L.S. is a 7-year-old who has been brought to the emergency department by his mother. She immediately tells you that he has a history of ED visits for his asthma. He uses an inhaler when he wheezes, but it ran out a month ago. She is a single parent with two other children, who are at home with a babysitter. Your assessment reveals the following:
Alert, oriented, extremely anxious.
Skin: Pale; nail beds are dusky and cool to the touch
HR: 136
RR: 36/min regular and even
Temp: 99.1
SpO2: 89%
Breath sounds are decreased in lower lobes bilaterally and congested with inspiratory and expiratory wheezes, prolonged expiration, and a productive cough.
As you ask his mother questions, you note that L.S.'s RR is increasing; he is sitting on the side of the bed, leaning slightly forward, and is having difficulty breathing.
1. What are your differential diagnoses for this patient based on what little information you have at this time?
2. What are your priority orders for this patient?
3. What labs might you want to order on this patient?
4. What are some other concerns that you might want to be thinking about for this patient?
L.S. is given albuterol and atrovent. His O2 saturation is now 88% on 6L of oxygen via facemask. He states that he doesn't feel any better. He is retracting and respiratory rate remains 34 breaths per minute. An IV infusion has been started and methylprednsolone would likely be beneficial for the patient at this time.
1. What would be the appropriate dose of methylprednisolone for L.S. if he weights 66 pounds?
2. What would the next steps likely be?
3. What are some things that you need to educate the mother about regarding her son's health related to your differential diagnosis?
We are doing discharge teaching for L.S. He has the following orders:
- Discharge to home.
- Follow up in 3 days for recheck.
- Albuterol MDI: 2 puffs with spacer every 4 hours PRN.
- Prednisolone 1mg/kg PO every day for 5 days (he weighs 23 kg).
- Fluticasone MDI: 1 puff twice a day.
- Montelukast 5mg every evening PO
- Provide peak flow meter
- Regular diet
1. Ms. S. asks why she will use the spacer with the medicine L.S. breathes in. Explain the purpose of a metered-dose inhaler (MDI) and spacer.
2. During your medication teaching session with Ms. S. and L.S., Ms. S. makes this statement: "So, if he has to take both inhalers at the same time, he should take the Flovent first, then the albuterol. Right?" Is this statement true or false? Explain your answer.
3. Ms. S. then asks "How long should we wait between the two inhalers if they are both due at the same time? Can we just give them one after the other?" What is your response?
4. As you continue your teaching, you explain the difference between controller and reliever medications. Explain the difference, and list which of L.S.'s medications are controllers and relievers.
5. You are asking L.S. to use a peak flow meter (PFM) at home. How would you explain the purpose of the PFM and how to use it?
6 L.S. tells you that he loves to play basketball and football, and asks you whether he can still do thse activities. How will you respond?
7. What are some additional teaching points that you would include in the discharge teaching?
Alert, oriented, extremely anxious.
Skin: Pale; nail beds are dusky and cool to the touch
HR: 136
RR: 36/min regular and even
Temp: 99.1
SpO2: 89%
Breath sounds are decreased in lower lobes bilaterally and congested with inspiratory and expiratory wheezes, prolonged expiration, and a productive cough.
As you ask his mother questions, you note that L.S.'s RR is increasing; he is sitting on the side of the bed, leaning slightly forward, and is having difficulty breathing.
1. What are your differential diagnoses for this patient based on what little information you have at this time?
2. What are your priority orders for this patient?
3. What labs might you want to order on this patient?
4. What are some other concerns that you might want to be thinking about for this patient?
L.S. is given albuterol and atrovent. His O2 saturation is now 88% on 6L of oxygen via facemask. He states that he doesn't feel any better. He is retracting and respiratory rate remains 34 breaths per minute. An IV infusion has been started and methylprednsolone would likely be beneficial for the patient at this time.
1. What would be the appropriate dose of methylprednisolone for L.S. if he weights 66 pounds?
2. What would the next steps likely be?
3. What are some things that you need to educate the mother about regarding her son's health related to your differential diagnosis?
We are doing discharge teaching for L.S. He has the following orders:
- Discharge to home.
- Follow up in 3 days for recheck.
- Albuterol MDI: 2 puffs with spacer every 4 hours PRN.
- Prednisolone 1mg/kg PO every day for 5 days (he weighs 23 kg).
- Fluticasone MDI: 1 puff twice a day.
- Montelukast 5mg every evening PO
- Provide peak flow meter
- Regular diet
1. Ms. S. asks why she will use the spacer with the medicine L.S. breathes in. Explain the purpose of a metered-dose inhaler (MDI) and spacer.
2. During your medication teaching session with Ms. S. and L.S., Ms. S. makes this statement: "So, if he has to take both inhalers at the same time, he should take the Flovent first, then the albuterol. Right?" Is this statement true or false? Explain your answer.
3. Ms. S. then asks "How long should we wait between the two inhalers if they are both due at the same time? Can we just give them one after the other?" What is your response?
4. As you continue your teaching, you explain the difference between controller and reliever medications. Explain the difference, and list which of L.S.'s medications are controllers and relievers.
5. You are asking L.S. to use a peak flow meter (PFM) at home. How would you explain the purpose of the PFM and how to use it?
6 L.S. tells you that he loves to play basketball and football, and asks you whether he can still do thse activities. How will you respond?
7. What are some additional teaching points that you would include in the discharge teaching?
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