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Pulmonary Clinical Case Study

Shaun is a 7-year-old boy who is brought to the emergency room in acute respiratory distress, has hx of Asthma. His mother states that Shaun was well until about an hour before, when he began to cough and wheeze and couldn’t catch his breath. Further questioning of his mother reveals that Shaun has had several episodes of coughing, usually at night, not associated with fever or congestion. There is a family history of asthma (father). Shaun takes no medications, is in the second grade, and is doing well in school. On examination, Shaun appears to be in moderate respiratory distress, is restless and apprehensive, and insists on sitting in an upright position, with shoulders flexed. Use of accessory muscles when breathing is also evident. On auscultation, there is diffuse wheezing in all lung fields and a prolonged expiratory phase of respiration. A chest x-ray reveals bilateral hyperinflation, with no evidence of air trapping. 

Answer the following multiple-choice questions based on the case study. 

 

1. Which approach would be most effective in preparing Shaun for obtaining arterial blood gasses? 

a. Have him sit on his parent’s lap during the blood draw to ensure cooperation. 

b. Explain the procedure, and praise him for his good behavior. 

c. Have two assistants restrain him so access can be quick and effective. 

d. Have him select which site to use for the blood draw. 

 

2. During an early asthma attack, a patient’s pH is increased and CO2 decreased, indicating alveolar hyperventilation and hypocarbia and 30 hypoxemia secondary to ventilation-perfusion mismatch. What clinical manifestations would you expect to find? 

a. Exhaustion and diminished breath sounds 

b. Use of accessory muscles of ventilation to overcome increased airway resistance 

c. Decreased heart and respiratory rates 

d. Increased inspiratory-to-expiratory ratio 

 

3. As the asthma attack progresses, the pH decreases, CO2 increases, and O2 decreases. These findings indicate which of the following? 

a. Respiratory acidosis 

b. Respiratory alkalosis 

c. Stabilization of blood gases 

d. Hyperoxemia 

 

4. Which of the blood gases is controlled primarily by the lungs and is referred to as the respiratory component of acid-base balance? 

a. pO2 

b. pCO2 

c. pH 

d. HCO2 

 

5. During an exacerbation, the patient with asthma usually has a(n) ________ forced expiratory volume in 1 second (FEV1)? 

a. Increased 

b. Decreased 

 

6. Which of the following is a usual hematological finding in a patient with asthma? 

a. Increased WBC count with a shift to the left, associated with underlying viral infection 

b. Increased IgE, associated with extrinsic asthma 31 

c. Increased eosinophils, associated with the body’s attempt to provide more oxygen to vital organs 

d. Decreased hemoglobin and hematocrit, associated with acute hypoxia 

 

7. Eosinophils are usually elevated when the patient with asthma has an underlying: 

a. Allergic reaction 

b. Viral infection 

c. Corticosteroid therapy 

d. Bacterial infection 

 

8. Pulmonary function studies: 

a. Are helpful in evaluating pulmonary diseases but inappropriate for 7- year-olds 

b. May be performed on a 7-year-old with proper preparation, instruction, and coaching 

c. May be performed on a 7-year-old, but coaching may alter findings, rendering them invalid 

d. Are not usually performed in evaluation of asthma 

 

9. When preparing discharge teaching for peak flow monitoring of asthmatic respiratory patterns, the nurse should keep in mind that monitoring: 

a. Requires expensive equipment and therefore often is inaccessible to the person without insurance 

b. Is useful for assessment of airflow obstruction during times of exacerbated symptoms only 

c. Is helpful in monitoring ongoing respiratory status and management of asthma 

d. Is the treatment of choice for most individuals with asthma  

 

Please list 3-Priority Nursing Diagnosis for this patient

SCIENCE
HEALTH SCIENCE
NURSING
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