The document provides information on a case study presentation for a 4-year old patient with asthma and acute exacerbation. It includes: - The patient's history of presenting with a cough and difficulty breathing and being found lethargic on examination. - Diagnosis of asthma with acute exacerbation and RSV infection. - The patient's growth development according to Erikson's stages and normal physical characteristics for their age. - Medical interventions including treatments, medications, and diagnostic tests. - Common patient problems like ineffective airway clearance and altered nutrition along with relevant nursing interventions.

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LaGuardia Community College
Practical Nursing Program
SCL 115 Maternal Child Health Nursing
Case Study Presentation on a Patient with
asthma with acute exacerbation
Directions: Utilize format in preparation for your clinical case study. Attach your

2. nursing care plan to the sheet and submit to your clinical instructor.
You will be required to present the case study orally during pre and
post conference
Date of Assignment: 11/28/2007
By
Anaise Ikama
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3. Client Initials: H. D. J Client Age: 4-years-old
Client History: Patient was admitted on 11/06/07 with a chief complaint of non-productive cough and difficulty breathing. On
11/09/07, received patient alert, awake, but lethargic. Patient’s skin was pink, warm with good turgor. Patient had a
D5 Ns 500ml with 20-mEq potassium, at 60 cc per hour on the posterior right hand. No swelling or redness was
noticed at the IV site. Patient had a wheezing breathe sound and retraction of chest muscles. Vital signs: BP: 100/63;
P: 119; RR: 46; Oxygen saturation: 94%; T: 99.4; Pain: 0 (denied any pain). At the end of my shift, Ms. Pangilina, my
head nurse, informed me of the client’s RSV lab result, which came out positive. Therefore, the client had to be
transferred into an airborne isolation room.
Primary Diagnosis: Asthma with acute exacerbation
I. Define the etiology of the diagnosis: “Asthma in children is a reversible airway-reactive disease characterized by bronchospasm,
increased mucus production, and edema of the mucosa of the bronchioles [, which] result in obstruction, air trapping, respiratory
distress, and changes in ventilation. Asthma is the leading chronic disorder in children. Most children experience their first attacks
between two to seven years of age…As it progresses, alveoli that are hypeerinflated and poorly ventilatedmay lead to impaired gas
exchange,hypoxemia, hypercapnea, and eventual respiratory acidosis and failure” (Marie Jaffe. Pediatric Nursing Care Plans).
Asthma can also be caused by Allergens - mold, pollen, animals; Irritants - cigarette smoke, air pollution; Weather - cold air, changes
in weather; Infections - flu, common cold
II. Describe the growth and development tasks ascribed to this age level
According to Erickson’s stages of development, this patient is in the early stage of childhood: initiative versus guilt. “Early
childhood is the period during which the child expands his or her imagination. He or she starts trying on or identifying with, the role of
the same-sex parent. The boy unconsciously adopts the mannerisms and attitudes of his father, whereas the girl adopts to those of her
mother…” (Patricia D. Barry. Mental Health and Mental Illness. Pp 100-101). The patient seems to behave in an age appropriate;
however, his asthmatic condition prevents him from expanding more his view regarding the world. As a matter of fact, while most of
the preschoolers are out there exploring their environment, this child is in the hospital fighting this diagnosis.
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4. III. Describe physical characteristics of this age level. Include height and weight.
Besides the fact that he is asthmatic, the patient body weight is within the norm (44.1 lbs). However, because of the minimum
appetite, the client will need encouragement and assistance in feeding to fight the disease.
IV. Medical Intervention:
The medical interventions for this patient included the administration of oxygen through a facemask and an albuterol nebulizer
was given every 3 hour to dilate the bronchioles.
A. Treatments:
Included the prevention of respiratory tract infections by administering cefuroxime; administration of the intravenous
fluid to prevent dehydration.
B. Medications:
∗Cefuroxime: 650 mg intravenously q 8 hours. Used for the treatment of respiratory tract infections, skin and
skin structure infections, urinary tract infection and meningitis. Nursing implication: Assess for vital
signs, appearance of the wound, sputum, urine and stool; WBC. Discontinue medication and notify
physician if rush, wheezing and laryngeal edema occur.
∗D5 w/Na .45% 500ml with 20-mEq potassium: at 60cc per hour. An intravenous (IV) solution used
to supply water, calories, and electrolytes (e.g., sodium, chloride) to the body.
∗Acetaminophen: 300mg by mouth (STAT): Used for mild pain or fever. Nursing implication: Assess amount,
frequency and types of drugs taken by the patient self-medication. Assess fever, pain (location and
intensity). If overdose occurs, acetycysteine “acetadote” is the antidote.
