Nursing Review of an Adolescent Asthma Patient

This article discusses the nursing review of an adolescent asthma patient suffering from status asthmaticus. It covers the primary and secondary symptoms, nursing interventions, and treatment options. The patient was reluctant to take inhalers and was also taking ibuprofen for a sprained ankle, which can be life-threatening in his severe asthmatic condition. The priority was to treat the severe asthmatic condition with prescribed medications and nursing interventions. The article also provides a clinical reasoning cycle and a plan for better patient outcomes.

Running head: NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
Name of the Student:
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Author Note:

1NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
Status asthmaticus is characterized by a sustained and chronic attack of asthma with
dry cough, wheezing, dyspnoea, wheezing and hypoxemia. It cannot be treated with standard
treatment therapy and may result in respiratory failure in some of the critical cases. In a case
study, a 14-year-old adolescent male named Simon Hayes was suffering from Status
asthmaticus. He was selected for his school football team and started wheezing severely. He
was not ready to come off and was not keen on taking inhalers. After examining the
condition, it was found that his rate of respiration was 32 breaths per minute and oxygen
saturation of 88% with rate of pulse at 132. His BP was 138/64 due to spasm in smooth
muscle and he was wheezing loudly and was having trouble to speak in full sentences.
Cyanosis and anxiety were also detected. He sprained his ankle and he was taking ibuprofen
for that. The two of the primary problems associated with the patient was 1) Severe asthmatic
condition and 2) Usage of ibuprofen in that condition which can life threatening for a patient.
As a nurse the first priority should be to take care of the severe asthmatic condition of
Simon. Bronchoconstriction due to Asthma produces mucus and decreases the capacity to
carry air inside alveoli. It reduces the amount of oxygen in the RBC (Lawson et al., 2014).
Due to lower exchange of oxygen and carbon-di-oxide the oxygen, level falls and the carbon-
di-oxide level increases the blood cells. Ipratropium bromide has been prescribed as an
inhaler to relax the respiratory muscles and clear pulmonary obstruction. It can reduce
laboured breathing and wheezing in the patient (Sharma et al., 2015). Salbutamol was also
prescribed for the same reason to Simon. Corticosteroid like Hydrocortisone has been
prescribed to decrease inflammation of the lung airways and prevent chronic asthmatic
trouble (Alangari, 2014). With decreased rate of wheezing, the vital capacity will increase
(Patel et al., 2013). The difficulty to speak and complete full sentences will also decrease
with relaxed breathing. Besides that, Simon had cyanosis and anxiety. Anxiety and asthma
are inter-related. Excessive coughing, breathing trouble can cause anxiety in a patient while

2NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
anxiety can escalate the asthmatic condition in the patient (Lu et al., 2014). Nocturnal asthma
can disrupt sleep and increase the level of anxiety in an adolescent patient. Cyanosis occurs
due to deleted level of oxygen in the RBC. As Simon had SaO2 of 88%, the Oxygen supply
was inadequate and the blood turns blue giving a bluish tint to the skin colour and mucous
membrane. Above mentioned drugs improve vital capacity, relaxes respiratory muscle and
clear pulmonary obstruction resulting in relaxed breathing, supply of more oxygen to the
blood and reduced wheezing (Arshad et al., 2014). The cyanosis condition also improves with
the usage of these drugs. So treating asthma can cure all the secondary symptoms of Simon
like coughing, wheezing, anxiety, cyanosis, speaking difficulty due to laboured breathing,
lower respiration rate and reduced oxygen saturation in blood (Ruotsalainen et al., 2013). The
major clinical problems of Simon was related to Asthma and those were primary or
secondary side effects of status asthmaticus. Along with drugs, nursing interventions are also
required to treat an adolescent like Simon for better patient outcome. The nurse should create
a plan for the adolescent patient and ensure the plan is religiously followed along with proper
medications. Simon was selected in his school team and was casual about the severity of his
condition.
1. The nurse should be empathetic to him and make him understand about the severity of
the condition (Roberts et al., 2016). The nurse should also support him mentally to
help him get rid of depression and anxiety, which in turn will improve his physical
condition (Barreto et al., 2014).
2. Asthma triggers should be controlled like dust, animal dander, flower pollen, cleaning
products and perfumes with irritant smell. They should be strictly avoided specially
when in close proximity with the patient. Making the patient aware of these things
will also help him to avoid asthma triggers throughout his life.

3NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
3. Checking pulse oximetry is important, as it will reflect the oxygen saturation level. If
oxygen saturation level is lesser than 90 percent, nasal cannula should be applied at
2L NC.
4. While resting and sleeping the patient should be positioned in upright position by the
nurse for less laboured breathing of the patient as it opens up lung bases and
respiratory airways (Heyduck et al., 2015). Some exercises that can help in breathing
should be part of his regime (Wanrooij et al., 2014).
5. The nurse should insist the patient to perform peak flow meter in regular intervals to
determine the rate of air exhalation of the patient. The reading from the meter can
reflect the breathing condition as lower the reading more difficulty the patient is
facing to breathe (Keleheret al., 2017).
6. In case of an adolescent patient like Simon the nurse can consider an airway cart if the
patient is finding it difficult to breathe for a long period.
7. Nurses should build up a healthy relationship with the family members of the
adolescent patient so that they can take additional care and ensure an ideal healing
environment for the patient (Fuchs et al., 2017).
8. The nurse should ensure that Simon is taking his prescribed drugs religiously. Nursing
interventions coupled with proper medication can deliver positive results for the
asthmatic patients (Panzera et al., 2013).
The second concern of the nurse is to stop Simon from taking ibuprofen to cure his ankle
sprain, which he inflicted during practice. Considering his asthmatic condition continuing
with ibuprofen can be life threatening for Simon in the severe asthmatic condition he is in (de
Martino et al., 2017). Using ibuprofen along with hydrocortisone increases the threat of side
effects due to drug interaction (Su, Huang & Wan, 2015). It causes inflammation, bleeding,
perforation and ulcer in the gastrointestinal tract (Sordillo et al., 2015). Anti-inflammatory

4NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
like ibuprofen should not be used with salbutamol inhalers in an asthmatic patient as it may
worsen the condition in the patient causing inflammation in the air pathways and in lungs
(Guvenir et al., 2018). The sprained ankle of Simon can be treated using natural care as
making his asthmatic condition better should be the priority. To treat the sprained ankle the
nurse should not use ibuprofen as it can be life threatening for Simon (Little et al., 2013).
Instead, natural care should be applied to treat the injured ankle. The ankle should be rested
for two to three days and activities causing pain, discomfort and swelling should be avoided.
Ice pack can be used in the injured area for 10-15 minutes in two to three hours interval. The
sprained area of the ankle should be compressed with bandage to reduce the swelling. The
bandage should be elastic and not too tightly wrapped for regular blood circulation. The ankle
should be elevated above the level of heart while sleeping and resting. This way the swelling
decreases as the extra fluid is drained by the help of gravity. The ankle will get better in a
week by this procedure and he can continue his medications for asthmatic conditions
simultaneously. This should be the aim for the nursing intervention.
Clinical Reasoning Cycle:
A Stage Guiding Questions Response

5NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
ssess
Gain an initial
impression
Is there unfamiliar
terms / information?
What do you know
about the person?
What is relevant to the
context of care?
No the information in the case
study were familiar.
The patient is an adolescent
male named Simon Hayes and
14 years old.
Simon was suffering from acute
asthmatic condition and
sprained his ankle during
practicing soccer.
(a) Review current
information
(b) Gather new
information
(c) Recall knowledge
(A&P, ethics, law,
cultural safety)
What current cues are
relevant?
What new information
will I get from the
person/ family/team?
What resources will I
use to gather new
information?
Simon was wheezing severely
and had 32 breaths per minute
with difficulty in speaking full
sentences.
Father of Simon informed that
he was taking inhalers though
reluctant about it and also
taking ibuprofen to cure his
sprained ankle.
The medications Simon was
taking should be checked from
the prescriptions. The primary
and secondary symptoms will
be checked for better diagnosis
and decision making.

6NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
What will you assess,
look for?
Which assessment
framework guides you?
What questions will you
ask?
Symptoms like labored breathe,
low oxygen saturation in blood,
cyanosis and anxiety should be
assessed to find a link among
them.
Physical examination of Simon
should guide about the
diagnosis and treatment ahead.
Examining upper airways, nose
and throat, checking the
wheezing sound by stethoscope
and looking for allergic
reactions in the skin should be
the framework that will guide
for treatment and cure.
Asking the patient about the
symptoms and trouble he is
having can provide lot of inputs
about the physical condition.
Based on that the nurse can
arrive at a decision and be sure
that the patient is suffering from
asthma.

7NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
Interpret data – what
does it all mean?
What data is
relevant/irrelevant?
What data is
normal/abnormal?
Are there any patterns
or connections?
What deductions/
inferences can you
make based on objective
& subjective data? Any
patterns or links?
Have you seen a similar
clinical situation
before/or has the
patient had a similar
experience?
The physical conditions and
symptoms of that are mentioned
in the case study like wheezing,
cyanosis are relevant to
diagnose the physical condition
in Simon.
The data given are normal and
in accordance with asthma like
the respiration rate of 32 per
minute, BP, 88% Oxygen
saturation and pulse rate.
Yes the symptoms given in the
case study were all interlinked.
The data given in the case study
and the prescriptions confirms
the severe asthmatic condition
of Simon. All the symptoms
like wheezing, cyanosis,
difficulty in talking is due to
asthma and reluctant self-care
of the patient.
Asthma is a common condition
in many adolescents but the
condition in Simon is much

8NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
What is going on here?
more severe than any other
patients that have been
encountered before.
Simon is a jovial adolescent
boy who wants to live like any
other boys of his age. His
physical condition is stopping
him from doing that. Simon is
reluctant about taking his
inhaler or medications as he
does not understand the severity
of the situation. The asthmatic
condition has worsened due to
that and need immediate
medical intervention.
P Stage Guiding Questions Response

9NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
lan
Synthesize all
information that has
been collected and
processed.
What are the
problems/issues?
Think about current
problems and anticipate
for future.
Prioritize
problems/issues?
What is urgent
/important /less
important?
The patient has a severe
asthmatic condition and
reluctant about taking proper
medications. He was taking
Ibuprofen in this condition
which can be life threatening
due to drug interaction.
The current priority should be
to stop taking ibuprofen and
start taking all the prescribed
inhalers and medications for
treating asthma. Also build a
clinical setting and cure plan by
the nurse for better results in
future.
Treating asthma should be the
priority by taking salbutamol,
ipratropium bromide and
hydrocortisone along with
follow the plans and treatments
of the clinical setting planned
by the nurse.
Urgent issue is to improve the
asthmatic condition of the
patient by medication and
nursing intervention. Treating

10NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
What should happen
to improve problems
/issues and by when?
What are your goals for
the patient?
What is the timeframe
for meeting goals?
Which goals are a
priority?
(SMART – Specific,
Measurable,
Achievable, Realistic,
Timely goal/s)
Improve the asthmatic condition
of Simon and sustain that is the
goal as a nurse.
The severity of the condition
should be lessened with 2
weeks while the primary and
secondary symptoms should get
cured with 4 to 5 weeks.
Improving asthmatic condition
of Simon within 2 weeks is the
first priority. Cyanosis, anxiety,
labored breathing and all other
symptoms should fade away in
4 to 5 weeks. The patient should
follow the clinical setting and
regime planned by the nurse
during this period religiously.
He should continue the same to
be precautious about future.
I Stage Guiding Questions Response

11NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
mplement
What action/
interventions will you
do?
Who should be
notified?
What actions will you
take?
What evidence/research
guides your actions?
What is the RN role?
For this situation what
role do other health
team members have?
Do you need to notify
Intake of ibuprofen should be
stopped immediately to prevent
detrimental effects like
inflammations and escalation of
asthma. Ensure medications and
inhaler for Asthma are taken
properly. Also make a cure plan
for the patient to follow.
Going through the medical
history, prescriptions and the
symptoms during diagnosis
should be the guideline for
implementing actions.
To be empathetic to Simon and
provide mental support to
reduce anxiety. Endure
prescribed drugs are taken
regularly and make a clinical
setting and a cure plan for the
patient.
The doctors and the other health
professionals should work with
the nurse in a collaborative way
to ensure holistic care provision
to Simon.
The family members of Simon

12NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
E Stage Guiding Questions Response

13NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
valuate
Assess the effectiveness
of actions
Has the patient
situation improved?
Compare with initial
assessment data.
Improvement or
deterioration?
Are actions/
interventions effective?
What are your next
steps?
The patient situation should
improve if the medications are
taken and treatment is done in
the clinical setting under the
supervision of the nurse.
The physical condition of Simon
due to asthma was critical. After
medications are taken and the
treatment is done in accordance
with the nursing intervention
wheezing has reduced,
respiration rate has gone up,
cyanosis has reduced and the
patient is able to finish the full
sentences when he is speaking.
The health of the patient has
certainly improved.
Preventing intake of ibuprofen
and prioritizing on the treatment
and medication of Asthma was
certainly effective to improve the
asthmatic condition of Simon.
Next step is to ensure Simon is
following the cure plan after
improving his health to sustain

14NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
What have you learned
from this experience?
Was my preparation /
prior understanding
enough?
Next time I would …
I should have …
From here I need to….
Simon had a severe condition of
asthma and improper medication
which made the condition worse.
It was difficult to understand and
plan at first but after going
through the medical history,
prescriptions and symptoms of
Simon it was easier to provide
healthcare.
After looking after a patient like
Simon with the severity of
condition he had it will be easier
to treat any patients with asthma.
Prior study and research about
the medications, clinical settings
and treatment about asthmatic
patients would have been
helpful.
Research about a disease, the
treatment and care of it should
be done beforehand.
This can be concluded from the paper that Simon had a severe asthmatic condition
where he was facing difficulty to lead a normal life for a guy of his age but the nursing
interventions made things better than it was. With proper medications and clinical care for

15NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
asthma the conditions improved in due time. The symptoms like wheezing, cyanosis,
laboured breathing and anxiety faded away making the physical and mental conditions of
Simon better than before (Bitsko, Everhart & Rubin, 2014). It was possible due to the care
given during the nursing supervision as taking medications and following the clinical setting
was ensured. Asthma patients in their adolescence should be aware of the condition and
concentrate on self-care along with nursing supervision and treatment for sustainable
progress of health and become completely cure in future.

16NURSING REVIEW OF AN ADOLESCENT ASTHMA PATIENT
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