Question

Pediatric Case Study

Scenario history: Johnny is 6 years old, admitted late yesterday with exacerbation of asthma. Johnny has a history of asthma for 2 1/2 years. He has been admitted to the hospital exacerbation x3; no ICU admission. He was admitted due to coughing, expiratory wheezing, runny nose, and increasing shortness of breath that began shortly after a low-grade fever.

Presenting signs: Temp 100.4, HR; 112, RR; 28, 02 Sat 91%

Expiratory wheezing, intercostal, and subcostal retractions; unable to complete a sentence without shortness of breath.

Peak flow meter- 60%.  

1. What instructions would you give to perform a peak flow reading?
2. Johnny is unable to use an MDI, what would you suggest to the doctor to order.
3. What would you include in an Asthma Action Plan for Johnny?
4. What B-2 Agonists and Corticosteroids commonly used in the treatment of asthma?

Answer 1

Que1. Measure to check the peak flow

1) move the marker to the bottom of the numbered scale .

2) stand up straight .

3) take a deep breath ,fill the all the way.

4)hold your breath while you place the Mouthpiecein your mouth , between your teeth.

Close your lips around it. Don not put the toung against or in the hole.

5) blow out as hard and fast you can in single blow. First burst of is very important. So blowing for longer time will not affect the results.

6) write down the number you get,but if you coughed and did not do steps ,do not write down the number . Instead step do again

7)move the marker back to bottom and repeat all these steps 2more times. Highest of 3numbers is peak flow number. Write it down in your log chart.

Que2. We can suggest the doctor for nebuliser . nebuliser is easy to manage and convenient .As nebuliser use comprised air to turn , Medication into fine a fine mist that is inhaled through a mouth piece or mask . When a mask is used it should be used snugly over the child face, if we move the mask slightly, it can reduce the amount of Medication that gets to the lung .

Que3. Action plan for johnny contains

An action plan can tell you when to add or increase Medication, when to call your child's provider when to get emergency immediately help.

-sit the child upright : stay calm and reassure Don't leave him alone.

- give four puffs of spacer

-wait four min if still not puff four time again.

- Call emergency number

OR

Action plan usually include three categories

Green , yellow ,red

Johnny is in yellow : asthma symptoms are more frequent or more severe ,it can treated by quick relief Medication to usewhen Symptom flare up , it may involve increasin or change the controller Medication. So Johnny should be informed whenever he feels like shortness of Breathing .He should take his Medication by MDI or nebuliser.

- if medication is not helpful in relieving symptoms he must dial. The emergency number

Que4. Beta agonist : there are two types of it

Short and long term

Short term beta agonist include:salbutamol , levobuterol,terbutaline, fenoterol, remiterol,pir buterol.

Levobuterol considered more potent with less side effects than racemic mixture.

Long term : salmeterol ,formeterol.

B) CORTICOSTEROIDS : beclomethason , budesonid, fluticasone,flunisolide, circlesonide. Theses reduce inflammation and hyper responsiveness.

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