∗Ibuprofen: 150 mg by mouth q 6 hours (PRN): Used for mild to moderate pain dysmenorrhea. Inflammatory disorders
including: rheumatoid arthritis (including juvenile), osteoarthritis. Lowering of fever. Also, it slows
progression of lung disease in cystic fibrosis patients > 5 years of age. Nursing implication: Assess for
signs and symptoms of GI bleeding (tarry stools, hypotension), renal dysfunction. Assess pain prior to 1-
2hr following administration. Monitor temperature and note signs associated with fever.
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5. C. Diets: Patient was kept on regular diet since 11/07/07
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6. 5. Diagnostic Tests: “Diagnosing asthma involves a thorough medical history, physical exam and lung function tests. When
assessing children under age 5, doctors seldom conduct lung function tests because young children usually have trouble following the
instructions. Instead, when a child's signs and symptoms, medical history and physical examination suggest asthma, the doctor may
prescribe a bronchodilator — a drug that opens the airways. If your [the] child's signs and symptoms improve after using the
bronchodilator, an asthma diagnosis is likely” (www.mayoclinic.com)
Name Purpose Norms Actual Client Result
1. Thorough
medical history
The medical history or anamnesis of a
patient is information gained by a
physician or other healthcare
professional by asking specific
questions, either of the patient or of
other people who know the person
with the aim of obtaining information
useful in formulating a diagnosis and
providing medical care
(en.wikipedia.org to the patient.)
Medical histories vary in
their depth and focus.
No history of hospitalization.
Client immunizations are up
to date. Denies any pertinent
past medical history.
2. White blood cell
count
White blood cells protect the body
against infection. The purpose of the
test is to find out how many white
blood cells you have because WBC
increases when one has an infection or
allergic reaction
5.5 – 15.5 k/mcl (microliter) 11.3 k/mcl
3. Mucus/Sputum
sample
To rapidly test for Respiratory
sensitive virus (RSV)
Will depend on the patient’s
condition Positive
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7. 6. List common client problems and nursing interventions
♦ Ineffective airway clearance related to obstruction and secretions
♦ Risk for fluid volume deficit related to altered intake
♦ Altered nutrition: less than body requirements related to inability to ingest food
Client’s problem/need (use
nursing diagnosis language)
Client’s short term goals/
outcome (planning)
Nursing Intervention Rationale for nursing
interventions
Ineffective airway clearance
related to
obstruction and secretions
as evidenced by
abnormal breath sounds
(wheezes and fine crackles),
tachypnea and changes in RR
♦Client’s respiratory status
will return to baseline
parameters for rate.
♦Client’s breath sounds will
clear with optimal air flow.
♦Client will be able to cough
up and remove secretions that
are thin and clear
1. Assess RR (for one full
minute), presence of tachypnea
(50-80 min), note nasal flaring,
hypernea (deep breathing),
hypopnea (shallow breathing)
(Marie Jaffe. Pediatric Nursing
Care Plans).
2. Assess breath sounds by
auscultation (Marie Jaffe.
Pediatric Nursing Care Plans).
1. Will reveal rate and type of
respirations (baseline or
deviations) that are related to
age and size of infant or
presence of anxiety in the child.
Dyspnea in the infant and
fatigue causing neck flexion
indicate chest pain or
impending respiratory failure.
(Marie Jaffe. Pediatric Nursing
Care Plans).
2. Provides indication of
patient airways, revealing
crackles heard in the presence
of secretions, rhonchi in larger
airway obstruction and
wheezes in small bronchiolar
narrowing (Marie Jaffe.
Pediatric Nursing Care Plans).
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8. 3. Assess skin color changes,
distribution and duration of
cyanosis or pallor (Marie Jaffe.
Pediatric Nursing Care Plans).
4. Assess cough (moist, dry,
hacking): duration, frequency,
if occurs at night or during day,
or during activity; mucus
production: amount, color
(clear, yellow, green),
consistency (thick, tenacious,
frothy); ability to expectorate
or if swallowing secretions
(Marie Jaffe. Pediatric Nursing
Care Plans).
5. Elevate head of the bed at
least 30 degree. Check the
patient’s position frequently to
ensure child doesn’t slide down
in bed. (Marie Jaffe. Pediatric
Nursing Care Plans).
6. Position on side q2h (Marie
Jaffe. Pediatric Nursing Care
3. Presence and degree of
cyanosis indicate uneven
distribution of gas blood in the
lungs, and alveolar
hypoventilation resulting from
airway obstruction (Marie
Jaffe. Pediatric Nursing Care
Plans).
4. Reveals characteristics of
cough as an indication that
may be produced by infection
or inflammation. Inability to
cough up secretions cause
obstruction from the stasis of
secretions, which lead to
infection and change in
respiratory status. (Marie Jaffe.
Pediatric Nursing Care Plans).
5. Facilitates chest expansion
and respiratory efficiency by
reducing pressure of
abdominal organs on
diaphragm (Marie Jaffe.
Pediatric Nursing Care Plans).
6.This will prevent
accumulation and pooling of
8

