Collaborative Case Study
Case Information:
James Washington is a 4-year old African American male who recently moved to the area
with his family. He presents to the clinic today with his mother, Mary, complaining of difficulty
breathing and cough. His symptoms started this morning shortly afte...
Case Information:
James Washington is a 4-year old African American male who recently moved to the area
with his family. He presents to the clinic today with his mother, Mary, complaining of difficulty
breathing and cough. His symptoms started this morning shortly after waking up, although his
mother states he has had some congestion and runny nose for the past 2-3 days.
1. What historical data should you gather from the patient and his mother? (Include
rationale for each of your questions) (2 points)
When did it start? (This will let the nurse know the severity of the symptom)
What make it better? (This will tell the nurse know what relive the asthma)
What make it worse? (This will let the nurse know what James should avoid and what
maybe the cause)
Does anyone in your family have asthma? (This will like the nurse know if there is a
possible problem)
Did you have any complication with your pregnancy? (This could rule out possibility
complication. This will the nurse know any past problem that may have contributed to the
asthma)
Does being outside make it worse? (This will let the nurse know some of the possible
cause)
How often do you cough? (This will tell us how severe is the asthma)
Does any family have a history of asthma? (This will like the nurse know if there is a
possible problem and if it could lead to more problems)
Case information:
James has had four or five similar episodes over the past 2 years, which required
unscheduled visits to his former pediatrician’s office. Each time James was sent home with an
Albuterol inhaler to be used as needed. His mother states that James has a lot of “colds” year-
round, which seem to last for a long time. During these episodes he wakes up at night coughing.
His mother also mentions that the daycare provider mentioned James would often start to cough
while playing and has to stop his activity to “catch his breath”.
Other past medical history includes:
Born at 39 weeks gestation
No significant medical illnesses other than wheezing
Never hospitalized
No medications except for the albuterol when needed
NKDA (no known drug allergies)
James lives with his parents and older sister
Mom smokes in the house
They live with a dog, two cats, and a hamster
Father has a history of asthma but “grew out of it” and has seasonal allergies
This study source was downloaded by 100000802832151 from CourseHero.com on 11-07-2022 02:07:32 GMT -06:00
2. What information in the patient’s history indicates increased potential for breathing
problems? (1 points)
Mother smokes in the house
They live with a dog, two cats, and a hamster
Father has a history of asthma but “grew out of it” and has seasonal allergies
No significant medical illnesses other than wheezing
No medications except for the albuterol when needed
His mother states that James has a lot of “colds” year-round which seem to last for a long
time
During these episodes he wakes up at night coughing. His mother also mentions that the
daycare provider mentioned James would often start to cough while playing and has to
stop his activity to “catch his breath”.
3. What are 5 common causes of wheezing in children? (2 points)
4. Describe the pathophysiology of Asthma. (3 points)
An allergic hypersensitivity to certain inhaled allergens (pollen), irritants (tobacco, ozone),
microbes, stress, or exercise that produces a complex response characterized by bronchospasm
and inflammation, edema in walls of bronchioles, and secretion of highly viscous mucus into
airways. These factors greatly increase airways resistance, especially during expiration, and
produce the symptoms of wheezing, dyspnea, and chest tightness (Jarvis, 2016, p. 453).
5. What physical examination data do you want to collect? (3 points)
Inspection: During severe attack: increased respiratory rate, SOB with audible wheeze, use of
accessory neck muscles, cyanosis, apprehension, retraction of intercostal spaces. Expiration
labored, prolonged. When chronic, may have barrel chest.
Palpation: Tactile fremitus decreased, tachycardia.
Percussion: Resonant. May be hyperresonant if chronic.
Auscultation: Diminished air movement. Breath sounds decreased, with prolonged expiration.
Voice sounds decreased.
Adventitious Sounds: Bilateral wheezing on expiration, sometimes inspiratory and expiratory
wheezing (Jarvis, 2016, p. 453).
This study source was downloaded by 100000802832151 from CourseHero.com on 11-07-2022 02:07:32 GMT -06:00
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