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Shadow Health Asthma Exacerbation Gabriel Martinez
Child and families (NURS 430)
Shepherd University
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Focused Exam: Asthma Exacerbation Results | Turned In
Patient Centered Care Child and Families - Fall 2022, NURS 430
Return to Assignment (/assignments/659600/)
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Care Plan : 7 of 8 (87%)
International classification for nursing practice (ICNP) nursing diagnoses (v2019_06_27) [Data set]. (2019). International Council of Nurses ( icn/what-we-do/projects/ehealth-icnptm/icnp-download
Diagnosis
Student Response Model Answer Explanation Points Earn
non adherence to medication regime non adherence to medication regime Gabriel's asthma exacerbation indicates he and his mother are not effectively managing his medication regime.
0 out of 0
Signs & Symptoms
Student Response Model Answer Explanation Points Earn
impaired breathing impaired breathing Gabriel's non adherence to medication regime is evidenced by his impaired breathing, limited knowledge of prescribed medication, and perceived inability to participate in sports.
0 out of 0
limited knowledge of prescribed medication
limited knowledge of prescribed medication
Gabriel's non adherence to medication regime is evidenced by his impaired breathing, limited knowledge of prescribed medication, and perceived inability to participate in sports.
0 out of 0
hypoxia perceived inability to participate in sports
Gabriel's non adherence to medication regime is evidenced by his impaired breathing, limited knowledge of prescribed medication, and perceived inability to participate in sports.
0 out of 0.
Your Results Lab Pass (/assignment_attempts/13286927/lab_pass.
Overview
Transcript
Subjective Data Collection
Objective Data Collection
Education & Empathy
Documentation
Care Plan
Student Survey
Nursing Diagnosis 1 out o
Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.
Prompt Student Response Model Answer Explanation
Why would a nursing diagnosis of overweight be incorrect, compared to non adherence to medication regime?
The patient's obesity is a symptom of his decreased ability to participate in social activities and his guardian's belief that exercise will induce an asthma attack. The most effective tool for Gabriel will be to focus on a medication regimend that meets therapeutic goals, including using his inhaler before exercise. This will help the patient to increase his exercise level and reduce his obesity, as his obesity can't be managed with effective asthma treatment.
Gabriel being overweight is a symptom of his decreased ability to participate in social activities, and his guardian’s belief that exercise will induce an asthma attack. The most effective goal for Gabriel will be to focus on a medication schedule that meets therapeutic goals, including using his albuterol inhaler before exercise. This will help Gabriel increase his physical activity. Gabriel's weight can't be managed without effective asthma management, but effective asthma management will have a positive impact on Gabriel's weight.
Your nursing diagnosis should always take into account wha condition is most serious, receiving the greatest benefit from your help. This diagnosi may not be the most obvious physical symptom to you or y patient, so always consider w is jeopardizing a patient's hea the most.
Short-Term Goal
Student Response Model Answer Explanation Points Earn
The patient and his guardian will verbalize their understanding of the instructions on how to manage the patient's medication by end of ED visit
The patient and his guardian will verbalize their understanding of the instructions on how to manage the patient's medication by end of ED visit
Having Yvonne and Gabriel verbalize and agree to their instructions on how to more effectively manage the patient's asthma medication by the end of their visit is the most effective short- term goal.
0 out of 0
Interventions
Student Response Model Answer Explanation Points Earn
Instruct patient and guardian on a medication schedule that incorporates his rescue inhaler and meets therapeutic goals
Instruct patient and guardian on a medication schedule that incorporates his rescue inhaler and meets therapeutic goals
These interventions focus on education around better medication management, including utilizing the patient’s albuterol rescue inhaler, explaining the common side effects of the patient's rescue inhaler, ensuring that the patient and guardian create an asthma action plan at school, ensuring the patient always has a rescue inhaler with him, and instructing the patient and guardian that Gabriel can engage in exercise safely if he uses his rescue inhaler beforehand.
0 out of 0
Self Assessment
Planning 3 out of 3
Data Collections
Student Response Model Answer Explanation Points Earn
Ask patient and guardian to state back and agree to their instructions on effective medication management
Ask patient and guardian to state back and agree to their instructions on effective medication management
It is important that your patient and his guardian state back and agree to their instructions, as changing lifestyle habits can be intimidating but necessary for the patient's health. Having Gabriel and his mother verbalize back their instructions also assures they remember and understand the details.
0 out of 0
Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.
Prompt Student Response Model Answer Explanation
Explain the rationale behind your nursing diagnosis.
By managing your medication regimen better, you will be able to work back into exercising and play sports, which will help you lose weight
Yvonne, Gabriel's diagnosis is non adherence to medication regime. We want to make sure that you and Gabriel both know how to effectively manage his asthma. You're doing a great job, but we're going to try and get Gabriel on board with using his rescue inhaler, too. His symptoms have been his perceived inability to participate in sports, his impaired breathing, and his misunderstandings about what his rescue inhaler does and the importance of keeping it with him. We're going to talk about some ways that he can incorporate his rescue inhaler into his asthma maintenance regimen.
A guardian should understand the patient's nursing diagnosi and the rationale behind it in order to increase their sense involvement and to identify ar for future improvement.
Explain your goal for Gabriel and the interventions and data collections through which you will achieve it.
I want you to understand what I am going to talk to you aboutb
Yvonne, I'd like to talk to you and Gabriel about how we can better manage his asthma medication. I'm going to have a conversation with both of you about managing his medication. We'll work together in this discussion, and then you and Gabriel will agree to his goals. Then I'm going to have you and Gabriel repeat what you've learned so we can make sure he understands fully.
