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The Client with Asthma
14. When preparing the teaching plan for the mother of a child with asthma, which of the following would the nurse include as signs to alert the mother that her child is having an asthma attack?
1. Secretion of thin, copious mucus.
During an asthma attack, secretions are thick and are not usually expelled until the bronchioles are more relaxed.
2. Tight, productive cough.
At the beginning of an asthma attack the cough will be tight but not productive.
3. Wheezing on expiration.
The child who is experiencing an asthma attack typically demonstrates wheezing on expiration initially. This results from air moving through narrowed airways secondary to bronchoconstriction.
The child's expiratory phase is normally longer than the inspiratory phase. Expiration is passive as the diaphragm relaxes.
4. Temperature of 99.4°F (37.4°C).
Fever is not always present
unless there is an infection that may have triggered the attack.
15. Which assessment findings would lead the nurse to suspect that a toddler is experiencing respiratory distress? Select all that apply.
1. Coughing.
2. Respiratory rate of 35 breaths per minute.
3. Heart rate of 95 bpm.
4. Restlessness.
5. Malaise.
6. Diaphoresis.
The early signs of respiratory distress include restlessness, tachypnea, tachycardia, and diaphoresis.
Other signs include hypertension, nasal flaring, expiratory grunting, wheezing, and intercostal retractions.
Coughing and malaise typically do not indicate respiratory distress.
A heart rate of 95 bpm is normal for a toddler.
16. A 10-year-old child with a history of asthma who is 5 feet 4 inches (138 cm) tall uses an inhaled bronchodilator only when needed. He takes no other medications routinely. His best peak expiratory flow rate is 270 L/ minute. The child's current peak flow reading is 180 L/minute. The nurse interprets this reading as indicating which of the following?
1. The child's asthma is under good control, so the routine treatment plan should continue.
A peak flow reading greater than 80% of the child's personal best (in this case, 220 L /minute or better) would indicate that the child's asthma is in the green zone or under good control.
2. The child needs to start a short-acting inhaled beta 2-agonist medication.
The peak flow of 180 L/ minute is in the yellow zone, or 50% to 80% of the child's personal best. This means that the child's asthma is not well controlled, thereby necessitating the use of a short-acting beta 2-agonist medication to relieve the bronchospasm.
3. This is a medical emergency requiring a trip to the emergency department for treatment.
A peak flow reading in the red zone, or less than 50% of the child's personal best (135 L/ minute or less), would require notification of the health care provider or a trip to the emergency department.
4. The child needs to begin treatment with inhaled cromolyn sodium (lntal) for asthma control.
Cromolyn sodium (lntal) is not used for short-term treatment of acute bronchospasm. It is used as part of a long-term therapy regimen to help desensitize mast cells and thereby help to prevent symptoms.
17. An adolescent complains of chest pain and goes to the school nurse. The nurse determines that the teenager also has a history of asthma but has had no problems for years. Which of the following would the nurse do next?
1. Call the adolescent's parent.
Calling the adolescent's parent would be appropriate, but this would be done after the nurse obtains the peak flow reading and additional assessment data.
2. Have the adolescent lie down for 30 minutes.
Having the adolescent lie down may be an option,
but more data need to be collected to help establish a possible cause.
3. Obtain a peak flow reading.
Complaints of chest pain in children and adolescents are rarely cardiac.
With a history of asthma, the most likely cause of the chest pain is related to the asthma. Therefore, the nurse should check the adolescent's peak flow reading to evaluate the status of the air flow.
4. Give two puffs of a short-acting bronchodilator.
Because the adolescent has not experienced any asthma problems for a long time, it would be inappropriate for the nurse to administer a short-acting bronchodilator at this time.
18. A 7-year-old child with a history of asthma controlled without medications is referred to the school nurse by the teacher because of persistent coughing. Which of the following would the nurse do first?
1. Obtain the child's heart rate.
Although determining the child's heart rate is an important part of the assessment, it would be done after the history is obtained.
2. Give the child a nebulizer treatment.
More information needs to be obtained
before giving the child a nebulizer treatment.
3. Call a parent to obtain more information.
Because persistent coughing may indicate an asthma attack and a 7-year-old child would be able to provide only minimal history information, it would be important to obtain information from the parent.
4. Have a parent come and pick up the child.
Although it may be necessary for the parent to come and pick up the child,
a thorough assessment including history information should be obtained first.
19. When developing a teaching plan for the mother of an asthmatic child concerning measures to reduce allergic triggers, which of the following suggestions would the nurse expect to include?
1. Keep the humidity in the home between 50% and 60%.
To help reduce allergic triggers in the home, the nurse should recommend that the humidity level be kept between 50% and 60%.
Doing so keeps the air moist and comfortable for breathing.
When air is dry, the risk for respiratory infections increases.
Too high a level of humidity increases the risk for mold growth.
2. Have the child sleep in the bottom bunk bed.
Typically, the child with asthma should sleep in the top bunk bed to minimize the risk of exposure to dust mites. The risk of exposure to dust mites increases when the child sleeps in the bottom bunk bed because dust mites fall from the top bed, settling in the bottom bed.
3. Use a scented room deodorizer to keep the room fresh.
Scented sprays should be avoided because they may trigger an asthmatic episode.
4. Vacuum the carpet once or twice a week.
Ideally, carpeting should be avoided in the home if the child has asthma. However, if it is present, carpeting in the child's room should be vacuumed often, possibly daily, to remove dust mites and dust particles.
20. After discussing asthma as a chronic condition, which of the following statements by the father of a child with asthma best reflects the family's positive adjustment to this aspect of the child's disease?
1. "We try to keep him happy at all costs; otherwise, he has an asthma attack."
Trying to keep the child happy at all costs is inappropriate
and can lead to the child's never learning how to accept responsibility for behavior and get along with others.
2. "We keep our child away from other children to help cut down on infections."
Although minimizing the child's risk for exposure to infections is important,
the child needs to be with his or her peers to ensure appropriate growth and development.
3. "Although our child's disease is serious, we try not to let it be the focus of our family."
Positive adjustment to a chronic condition
requires placing the child's illness in its proper perspective.
Children with asthma need to be treated as normally as possible
within the scope of the limitations imposed by the illness.
They also need to learn how to manage exacerbations
and then resume as normal a life as possible.
4. 'I’m afraid that when my child gets older, he won't be able to care for himself like I do."
Children with a chronic illness need to be involved in their care
so that they can learn to manage it.
Some parents tend to overprotect their child with a chronic illness.
This overprotectiveness may cause a child to have an exaggerated feeling of importance or later, as an adolescent,
to rebel against the overprotectiveness and the parents.
21. An 8-year-old child with asthma states, "I want to play some sports like my friends. What can I do?" The nurse responds to the child based on the understanding of which of the following?
1. Physical activities are inappropriate for children with asthma.
Those are beneficial to asthmatic children, physically and psychosocially.
2. Children with asthma must be excluded from team sports.
3. Vigorous physical exercise frequently precipitates an asthmatic episode.
Most children with asthma can engage in school and sports activities that are geared to the child's condition and within the limits imposed by the disease.
4. Most children with asthma can participate in sports if the asthma is controlled.
The coach and other team members need to be aware of the child's condition and know what to do in case an attack occurs.
Those children who have exercise- induced asthma
usually use a short-acting bronchodilator before exercising.
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