Asthma Case Study (Peds)

[Zelda21]

I am working on a case study for my pediatric lab. I won't post the entire case study, because I don't want to share my school's work, or give other student's my answers. I've made it through most of the questions, but I am stuck on a couple things. I'm in the spring semester of my junior class (BSN program).

5 year old came in ED with asthma symptoms. Being transferred to floor. Case study states ER nurse was busy and her report simply said the pt. is stable and has wheezing and a temperature of 101.3F.

After "my assessment" I gather the pt. has worsened upon transfer from ED to the floor. Current VS are RR 52, HR 112, BP 108/56, T 101.8 F, SaO2 92%. He has rales in RLL, wheezing, and diminished breath sounds in lung bases.

I need to explain an order for a clear liquid diet (after his respirations are below 40/min).

So I think that - clear liquids help with the dehydration (CS said he had dry mucous membranes and poor skin turgor) and that increasing liquids will help loosen the secretions and mucous. As for the only do this after

I need to explain why I would notify the physician if the pt's temp is above 101.5F

Technically the pts temp is already above that (but this is what my assignment says, so I'm just roiling with it). I'm thinking that this might lead to believe a bacterial infection is forming, due to thick secretions, and all the stress on the child's body. An increasing temp could warrant checking for an infection? Also I think that his temp might be raised due to the normal inflammation process, so maybe a higher temp is normal in an asthma exacerbation case? But then I also think maybe an increase in his temp may be due to volume depletion, which I think it a problem in this child. So increase temp is because the child is still not meeting his fluid requirements? (Later in the CS an IV fluid regime is started, which is why I think this may be part of it).

[Esme12, ASN, BSN, RN]

Think about why you don't want a heavy diet in a sick kid that is breathing fast. Think why you would only want clear liquids. What foods can build up mucous in the child's throat causing an increase of the production of mucous? How would a full stomach affect a child in respiratory distress? It is kind of like running a marathon after a Thanksgiving meal. IF the child has an increase mucous production and cough many children regurgitate....which would be easier?

Why would a child with asthma have rales and an elevated temp? Why would this be important? Is rales a usual finding in asthma without infection? Why would the MD want to know if the child's temp goes higher after hydration and admission?

Why are small changes a big deal with children?

[Zelda21]

Think about why you don't want a heavy diet in a sick kid that is breathing fast. Think why you would only want clear liquids. What foods can build up mucous in the child's throat causing an increase of the production of mucous? How would a full stomach affect a child in respiratory distress? It is kind of like running a marathon after a Thanksgiving meal. IF the child has an increase mucous production and cough many children regurgitate....which would be easier?

Thanks for helping me! Alright so clear liquid diet because other foods/drinks can increase mucous production, which we don't want. With the

Why would a child with asthma have rales and an elevated temp? Why would this be important? Is rales a usual finding in asthma without infection? Why would the MD want to know if the child's temp goes higher after hydration and admission?

Rales could signify a deeper problem in the lungs, with the temp such as infection? Rales isn't a normal finding without infection. So the elevated temperature is letting the MD know the the child's condition is worsening. The infection could be what is causing the asthma attack.

Why are small changes a big deal with children?

Small changes can mean a significant change in status for children. Children crash very quickly.

Am I starting to understand? Or still way off?

[Esme12, ASN, BSN, RN]

You are on the path. Children will compensate and compensate and compensate....then crash.

Solid food is difficult to digest and places a strain on the systems already struggling to keep up. Children will throw up on principle and it the body is busy trying to breathe it will get rid of the food it can't digest.

Increased mucous production can further the airway compromise and cause children to choke, gag and vomit. Children airways a very small in compared to an adult. If an adult has 1mm of swelling in a 5mm airway they still have 4 mm to breathe with. If a child has a 2mm airway and they have 1mm of swelling their airway is almost absent. That is a big deal.

Pneumonia is a concern with the temp and the child will need antibiotics and the PNA will further increase the danger to the airway.

The other thing to remember that in children....a decreasing RR is not always a good sign...it may mean they are triing and are going to crash.

Well done!