Case Study

Mary is an eight-year-old girl who is admitted to the hospital with

acute asthma / RAD.




Nursing Assessment:


Subjective Data:

§  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.


Objective Data: 

Physical examination reveals:  

Vital Signs: 

              T - 98.6ºF, Pulse – 82, Respiratory rate – 22, BP - 118/75 mmHg.

Respiratory Assessment:

§  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.

             Clear drainage.

Ears - The tympanic membranes are mobile and without erythema or

          air/fluid levels.

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

     the classification?


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