What is the best intervention for the nurse caring for a child experiencing an acute asthma attack?

Choice A rationale

Alpha-1 antitrypsin (AAT) deficiency is an autosomal co-dominant genetic disorder, not strictly recessive. While individuals with two deficient alleles (PiZZ) are at highest risk, heterozygous carriers (PiMZ) also have an increased risk for developing COPD, particularly with environmental exposures like smoking. Therefore, stating children will be at high risk is an oversimplification and potentially inaccurate regarding the genetic transmission pattern.

Choice B rationale

While genetic counseling is an appropriate recommendation for individuals with AAT deficiency to understand inheritance patterns and reproductive risks, it is not the most immediate and direct response regarding the client's personal health implications. The client's question focuses on what the diagnosis means for *them*, not their offspring initially.

Choice C rationale

AAT deficiency significantly increases the risk for developing emphysema, a form of COPD, especially when compounded by environmental factors such as smoking. AAT normally protects lung tissue from elastase, and its deficiency leads to unchecked protease activity and subsequent lung destruction. This response directly addresses the client's personal health risk and a major modifiable factor.

Choice D rationale

This statement is inaccurate. AAT deficiency is not a recessive gene in a simple Mendelian sense where only homozygous recessive individuals are affected. It's an autosomal co-dominant condition where both alleles contribute to AAT levels, and even heterozygous carriers (PiMZ) can have lower AAT levels and increased risk for COPD, especially with smoking. Thus, it certainly impacts health.

Choice A rationale

Offering plenty of fluids is important for hydration and thinning secretions in asthma, but carbonated beverages can cause gastric distension and worsen respiratory distress by pressing on the diaphragm, making them unsuitable. Furthermore, this intervention does not directly address the acute bronchoconstriction that defines an asthma attack.

Choice B rationale

While humidified oxygen might be indicated for hypoxemia, a cool mist tent is not the primary intervention for acute asthma. The core problem is bronchoconstriction, which requires bronchodilators to open the airways. A cool mist tent offers general comfort but does not provide specific therapeutic relief for the underlying pathophysiology.

Choice C rationale

Administering sedatives to a child experiencing an acute asthma attack is generally contraindicated. Sedation can depress respiratory drive, worsen hypoventilation, and mask signs of worsening respiratory distress, potentially leading to respiratory arrest, especially when the child's respiratory effort is already compromised.

Choice D rationale

Positioning the child with arms resting on the overbed table, often referred to as the "tripod position," allows for the use of accessory respiratory muscles (e.g., sternocleidomastoid, scalenes) to facilitate breathing. This position optimizes lung expansion and reduces the work of breathing by providing a stable base for shoulder girdle muscles to pull up the chest cage.