LYCEUM-NORTHWESTERN

UNIVERSITY
COLLEGE OF NURSING

Related Learning Experience Plan

2nd Semester 2020-2021

Course Title: NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS
(ACUTE AND CHRONIC)

Sample of Alternative Activities for Clinical Practice

(RLE equivalent 16 hours)

CASE NUMBER 6

Nursing Care of a Child with Alterations in Oxygenation

Case study:
Marco, a 7-yearold child has been admitted in the pediatric ward with a diagnosis of asthma.
Assessment findings reveal presence of cough, nasal flaring and wheezes upon auscultation. His
PR is 110 bpm, RR = 25 breaths/min with a peak flow of 50% and an oxygen saturation of 95%.
Marco’s mother says that her child’s asthma has been under control for the past two months, with
the help of his inhaler. He has been prescribed with Pulmicort daily and Albuterol as a
bronchodilator. However, two hours prior to admission, Marco initially complains of difficulty
breathing while he was playing outdoors with his cousins. The mother’s main concern was for her
son’s frequency of getting sick and asthma attacks.

1. What are the major problems you would address for Marco during his hospital stay?
-The major problems I would address for Marco during his hospital stay is that he
has asthma, he would have breathing problems and coughing especially at night
causing him trouble of sleeping and wheezing, he might feel chest tightness. I
would also tell him that he would have to avoid any allergies that might trigger his
asthma such as pollen and other activities that make you breathe harder.

2. Describe the pathophysiology of this health disorder.

-Asthma is a chronic inflammatory disorder of the airways, Gene-by-environment

interactions are important to the expression of asthma. Inflammation has a central role
in the pathophysiology of asthma. As noted in the definition of asthma, airway
inflammation involves an interaction of many cell types and multiple mediators with the
airways that eventually results in the characteristic pathophysiological features of the
disease: bronchial inflammation and airflow limitation that result in recurrent episodes
of cough, wheeze, and shortness of breath. Airborne allergens, such as pollen, dust
mites, mold spores, pet dander or particles of cockroach waste. Respiratory infections,
such as the common cold. Physical activity and Cold air can trigger asthma
3. What is the classification of the medications prescribed for Marco? How do the
medications work and what are the side effects?
-Pulmicort belongs to a class of drugs known as corticosteroids. It works directly in the lungs
to make breathing easier by reducing the irritation and swelling of the airways, you inhale
this medication by mouth, usually once or twice daily or as directed by your doctor,
common side effects are dry throat, sore throat and hoarseness. While Albuterol belongs
to a class of drugs known as bronchodilators, Common side effects of albuterol include
tremor, nervousness in children and dizziness. It works by inhaling it to make relaxing
and opening air passages to the lungs to make breathing easier

4. What is a peak flow meter? What instructions will you include in the plan of care for
Marco on the use of this device?
- A peak flow meter is a handheld device that measures how well air moves out of your
lungs. During an asthma episode, your airways often narrow. A peak flow meter can
measure this narrowing hours, even days, before you have any asthma symptoms. What
instruction I would give for using this device is using it properly to get an accurate result
and use it preferably once in the morning and again at night. Furthermore your peak flow
rate is 50% to 80% of your personal best, an indication that your asthma is getting worse
if your peak flow rate is 80% to 100% of your personal best, an indication that your
asthma is under control
5. Marco’s health condition improves and schedule for discharge. His doctor orders
continuation of the drug treatment, Pulmicort and Albuterol. What should be monitored
for this medication?
- you should monitor the dosage he’s taking and Pulmicort should be taken once daily
 depending on the response or reaction of the medication he should be carefully
monitored for asthma instability, and including objective measures of airway function.
While albuterol can cause heart rhythm changes and potassium levels that drop lower
than normal. Use caution when taking Albuterol, monitor vital signs.
6. Develop a discharge teaching plan for Marco and his parents related to his health condition.

LYCEUM-NORTHWESTERN
UNIVERSITY
COLLEGE OF NURSING

7. What developmental stage does Marco belong? Based upon his developmental level,
identify three key teaching needs and the best communication techniques to use with him.
Provide rationale for your choice of communication techniques.
-Marco belong to middle childhood stage and based upon his developmental level
here are three key teaching needs, Encourage independence and active participation,
Encourage physical closeness, Use play therapy.

8. Using the nursing process, identify three priority nursing diagnoses for Marco.
Formulate a nursing care plan based on the first prioritized nursing problem. Use the
format given.