3 HESI RN CASE STUDY PEDI

3 HESI RN CASE STUDY PEDI

Safe and Effective Care: Health Promotion

The school nurse's observations of Joshua include the following: absence of fever or sore throat, persistent dry cough, wheezing, exercise intolerance, and a history of resolution of symptoms after β2-agonists treatments in the emergency department (ED).

1. 1.ID: 17498049946

Which of the school nurse’s observations are consistent with the diagnosis of bronchitis?

• A dry cough that becomes productive. Correct

A dry, hacking cough that becomes productive in 2 to 3 days is characteristic of bronchitis. The cough associated with asthma is nonproductive.

• The absence of fever or sore throat.

Bronchitis is typically caused by a virus and is accompanied by a low grade fever and a sore throat. Fever is not associated with asthma.

• Exercise intolerance.

Bronchitis resolves in 5 to 10 days and chronic exercise intolerance is not a feature. It is a feature of poorly controlled asthma.

• Response to β2-agonists.

As a viral illness, bronchitis responds to symptomatic treatment: antipyretics,

analgesics, and humidity. In young children, response to β2-agonists is often used as a diagnostic tool for asthma.

1. Safe and Effective Care: Management of Care

The school nurse asks Joshua’s parents to take him to a healthcare provider (HCP) to evaluate his respiratory problem. After pulmonary function testing is performed, it is determined that Joshua has moderate persistent asthma and allergic rhinitis. Joshua returns to school with a note from his mother stating that he may not participate in recess on the playground.

2. 2.ID: 17498049954

Joshua’s mother asks the school nurse to explain the pulmonary function test. Which of the following is the best response?

• "Pulmonary function tests are only accurate in children ages 8 and

older who can blow a big breath out.” Although a large exhalation is required to perform the test, children as young as age 5 are able to perform pulmonary function tests. Interpretation is adjusted based on gender, age, and height.

• "While helpful, pulmonary functions tests are an expensive alternative

to careful history and physical assessment.” Pulmonary functions tests are the most objective measure for the diagnosis of asthma.

• "Pulmonary function tests are used to detect airflow limitation even

when no symptoms are clinically evident.” Correct Symptoms in children with asthma are typically seasonal or nocturnal and are often not evident on physical examination. Pulmonary function tests are able 1 / 2

used to detect effects of airway inflammation that may otherwise be undetectable.

• "Pulmonary function tests are of use at the time of diagnosis. Joshua

will need no further testing.” Pulmonary function tests are performed periodically to assess response to treatment or to determine the need to change therapy.Awarded 1.0 points out of 1.0 possible points.

3. 3.ID: 17498049956

If Joshua fails to adhere to the proper administration of his asthma medications, what symptoms would be expected to occur?

• Continual symptoms throughout the day.

Continual symptoms are an indication of severe persistent asthma.

• Nighttime cough more than once a week but not nightly. Correct

Nocturnal cough more than once a week is a feature of moderate, persistent asthma as are daily symptoms and interference with physical activity.

• Control of symptoms by single drug therapy with a β2-agonist such as

albuterol.This is an appropriate drug strategy for children with intermittent asthma.Children with persistent levels of asthma require controller medication.

• Symptoms two times a week, but less than one time a day.

This describes mild persistent asthma.Awarded 1.0 points out of 1.0 possible points.

4. 4.ID: 17498049959

In developing plan of care goals, the school nurse recognizes what level of activity is appropriate for children with asthma?

• Running that exacerbates airway constriction and is contraindicated.

Cough or wheezing while running is a sign of uncontrolled asthma. Controller medication needs to be increased and/or a β2-agonist needs to be taken 10 minutes prior to exercising.

• Children with asthma who have a history of emergency department

visits should limit physical activity.Emergency department visits are a sign of poorly controlled asthma or improper diagnosis. Adherence with controller medication should eliminate emergency department visits.

• Children with asthma should participate fully in all activities, including

sports. Correct The National Asthma Education and Prevention Program, which sets standards for the management of asthma, states that this as a primary goal of care.

• Children should participate in recess but cannot participate in

organized sports.Children with asthma can participate fully in sports. Swimming is a particularly good sport for children with asthma since humidity aids in preventing bronchospasm

• Safe and Effective Care: Safety and Infection Control
• / 2