For This Question, Please Read The Following Case Study ✓ Solved

For this question, please read the following case study and then

For this question, please read the following case study and then respond to the questions noted below:

Johnathan, age 7, presents to the office with symptoms of worsening cough and wheezing for the past 24 hours. He is accompanied by his mother, who is a good historian. She reports that her son started having symptoms of a viral upper respiratory infection 2 to 3 days ago, beginning with a runny nose, low-grade fever of 101.0 degrees F orally, and loose cough. Wheezing started on the day before the visit, so Johnathan's mother started administering albuterol metered-dose inhaler (MDI) two puffs before bed and then two puffs at around 2 AM. The cough and wheezing appear worse today, according to the mother. He had difficulty taking deep-enough breaths to inhale this morning's dose of albuterol, even using the spacer. Johnathan has been a patient at the clinic since birth and is up to date on his immunizations. His growth and development have been normal, and he is generally healthy except for mild intermittent asthma. This is his first asthma exacerbation of the school year, and his mother expresses a concern about sending him to school with an inhaler. Johnathan is afebrile with a respiratory rate of 36 and a tight cough every 1 or 2 minutes. He weighs 45 pounds (20.5 kgs.). The examination is all within normal limits except for his breath sounds. He has diffused expiratory wheezes and mild retractions. Pulse oximetry readings have been 93% of oxygen saturation.

Paper For Above Instructions

Johnathan's case presents a classic approach to managing asthma exacerbations in children. As healthcare practitioners, it is essential to understand the pharmacological therapies, education requirements, assessment tools, classification of asthma, and parents' concerns in such scenarios.

Pharmacological Therapies

The primary pharmacological therapy for Johnathan’s acute exacerbation involves the use of bronchodilators, specifically short-acting beta-2 agonists (SABAs), such as albuterol. Given that he has already been using his albuterol MDI, it may be appropriate to increase the dosage during this exacerbation under the guidance of a healthcare provider. The National Heart, Lung, and Blood Institute (NHLBI) guidelines suggest administration of 2-6 puffs every 4-6 hours as needed, or using a nebulizer if the inhaler is ineffective (NHLBI, 2020).

In addition, considering his oxygen saturation is at 93%, which indicates mild hypoxemia, supplemental oxygen may also be necessary to improve his oxygen levels while further assessment is made. If symptoms do not improve with albuterol, systemic corticosteroids (like prednisone) may be warranted to reduce airway inflammation (Global Initiative for Asthma [GINA], 2021).

Patient Education

It is crucial to educate Johnathan and his mother about managing asthma exacerbations effectively. Key information includes: understanding triggers—such as viral infections or allergens—and recognizing early warning signs of exacerbation, such as increased respiratory rate, using the inhaler more frequently, or difficulty breathing. They should also be taught the correct technique for using the metered-dose inhaler, including the use of a spacer for enhanced medication delivery (Bousquet et al., 2019).

Additionally, Johnathan’s mother should receive information on developing an asthma action plan that includes measures to take during an exacerbation, when to use rescue medications, and when to seek medical attention (e.g., if the child shows continuous difficulty breathing or if symptoms do not improve) (Centers for Disease Control and Prevention [CDC], 2020).

Assessment Tools

An appropriate clinical assessment tool for Johnathan is the Asthma Control Test (ACT) or the child-specific version known as the Childhood Asthma Control Test (c-ACT). These tools help assess asthma control and symptoms over the past four weeks, which can guide treatment recommendations and adjustment (Nathan et al., 2014). Additionally, peak flow meters may be beneficial in monitoring Johnathan’s lung function and providing objective data on his respiratory status.

Classification of Asthma

Asthma is classified into several categories based on frequency and severity of symptoms. According to the NHLBI, asthma can be classified as intermittent, mild persistent, moderate persistent, or severe persistent (NHLBI, 2020). In Johnathan's case, given that he has a history of mild intermittent asthma, this exacerbation may be classified as a temporary worsening of his condition and requires intervention but does not indicate a change in the overall classification.

Addressing Parental Concerns

Regarding his mother’s concern about sending Johnathan to school with an inhaler, it is essential to reassure her about the safety and importance of having his inhaler available. Schools typically have policies in place that allow children with asthma to carry their inhalers. It is vital to discuss the school’s emergency response plan in case Johnathan experiences difficulty during school hours (American Academy of Pediatrics, 2019). Providing a written asthma action plan to the school staff can also help ensure they are prepared to assist Johnathan if he suffers an exacerbation at school.

Plan of Care

The appropriate plan of care for Johnathan should include the following steps:

1. Increase the albuterol dosage during exacerbation as per guidelines.
2. Provide systemic corticosteroids if the asthma symptoms do not improve.
3. Administer supplemental oxygen if needed to maintain oxygen saturation levels above 95%.
4. Educate Johnathan and his family on recognizing asthma triggers, using a peak flow meter, and understanding when to use rescue medications.
5. Develop an asthma action plan that can be shared with the school.
6. Follow up within a week or sooner if symptoms worsen to reassess asthma control and medication efficacy.

In conclusion, the management of Johnathan’s asthma exacerbation must be comprehensive, focusing on immediate symptom relief and long-term preventative education. Proper pharmacological therapy, patient and family education, utilization of assessment tools, understanding asthma classification, addressing parental concerns, and implementing an effective plan of care are critical to improving Johnathan's outcomes and quality of life.

References

• American Academy of Pediatrics. (2019). Managing asthma in children in school settings.
• Bousquet, J., Mantzouranis, E., Cruz, A. A., et al. (2019). Uniform Definition of Asthma Control. Journal of Allergy and Clinical Immunology, 143(2), 367-372.
• Centers for Disease Control and Prevention. (2020). Asthma Care: Patient Education.
• Global Initiative for Asthma. (2021). GINA Report, Global Strategy for Asthma Management and Prevention.
• Nathan, R. A., Sorkness, C. A., Kosinski, M., et al. (2014). Development of the Asthma Control Test: a survey for assessing asthma control. Journal of Allergy and Clinical Immunology, 113(1), 59-65.
• National Heart, Lung, and Blood Institute. (2020). Guidelines for the Diagnosis and Management of Asthma.
• Rabe, K. F., Adachi, M., Lai, C. K., et al. (2017). Global strategy for the diagnosis, management, and prevention of asthma in children. European Respiratory Journal 49(1).
• Solé, D., et al. (2015). The burden of asthma in children and its impact on their families. Journal of Asthma, 52(6), 623-629.
• Thomas, M., et al. (2018). The role of the school in asthma management: a community-based participatory approach. BMC Public Health, 18(1), 1-10.
• Wang, W., et al. (2021). Assessing control of asthma in children: a randomized controlled trial comparing peak flow monitoring methods. Pediatric Pulmonology, 56(12), 3638-3647.