Virtual Case Scenario: Kelsey Young (The Neighborhood, Season 2; Episodes 5-7)
Learning Objectives:
Student participants will:
1. Perform a physical assessment in the healthcare provider (HCP) office.
2. Understand the pathophysiology of asthma.
3. Understand the evidence-based practices related to pediatric asthma.
4. Recognize the significance of an asthma exacerbation.
5. Analyze data related to asthma and determine appropriate interventions.
6. Prepare to administer meds according to provider orders.
7. Attend to psychosocial issues of family members related to asthma exacerbation.
8. Provide patient education related to pediatric asthma care.
Read the chapter on assessment and the respiratory system, focusing on asthma.
Background: Kelsey Young is the 7-year-old daughter of Angie and Steve Young. She is
enrolled in second grade at the NBH elementary school. She has a very stable home life. She
has a younger brother Marcus and a new sibling on the way. Kelsey has had ongoing issues
with reactive airway disease. Her mom manages her with an albuterol inhaler with a
spacer, and loratadine (Claritin) syrup. Of concern is the fact that Kelsey is allergic to cats;
despite this, she has two cats in her home. Mom has discussed looking for new homes for
the cats but this only makes Kelsey upset and start to cry.
a) Current client history: Kelsey has an increase in her allergy symptoms this week.
On Friday (the fourth day of her symptoms) she has been coughing all night and
has some subtle wheezing in the morning. Her mom gives her loratadine (Claritin)
and her inhaler and sends her to school. The school nurse calls home and suggests
Kelsey be seen by her healthcare provider. She arrives at the NBH Clinic and you
are her nurse getting her intake.
b) You ask Kelsey and her mom, Angie to come to the exam room. How will you
begin your intake? What information should obtain? Refer back to the
Assessment module.
Is there a family history of allergies or asthma? Is there a personal history of any allergic
conditions? What type of respiratory symptoms is the person experiencing? Under what
circumstances do these symptoms occur? Has a family history of asthma, eczema or allergies.
Has eczema or an allergy, such as hay fever.
Has had bronchiolitis.
Was born prematurely, especially if they required a ventilator.
Had a low birth weight.
Is exposed to second-hand cigarette smoke or has a mother who smoked during pregnancy.
c) Here is some of her data.
, Weight 55 lb
Height 50 inches
BMI
Gender Female
Race African American
Religion
Marital status NA
Allergies NKDA (no known drug allergies)
a) Past medical history: Kelsey has had ongoing issues with reactive airway
disease. Her episodes appear to be seasonal and she is managed with loratadine
(Claritin) and an albuterol inhaler with a spacer.
b) Surgical history: none
c) Review of systems (ROS)/ subjective: Kelsey tells you her breathing is hard,
her nose is runny, and she feels bad.
d) Social history: Active 7-year-old, has one brother and two cats. She lives at home
with mom and dad and her brother.
e) Current medications: loratadine (Claritin) syrup, albuterol inhaler with a spacer
as needed
f) Physical examination is below. What is missing from your assessment?
Spo2 not mentioned.
General Excellent health, up to date on all
immunizations
VS T- 98.7, BP 95/60, HR 90, RR 32
Skin Dry, pale.
HEENT Mucous membranes moist, small amount
clear drainage in nose
Respiratory Labored breathing, 2+ intercostal retractions
noted; inspiratory and expiratory wheezes
Learning Objectives:
Student participants will:
1. Perform a physical assessment in the healthcare provider (HCP) office.
2. Understand the pathophysiology of asthma.
3. Understand the evidence-based practices related to pediatric asthma.
4. Recognize the significance of an asthma exacerbation.
5. Analyze data related to asthma and determine appropriate interventions.
6. Prepare to administer meds according to provider orders.
7. Attend to psychosocial issues of family members related to asthma exacerbation.
8. Provide patient education related to pediatric asthma care.
Read the chapter on assessment and the respiratory system, focusing on asthma.
Background: Kelsey Young is the 7-year-old daughter of Angie and Steve Young. She is
enrolled in second grade at the NBH elementary school. She has a very stable home life. She
has a younger brother Marcus and a new sibling on the way. Kelsey has had ongoing issues
with reactive airway disease. Her mom manages her with an albuterol inhaler with a
spacer, and loratadine (Claritin) syrup. Of concern is the fact that Kelsey is allergic to cats;
despite this, she has two cats in her home. Mom has discussed looking for new homes for
the cats but this only makes Kelsey upset and start to cry.
a) Current client history: Kelsey has an increase in her allergy symptoms this week.
On Friday (the fourth day of her symptoms) she has been coughing all night and
has some subtle wheezing in the morning. Her mom gives her loratadine (Claritin)
and her inhaler and sends her to school. The school nurse calls home and suggests
Kelsey be seen by her healthcare provider. She arrives at the NBH Clinic and you
are her nurse getting her intake.
b) You ask Kelsey and her mom, Angie to come to the exam room. How will you
begin your intake? What information should obtain? Refer back to the
Assessment module.
Is there a family history of allergies or asthma? Is there a personal history of any allergic
conditions? What type of respiratory symptoms is the person experiencing? Under what
circumstances do these symptoms occur? Has a family history of asthma, eczema or allergies.
Has eczema or an allergy, such as hay fever.
Has had bronchiolitis.
Was born prematurely, especially if they required a ventilator.
Had a low birth weight.
Is exposed to second-hand cigarette smoke or has a mother who smoked during pregnancy.
c) Here is some of her data.
, Weight 55 lb
Height 50 inches
BMI
Gender Female
Race African American
Religion
Marital status NA
Allergies NKDA (no known drug allergies)
a) Past medical history: Kelsey has had ongoing issues with reactive airway
disease. Her episodes appear to be seasonal and she is managed with loratadine
(Claritin) and an albuterol inhaler with a spacer.
b) Surgical history: none
c) Review of systems (ROS)/ subjective: Kelsey tells you her breathing is hard,
her nose is runny, and she feels bad.
d) Social history: Active 7-year-old, has one brother and two cats. She lives at home
with mom and dad and her brother.
e) Current medications: loratadine (Claritin) syrup, albuterol inhaler with a spacer
as needed
f) Physical examination is below. What is missing from your assessment?
Spo2 not mentioned.
General Excellent health, up to date on all
immunizations
VS T- 98.7, BP 95/60, HR 90, RR 32
Skin Dry, pale.
HEENT Mucous membranes moist, small amount
clear drainage in nose
Respiratory Labored breathing, 2+ intercostal retractions
noted; inspiratory and expiratory wheezes
