NUA 311 Holistic Assessment in Nursing

Collaborative Case Study Case Information: James Washington is a 4-year old African American male who recently moved to the area with his family. He presents to the clinic today with his mother, Mary, complaining of difficulty breathing and cough. His symptoms started this morning shortly after waking up, although his mother states he has had some congestion and runny nose for the past 2-3 days. 1. What historical data should you gather from the patient and his mother? (Include rationale for each of your questions) (2 points) When did it start? (This will let the nurse know the severity of the symptom) What make it better? (This will tell the nurse know what relive the asthma) What make it worse? (This will let the nurse know what James should avoid and what maybe the cause) Does anyone in your family have asthma? (This will like the nurse know if there is a possible problem) Did you have any complication with your pregnancy? (This could rule out possibility complication. This will the nurse know any past problem that may have contributed to the asthma) Does being outside make it worse? (This will let the nurse know some of the possible cause) How often do you cough? (This will tell us how severe is the asthma) Does any family have a history of asthma? (This will like the nurse know if there is a possible problem and if it could lead to more problems) Case information: James has had four or five similar episodes over the past 2 years, which required unscheduled visits to his former pediatrician’s office. Each time James was sent home with an Albuterol inhaler to be used as needed. His mother states that James has a lot of “colds” yearround, which seem to last for a long time. During these episodes he wakes up at night coughing. His mother also mentions that the daycare provider mentioned James would often start to cough while playing and has to stop his activity to “catch his breath”. Other past medical history includes:  Born at 39 weeks gestation  No significant medical illnesses other than wheezing  Never hospitalized  No medications except for the albuterol when needed  NKDA (no known drug allergies)  James lives with his parents and older sister  Mom smokes in the house  They live with a dog, two cats, and a hamster  Father has a history of asthma but “grew out of it” and has seasonal allergies This study source was downloaded by from CourseH on :07:32 GMT -06:00 NUA 311 Holistic Assessment in Nursing 2. What information in the patient’s history indicates increased potential for breathing problems? (1 points)  Mother smokes in the house  They live with a dog, two cats, and a hamster  Father has a history of asthma but “grew out of it” and has seasonal allergies  No significant medical illnesses other than wheezing  No medications except for the albuterol when needed  His mother states that James has a lot of “colds” year-round which seem to last for a long time  During these episodes he wakes up at night coughing. His mother also mentions that the daycare provider mentioned James would often start to cough while playing and has to stop his activity to “catch his breath”. 3. What are 5 common causes of wheezing in children? (2 points)  Exposure to smoke  Asthma  Respiratory disorder  Allergy  Chocking 4. Describe the pathophysiology of Asthma. (3 points) An allergic hypersensitivity to certain inhaled allergens (pollen), irritants (tobacco, ozone), microbes, stress, or exercise that produces a complex response characterized by bronchospasm and inflammation, edema in walls of bronchioles, and secretion of highly viscous mucus into airways. These factors greatly increase airways resistance, especially during expiration, and produce the symptoms of wheezing, dyspnea, and chest tightness (Jarvis, 2016, p. 453). 5. What physical examination data do you want to collect? (3 points) Inspection: During severe attack: increased respiratory rate, SOB with audible wheeze, use of accessory neck muscles, cyanosis, apprehension, retraction of intercostal spaces. Expiration labored, prolonged. When chronic, may have barrel chest. Palpation: Tactile fremitus decreased, tachycardia. Percussion: Resonant. May be hyperresonant if chronic. Auscultation: Diminished air movement. Breath sounds decreased, with prolonged expiration. Voice sounds decreased. Adventitious Sounds: Bilateral wheezing on expiration, sometimes inspiratory and expiratory wheezing (Jarvis, 2016, p. 453). This study source was downloaded by from CourseH on :07:32 GMT -06:00 NUA 311 Holistic Assessment in Nursing Case Information: On physical exam, James has a non-productive cough and some audible wheezing. He is afebrile with a heart rate of 92 and respiratory rate of 24 with mild accessory muscle use but no retractions. His oxygen saturation is 92% on room air. He is noted to have boggy turbinates bilaterally with some clear nasal drainage but exam of his eyes, ears, mouth, and throat is otherwise unremarkable. His voice is not hoarse and his neck has full ROM w