Mary is an eight-year-old girl who is admitted to
the hospital with acute asthma / RAD.
Mary is an eight-year-old girl who is admitted to the hospital with
acute asthma / RAD.
§ She is up to date on her immunizations
§ No hospitalizations or surgeries and no regular medications
§ Mother reports that the child has a nocturnal nonproductive cough two to three times per month for the past 3 months associated with increasing episodes of shortness of breath that resolve spontaneously.
§ During soccer games, the girl has recurrent episodes, which are only relieved when she uses a friend's albuterol inhaler.
§ She is a 4th grader doing well academically, with no school absences.
Physical examination reveals:
T - 98.6ºF, Pulse – 82, Respiratory rate – 22, BP - 118/75 mmHg.
§ Nasal flaring and intercostals retractions
§ Productive cough
§ Expiratory wheezing with use of accessory muscles.
§ Chest anteroposterior (AP) diameter does not seem to be increased.
§ Pulmonary auscultation reveals inspiratory and expiratory wheezing scattered throughout both lung fields.
Color - normal, without cyanosis.
Nares - moderate congestion without sinus tenderness or flaring.
Ears - The tympanic membranes are mobile and without erythema or
Mental status – alert and oriented.
Family history - reveals that the girl lives with her mother, father, and older sister in a house on the outskirts of the community. The father had a history of seasonal hay fever as a child. Both parents are smokers, and the mother reports that her husband has had some difficulties with episodic cough and shortness of breath, but has not seen a physician.
Critical Thinking Questions:
1. Mary is exhibiting most of the common clinical manifestations of acute
asthma. What is the etiology of these manifestations?
2. What other assessment information should the nurse acquire?
3. What are possible triggers for her asthma attacks?
4. What is the most common “Reliever” medication that is used? What is
5. How would the nurse know that the medication is effective?
6. What is the purpose of a peak flow meter?
Mary is being discharged and will be placed on Intal.
7. What is the classification of Intal (Cromolyn)? What are other
classifications of “Controller” medications? What is the purpose of giving this