Asthma Exacerbation Concept Map

Chief Complaint and HPI: Gabriel Martinez brought to ED by his mother for a moderate asthma exacerbation. His Initial score on PAS was a 9. Most recent PAS score Is 5. Exacerbation started 4 hours prior after he was playing kickball after school. Gabriel was exposed to secondhand smoke which triggered his asthma. Gabriel's mom, Yvonne picked him up from school, she noticed he was coughing and having trouble breathing. His asthma exacerbation worsened over the course of 4 hours. His mom was unable to find his rescue inhaler because Gabriel said he threw it out few weeks ago because he did not like the side effects. Gabriel's peak flow meter readings at home were 55%, 59% and 60% of his normal. His mom tried administering extra dose of daily maintenance inhaler, but It was Ineffective. Gabriel rated his pain at 4 and said he Is experiencing soreness In his chest and neck. His cough Is less frequent than It was and his wheezing Is Improved.

Patho For Main Medical Diagnosis:

Asthma Exacerbation

Asthma is persistent but variable inflammation of the airways. Airflow Is limited due to bronchoconstriction, airway hyperresponsiveness and edema of the airways. Exposure to allergens or irritants initiates the inflammatory cascade.

Clinical manifestations include wheezing, cough, dyspnea, and chest tightness. Decreased or absent breath sounds may signal a significant decrease in air movement resulting from exhaustion and an Inability to generate enough muscle force to breathe.

In some people, compromised pulmonary function may lead to a state of continuous symptoms and chronic debilitation. Pneumonia, tension pneumothorax, status asthmaticus and acute respiratory failure are possible complications of an asthma exacerbation.

Labs and diagnostics include history and physical exam, spirometry with response to bronchodilator therapy, peak expiratory flow rate, chest x-ray, pulse oximetry, allergy skin testing, blood levels of eosinophils and IgE, capillary, ABGs

Hx of eczema, environmental allergies such as pets, dust, and pollen; past hospitalization, persistent asthma since 5 years old

Home medications Include Albuterol metered-dose Inhaler at 90 mcg 1-2 puffs Inhaled q2-4h and PRN for cough or wheezing, fluticasone proprionate metered-dose Inhaler at 88mcg 2 puffs Inhaled BID, OTC antihistamine if experiencing allergy symptoms, unknown Rx cream treatment for eczema

Hospital medications: Albuterol nebulizer 5mg/ml, dexamethasone 20mg PO, oxygen 2L via nasal cannula

Gabriel Martinez, 8 y.o., DOB: 2/4/13, patient has environmental allergies to pet dander, dust, and pollen. No allergies to latex, medication or food.

Primary Diagnosis: Mild Asthma Exacerbation

T 37.2, BP 123/82, HR 121, RR 22, SaO2 98%, Pain 4. Heart Is racing, possible albuterol side effect, no skin Issues but occasionally experiences eczema, reports frustration with asthma diagnosis. Pt exhibiting tachycardia, hypertension, tachypnea, expiratory and Inspiratory wheezing noted upon auscultation, Intercostal retractions, speaks partial sentences, with PAS score of 9. Patient Is obese within 95> percentile.

Nursing Diagnosis

Ineffective health management r/t nonadherence with prescribed regimen aeb impaired breathing, limited knowledge of prescribed medication, decreased ability to participate In social activities

Ineffective breathing pattern r/t increased physical exertion aeb chest and neck soreness, coughing, wheezing and Intercostal retractions.

Goal: Gabriel and his mother will verbalize their understanding of the instructions on how to manage his asthma by the end of his emergency department visit.

Interventions: 1. Instruct Gabriel and his mom to avoid environmental triggers such as pet dander, dust and pollen to prevent asthma exacerbation. 2. Instruct Gabriel and his mom to create and asthma action plan at school and having one additional rescue Inhaler available at the after-school program. 3. Instruct Gabriel and his mom to always have Gabriel carry an albuterol rescue inhaler with him. 4. Instruct the patient and Yvonne that Gabriel can engage In physical activity as long as he uses 2 puffs of the albuterol Inhaler 15 minutes before an activity. 5. Teach the Importance of a medication schedule that Incorporates his rescue inhaler and meets therapeutic goals.

Goal met. Yvonne and Gabriel verbalized correct health management Interventions that will aid them In managing Gabriel's asthma.

Goal: The patient will demonstrate a breathing pattern that supports blood gas results that are within the client's normal parameters before the time of discharge.

Interventions: 1. Monitor oxygen saturation continuously using pulse oximetry. 2. Position client In high fowler's to promote gas exchange and lung expansion. 3. Administer oxygen via nasal cannula as ordered. 4. Observe color of tongue, oral mucosa and skin for signs of cyanosis. 5. Assess Gabriel for hemodynamic stability.

Goal met: Gabriel Is displaying relaxed breathing patterns, Intercostal retractions, chest and neck soreness Is no longer present. Patient verbalized he no longer feels fatigued.