• 2 years

• 14.3 Kg

• Diagnosis: Asthma

• Full term pregnancy

• Pews Score: 2

• Expiratory wheezes

Work of Breathing

• Subcostal indrawing

• Intercostal Indrawing

• Tracheal Tug

Oxygen Saturation

• 93% on room air

Respiration Rate

• 37/min

Cough

• Unproductive

• At times resisted coughing

• 140 (High) (Pre salbutamol- no changes post)

Blood Pressure

• 96/67

Cap refill

• 2.5 seconds

CWMS

• All normal

• Distended

• Firm

• Bowel sounds hypoactive

• No pain reported

Toileting record

• Last Bowel movement 36 hours prior

• Urinating Q4H and minimal amount

Intake

• Approximately 600mL by end of shift

• Intake was aproximatley 50 mL/hour (started at 20 ml/hour and ended shift drinking aproximatley 70ml/hour)

• Recommended hourly intake is 48ml/hour

• Decreased appetite and fluid intake till end of shift

• Alert and orientated X3

• Monitor for decreased LOC

Neuro vitals all stable

Initially pain observed via FLACC score

• Admin of Tylenol and then Advil seemed to reduce this significantly

• Smokers

• Mother has history of asthma

• Mother has seasonal allergies

• Fully immunized

Siblings:

• Two older siblings

• Still reliant on parents

Parents are supportive

Extended family is helping take care of other children

Large support system including family and friends

• Autonomy vs. Shame and Doubt

Piaget's Stage

• Preoperational

Developmental Milestones

• All milestones met

Fear of new things

Decreased activity levels reported form family

• Raised O2stat from 93% - 97% consistently

• Poor adherence at first but became more comfortable

Dexamethasone

• First day of medication administration

Tylenol and Advil given to help calm and manage any pain in child

• Hemoglobin: 110 (low)

• Red cell distribution: 15.6 (High)

Blood Gases

• Venous Blood PH: 7.30 (Low) (acidic)

• Venous Blood HCO3: 19 (Low)

• Serum Bicarbonate: 18 (Low)

• Anion Gap: 17 (High)

• Whole blood lactic acid: 3.6 (High)

Electrolytes

• Sodium: 134 (Low)

• Whole blood glucose: 14.7 (High)

• Random Glucose: 15.9 (High)