with symptoms of a respiratory infection (e.g.,
fever, aches, sore throat and cough) is tested. This panel is
primarily performed when you are seriously ill, hospitalized,
and/or at an increased risk for a severe infection with
complications or multiple infections (co-infections).
7. MPL Drug name Actual strength Regimen Clinical
impression/DTP
Intervention Follow up
Fever Acetaminophen and
ibuprofen
160 mg/5 mL—10 mL
100 mg/5 mL—10
PO Q 4 h PRN
PO 6 h PRN
Exacerbated asthma. Stop using
ibuprofen.
Parcetamol is
enough
Monitoring
temperature
nonproductive
cough(dry cough)
- - - - No need for drug
because its an
symptoms of
asthma.
Monitoring Asthma
in order to relief the
dry cough
Influenza A ( H1N1
strain)
- - - Drug not indicated
for conditions.
Exacerbated asthma
Give Oseltamivir
(23-40 kg: 60 mg PO
q Day x10 days)
Respiratory viral
panel nasal swab
Pneumonia - - - Drug not indicated
for conditions
Give amoxicillin ( 20
to 40 milligrams /kg
of body weight /day,
divided and given
every 8
Monitoring WBCs
Neut
lymph
Temperature
X rays
Asthma 1. Albuterol
nebulized
2. Fluticasone
2.5 mg
44 mcg
Q 4–6 h PRN
MDI two puffs BID
Adverse drug
reaction
Give K supplement
700mg/day
K
initial oxygen
saturation
Heart rate
8. ASSESSMENT
› I found that this girl is suffering from Exacerbated asthma due to
1. Fever
2. Cough
3. Pneumonia
4. Influenza
5. Shortness of breath
6. Malaise
7. Wheezy
8. subcostal retractions, tracheal tugging with tachypnea
9. ibuprofen
9. Plan
› Patient should discontinue ibuprofen (CI in asthma ) exacerbate
asthma.
› Patient should treat both of pneumonia (Give amoxicillin 20 to 40
milligrams /kg of body weight /day, divided and given every 8) and
influenza A(Oseltamivir 23-40 kg: 60 mg PO q Day x10 days) because
they are the main risk factor for asthma (exacerbate asthma).
› Albutrolol cause hypokalemia so give patient k supplement(700
mg/day).
› Continuo using Albuterol 2.5 mg nebulized Q 4–6 h PRN and
Fluticasone 44 mcg MDI two puffs BID
