Tommy Gibbs: Pedi Asthma Exacerbation
It is February & the height of the flu season. Mrs. Gibbs brings Tommy, age 8, to General Hospital Urgent Care Center. He has a history of Asthma, diagnosed at age 4. He has no other medical problems. He received the flu vaccine in October. Mrs. Gibbs reports that Tommy has had a fever, cough, chills, & general malaise for 2 days.
He has an albuterol inhaler that he takes to school for use if needed &
a nebulizer machine at home. He takes no other medications.
Tommy used the albuterol nebulizer several times yesterday, & then last night the nebulizer didn’t seem to help. Mrs. Gibbs put Tommy in the shower & the steam of the shower helped. But this morning he was short of breath, wheezing & having a hard time talking.
Of note both Mr. & Mrs. Gibbs are cigarette smokers.
Vital Signs: BP 130/72, HR 142, RR 38, POX 87% RA, Temp 101.6, Weight 110 lbs (50 kg)
Physical Assessment: Neuro A & O x3; Lungs breath sounds diminished, faint expiratory wheeze; Heart Sounds regular, tachycardic, S1,S2, no murmurs appreciated; Abd soft, nontender, non-distended, bowel sounds +; Extremities PP+, no edema.
The Health Care Provider asks the nurse to place Tommy on nasal 02 & titrate to POX of 92% & if needed to maintain adequate POX use non-breather mask, obtain IV access & routine labs, place on the cardiac monitor, & give an albuterol nebulizer treatment stat & solumedrol 100 mg IV stat.
Respond to Questions:
- What is the pathophysiology & may have contributed to this acute event?
- Explain why the treatments & medications were ordered. How will they help Tommy?
- What is the Health Care Provider trying to prevent?