Breathing treatment question

[raebabelvn, LVN]

I have asthma, so I can push the boundaries of medication myself. I know my limits and when I need to seek medical help. However, I'm working a home health peds case, and the doctors orders are atrovent and xopenex q4h prn. The poor little guy has been sick all week, and earlier tonight he was doing great. No wheezing, no chest tightness, no fever. Then around 0130, he flipped. Tons of wheezing and tightness, he woke up coughing up sputum.... when I finally got him back to sleep, I took the opportunity to listen to his lungs. 2 hours after the treatment he was wheezing worse than before the treatment. His sats started dropping too. I repositioned and suctioned till his trach was clear. I have his sats back up and he's stable.

So my questions for you peds nurses, what would you have done?

[annabeap, MSN, APRN, NP]

I've noticed some of my kids drop their sats after treatments- especially on night shift when they're not taking in deep breaths and/or coughing effectively.

But alas, I am no pulmonologist, so I have no true opinion on what could've been done differently. As long as you were following orders, giving appropriate PRN doses, good work! :)

There's been much more asthma education on my unit lately- each kid has an algorithm (aka, what to do when he shows xyz). And I usually notify our MD if the pt needs something more, or is using the PRNs.

[NotReady4PrimeTime, RN]

The temptation to suction the daylights out of these trached kids when they drop their sats is very common but often the suctioning itself stimulates bronchospasm. When that happens the kiddies typically need a PRN bronchodilator like albuterol or levalbuterol, a little judicious suctioning and time to recover. They often have very little reserve so the time to recover is important. The fact that he had been sick all week just adds to that. You did all the things I would have done.

[caliotter3]

A recent client's mother suctioned her nearly every five minutes and demanded that I do the same. She went too deep and would evoke bleeding. The sad thing is when you attempt to do teaching with people like this, they argue you down and continue in earnest. The child looked none too eager when mom came at her with the suction catheter.

[raebabelvn, LVN]

Parents drive me nuts sometimes. Especially when I use my training and knowledge as a healthcare professional to make decisions that they don't agree with.

I didn't even think about the recovery time from suctioning! That'll be a good thing to keep in mind tonight.