CASE LEARNING OBJECTIVES
Classify current asthma severity
Recognize the clinical signs and symptoms of asthma
Develop an appropriate treatment and monitoring plan for acute asthma therapy
List the factors that may affect a patient's adherence to asthma therapy
Educate a patient who is on asthma medication about the use of inhaled delivery devices, peak flow meters, and asthma education plans
"I am having trouble catching my breath."
History of Present Illness
Jeremy Weber is an 11-year-old African American male who presents to the emergency department (ED) complaining of shortness of breath, which has been getting progressively worse over the past 12 hours. His shortness of breath started on the playground at school after a kickball game with his classmates. After the game, in addition to shortness of breath, JW experienced wheezing, coughing, and chest tightness. At this time, he self-treated his breathing difficulty with an old Primatene Mist inhaler that he carries in his pocket wherever he goes. Initially, he was having difficulty breathing, but now he is in acute distress. On arrival to the ED, his oxygen saturation (SAO2) was 85% (0.85) and he was able to answer questions only with single words. He was treated with three nebulized albuterol treatments with some relief; repeat SAO2 was 90% (0.90). JW has had a runny nose and watery eyes for the past 2 weeks, which is not unusual for him.
Asthma × 8 years with five hospitalizations since diagnosis, but no history of intubation
Perennial allergic rhinitis × 5 years
Positive for allergic rhinitis (mother and sister)
Social History/Work History
Currently enrolled in the fifth grade and lives with his mother, father, and sister. There are no animals at home.
Denies any tobacco use, but does have exposure to secondhand smoke at home. Also denies any alcohol or drug use.
Allergies/Intolerances/Adverse Drug Events
Medications (Prior to Admission)
Primatene Mist inhaler one to two puffs PRN
Albuterol 90 mcg one to two puffs every 4 to 6 hours PRN shortness of breath (has not been filled in over 6 months)
Cetirizine 10 mg PO daily PRN allergies
Methylphenidate 10 mg PO q 9 am and 3 pm
Negative, except for above
The patient appears slightly anxious, is in respiratory distress, and ...