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INTRODUCTION

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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

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PATIENT PRESENTATION

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Chief Complaint

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"I am having trouble catching my breath."

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History of Present Illness

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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.

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Past Medical History

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Asthma × 8 years with five hospitalizations since diagnosis, but no history of intubation

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Perennial allergic rhinitis × 5 years

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ADHD × 3 years

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Family History

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Positive for allergic rhinitis (mother and sister)

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Social History/Work History

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Currently enrolled in the fifth grade and lives with his mother, father, and sister. There are no animals at home.

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Tobacco/Alcohol/Substance Abuse

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Denies any tobacco use, but does have exposure to secondhand smoke at home. Also denies any alcohol or drug use.

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Allergies/Intolerances/Adverse Drug Events

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No known drug allergies

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Medications (Prior to Admission)

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Primatene Mist inhaler one to two puffs PRN

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Albuterol 90 mcg one to two puffs every 4 to 6 hours PRN shortness of breath (has not been filled in over 6 months)

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Cetirizine 10 mg PO daily PRN allergies

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Methylphenidate 10 mg PO q 9 am and 3 pm

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Review of Systems

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Negative, except for above

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Physical Examination

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General
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The patient appears slightly anxious, is in respiratory distress, and ...

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