9. Plans).
7.Provides fluids at frequent
intervals over 24 h time
periods; encourage clear
liquids, and avoid milk as much
as possible (Marie Jaffe.
Pediatric Nursing Care Plans).
8. Provides for periods of rest
by organizing procedure and
care and disturbing the child as
little as possible (Marie Jaffe.
Pediatric Nursing Care Plans).
9. Assist to perform deep
breathing and coughing
exercises in child when in a
relaxed position for postural
drainage unless procedure are
contraindicated (Marie Jaffe.
Pediatric Nursing Care Plans).
10. Administer bronchodilator,
antibiotics, and small volume
of nebulizer according to the
physician order. (Marie Jaffe.
Pediatric Nursing Care Plans).
secretions (Marie Jaffe.
Pediatric Nursing Care Plans).
7. Maintains hydration status,
and clear liquids liquefy and
mobilize secretions; milk tends
to thicken secretions (Marie
Jaffe. Pediatric Nursing Care
Plans).
8. Prevents unnecessary energy
expenditure resulting in fatigue
(Marie Jaffe. Pediatric Nursing
Care Plans).
9. Promotes deeper breathing
by enlarging tracheobronchial
tree and initiating cough reflex
to remove secretions. (Marie
Jaffe. Pediatric Nursing Care
Plans).
10. Treats conditions affecting
secretion; enhancing outflow
and destroying infectious
agents by interfering with cell
way synthesis (Marie Jaffe.
Pediatric Nursing Care Plans).
9

10. Client/Family Teaching
• Inform parents/child in handwashing techniques and avoid contact with those who have respiratory infections. Prevents
transmission of microorganisms from touching or handling supplies or via airborne droplets (Marie Jaffe. Pediatric Nursing
Care Plans).
• Inform parents of need to maintain or increase fluids, type of fluids to include and avoid, to offer 50-100 ml to child q2h
during waking hours using small cup or straw. Liquefies secretions and maintains hydration (Marie Jaffe. Pediatric Nursing
Care Plans).
• Demonstrate and instruct the client in deep breathing and coughing exercises. Helps raise and expectorate secretions by
initiating cough reflex; raising secretions prevents accumulation of secretions in the lungs and airways, which reduces surface
area for gas exchange predisposition to infections (Marie Jaffe. Pediatric Nursing Care Plans).
10

11. Worked Cited
Elmhurst Hospital. “Client Record”. (November 6, 07). Retrieved November 9, 07 from the nursing station on the 7th
floor
En.wikipedia.org. “Medical History.” October 9, 2007. Retrieved November 17, 2007 from
http://en.wikipedia.org/wiki/Medical_history
Marie Jaffe. Pediatric Nursing Care Plan. 2nd
Ed. (1998). Englewood, Colorado. Skidmore-Roth Publishing,Inc.
Patricia D. Barry. Mental Health and Mental Illness. 7th
Ed. (2007). Philadelphia, PA. (pp. 100-101).
www.mayoclinic.com. “Asthma: Steps in Diagnosis” October 4, 2006. Retrieved November 16, 2007 from
http://www.mayoclinic.com/health/asthma/AS00003
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