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Judah C.

4 years old

Asthma triggered by viral illness

19.5kg

NKA

Mother has asthma, grandfather has emphysema. Judah has no history of asthma.

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Alert and oriented x3

Behaviour and verbal responses are appropriate for his developmental stage and age group.

Motor response is unremarkable, he is mobilizing often.

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BP 124/75 (MAP 90) - the systolic rate is slightly elevated (91-114)

HR 106

T 36.4

O2 98%

Hbg 138 H

Hct 0.40 H

Neutrophil 11.2 H

C-reactive protein 10.4 H

Rhythm is regular

CWMS - colour is pink/normal, skin is warm, movement is within expected ROM, sensation is adequate

All peripheral pulses 3+

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Bowel sounds present in all quadrants

Abdomen flat, soft and non-tender

No nausea, vomiting, diarrhea or constipation

Bowel movements decreased from baseline

K+ 3.3 L - may be low due to decreased nutritional intake.

Appetite has decreased over past 4 days before admission to ER.

No signs of dehydration, fluid intake is still adequate PO but being monitored.

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No eczema, rashes or other skin abnormalities.

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I utilized the FLACC pain scale with Judah, as well as verbal descriptors and pointing/motioning to the area of concern. He was not often in very much pain and was able to breathe and mobilize well. He was receiving a regular scheduled dose of acetaminophen before I had cared for him, by then it was changed to a PRN.

Judah's energy had initially been quite decreased, but the last day I was caring for him he seemed to be back to his baseline and was quite lively.

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In hospital, Judah's mom would stay with him during the day and overnight. His dad would come to visit during the day and bring Judah's younger brother along. Beyond Judah's nuclear family, he has grandparents on both his mom and dad's side. There are cats at their grandparents house which Judah has expressed a fondness of. Judah lives at home with his parents and his younger brother.

Judah's parents have displayed great coping skills during the interactions that I had with them. They seem to be taking advances to Judah's care well, and are engaging in teaching and learning opportunities when possible. His mother, who has been present for the duration of his stay in hospital, has been part of interventions such as administration of inhalers throughout the entire stay. Early on there was some difficulty with the administration and type of metered dose inhaler attachment being used, as Jonah is not receptive to the mask recommended for his age group, but that became a teaching opportunity quickly and also a place to collaborate on Judah's care plan. Judah's parents recognize and are attentive to his behaviour and his own opportunities, which helps to aid care planning as a nurse.

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Judah seems to be coping well with the hospital stay. He is interactive with health care staff and with his family. He has a lot of energy still, though part of this is probably related to the lack of stimulation in hospital. He has been in good spirits otherwise and seems to feel supported by his family.

His parents also seem to be coping well with their child being in hospital care. They did not express any concern around the time spent in hospital and it taking away from their employment or other responsibilities. It also helps that Judah has been steadily improving since being admitted to ER and receiving initial treatments.

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Piaget - Preoperational (2-7 years)

Erikson - Initiative vs. Guilt (preschool)

At this age, Judah was displaying adequate developmental growth. This was displayed by him playing with LEGO with his younger brother, as well as other small toys which required fine motor skills to play with. Judah would ask many questions, and often times repeat the same ones. This to me displayed either a remarkable sense of humour, or he is still developing understanding to certain concepts and things I would answer or try to explain.

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Salbutamol 100mcg/puff 6 puffs PRN

Acetaminophen 292.5mg PO Q6H

Discontinued:

Salbutamol Nebule 2.5mg Q2H

Dexamethasone (dose N/A)

Blow-by oxygen supplementation < 3L or 30% - 6L/min

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RR 29-41

O2 90-96%

Decreased air entry to left lower lobe, fine crackles to lower right lobe.

Depth of respirations is regular, most likely due to use of accessory muscles and subcostal retractions.

In ER, it was noted that there was mild tachypnea, mild subcostal retractions and a bilateral expiratory wheeze.

PRAM score was initially 6 upon admission, but has since dropped to 1 after multiple days in hospital.

No history of asthma before this incident, however there is a history of upper respiratory viral illness.