A nurse in the emergency department (ED) is assisting with the care of a 10-year-old child.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress

Condition Most Likely Experiencing

Choose 1 correct condition:

1. Acute Asthma Exacerbation
   The child has a history of asthma, presents with wheezing, difficulty breathing, and increased use of an albuterol inhaler. These findings are consistent with an acute asthma exacerbation triggered by a possible upper respiratory infection or environmental allergen.
2. Foreign Body Aspiration
   The child’s sudden onset of coughing and wheezing during lunch could suggest aspiration of a foreign body. However, the history of asthma and bilateral wheezing makes this less likely.
3. Acute Bronchitis
   The child’s cough and wheezing could be due to acute bronchitis, often caused by a viral infection. However, the history of asthma and the use of accessory muscles to breathe make asthma exacerbation more likely.
4. Anaphylaxis
   The child’s difficulty breathing and wheezing could indicate anaphylaxis, especially if there was exposure to a known allergen. However, the absence of urticaria, angioedema, or hypotension makes this less likely.

Actions to Take

Choose 2 correct actions:

1. Administer albuterol nebulizer treatment.
   Albuterol is a short-acting beta-agonist that relaxes bronchial smooth muscle and improves airflow in asthma exacerbations.
2. Monitor oxygen saturation continuously.
   Continuous oxygen saturation monitoring is essential to assess the child’s respiratory status and response to treatment.
3. Administer epinephrine intramuscularly.
   Epinephrine is used for anaphylaxis, not for asthma exacerbation, unless there is a concurrent anaphylactic reaction.
4. Obtain a chest X-ray.
   A chest X-ray is not immediately necessary for asthma exacerbation unless there is suspicion of pneumothorax or foreign body aspiration.
5. Encourage the child to drink fluids.
   While hydration is important, it is not a priority action during an acute asthma exacerbation.

Parameters to Monitor

Choose 2 correct parameters:

1. Peak expiratory flow rate (PEFR).
   PEFR measures the child’s ability to exhale air and is a key indicator of asthma severity and response to treatment.
2. Oxygen saturation.
   Oxygen saturation monitoring is critical to assess the child’s oxygenation status and need for supplemental oxygen.
3. Capillary refill time.
   Capillary refill time is more relevant in assessing perfusion status, such as in shock, and is not a priority in asthma exacerbation.
4. Serum potassium level.
   Frequent albuterol use can cause hypokalemia, but this is not an immediate priority parameter to monitor during an acute exacerbation.
5. Urine output.
   Urine output is important for assessing hydration status but is not directly related to asthma management.