You should communicate the Care Plan to the guardian, allowing them to exercise involvement and agency in th patient's healthcare.
Explicitly ask for Yvonne's consent to the Care Plan.
Do I have you consent to begin this care plan?
Does this plan for Gabriel sound good to you?
A guardian must consent to a interventions in the patient's C Plan. Disagreements are opportunities to provide furthe patient education and to cons alternative options.
Inform Yvonne you will now begin educating them.
ALright Gabriel, i will begin to teach you on what you can do to be healthier
Yvonne, if you don't have any other questions, we can start our discussion now.
It's time to begin your educati interventions, so let your patie guardian know.
Discussion Of Care
Explain the rationale behind your nursing diagnosis.
By managing his medication regimen, he will be able to exercise which will be very helpful in promoting his overall health and lowering his weight
Gabriel, we want to make sure that you and your mom know how to effectively manage your asthma. I understand that lately you haven't been able to participate in social activities like kickball or playing with your friends because of your asthma. Some of your symptoms are your impaired breathing and your misunderstandings about your albuterol inhaler. We're going to talk about some ways that you can use your albuterol inhaler to make sure that you can breathe really well so that you can run around and play with your friends. I know that sounds like a lot, but if you, your mother, and I work together, you'll be able to better manage your asthma.
A patient should understand t nursing diagnosis and the rationale behind it to increase their sense of involvement an identify areas for future improvement.
Explain your goal for Gabriel and the interventions and data collections through which you will achieve it.
We would like gabriel to use his inhaler before exercising as this will help prevent asthma exacerbations and will improve his weight
Ok, Gabriel, let’s talk about how we can better manage your asthma medication. I'm going to have a conversation with you about things you can do to ensure that you know how to utilize your rescue inhaler. We'll work together to discuss them, and then you can agree to your goals. Then I'm going to have you and your mom repeat what you've learned, so we can make sure you understand fully.
You should communicate the Care Plan to the patient, allow them to exercise involvement agency in their own healthcar
Explicitly ask for Gabriel's consent to the Care Plan.
Do I have your consent to begin this care plan
Does this plan I just talked about sound good to you?
A patient must consent to all interventions in their Care Pla Disagreements are opportuni to provide further patient education and to consider alternative options.
Inform Gabriel and Yvonne you will now begin educating them.
I will now begin educating you Gabriel, if you don't have any other questions, we can start our discussion now.
It's time to begin your educati interventions, so let your patie know.
Student Response Model Answer Explanation Points Earn
Fully Fully Yvonne and Gabriel correctly verbalize their understanding of the instructions on how to manage the patient's medications by the end of this ED visit. Your goal has been fully achieved.
2 out of 2
Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.
Prompt Student Response Model Answer Explanation
Intervention & Evaluation 2 out of
Intervention & Evaluation Rationale
Focused Exam: Asthma Exacerbation Results | Turned In
Patient Centered Care Child and Families - Fall 2022, NURS 430
Return to Assignment (/assignments/659600/)
If contacting Shadow Health Support via email using nhpsupport@elsevier, please put Shadow Health in the subject of the email or use the following link for a more timely res Click here for more information (service.elsevier/app/contact/supporthub/shadow-health/)
Documentation / Electronic Health Record
ED Nursing Note
Student Documentation Model Documentation
Chief Complaint
Asthma exacerbation, hard to breath, tightness in chest
Gabriel Martinez, age 8, came in to the ED with a moderate ast exacerbation, initially scoring a 9 on the PAS score. His exacer started 4 hours prior after he played kickball at his after-school program. His mother could not find his rescue inhaler, and whe peak flow meter readings were at 55-60% of his normal range, brought him to the ED. Gabriel was given albuterol treatment v nebulizer and an oral steroid. His most recent PAS score is a 5
History of Present Illness
-Pt. reports an asthma attack after playing kickball -Pt. was exhibiting wheezing and coughing -Mother reports peak flow meter readings at home of 55%, 59%, and 60% -Mother reporst that the rescue inhaler normally helps, however it was lost and the maintenance inhaler did not seem to do much
Gabriel Martinez is an 8-year-old boy who came to the ED experiencing a moderate asthma exacerbation. His initial score the PAS was a 9. His most recent PAS score is a 5. His exacer started 4 hours prior, after he was playing kickball at his after-s program. Gabriel was also exposed to secondhand smoke, wh known trigger for his asthma.
When Gabriel’s mom, Yvonne, picked him up from his program noticed he was coughing and having trouble breathing. His asth exacerbation worsened over the course of 4 hours, and Ms. Ma was unable to find Gabriel’s rescue inhaler. Gabriel said that he away his rescue inhaler a few weeks ago because he disliked t side effects. Gabriel’s peak flow meter readings at home were 5 59% and 60% of his normal. His mom tried administering an ex dose of his daily maintenance inhaler, but it was ineffective.
Gabriel ranks his current pain at a 4, and said he is experiencin soreness in his chest and neck. His cough is less frequent than was, and his wheezing is improved (only wheezing on expiratio
Your Results Lab Pass (/assignment_attempts/13286927/lab_pass.
Overview
Transcript
Subjective Data Collection
Objective Data Collection
Education & Empathy
Documentation
Care Plan
Student Survey
Flowsheets PreFlowsheets Documentation Preintervention PAS Score PAS Score
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Student Documentation Model Documentation
Allergies
-Tree pollen, pet dander, and dust trigger Gabriel's asthma, they make him short of breath or easier to get an asthma attack -otherwise no allergies
Patient has environmental allergies to pet dander, dust, and po No allergies to latex, medication, or food.
Home Medications
-maintainence inhaler - Fluticasone propionate, two times daily, two puffs at a time -rescue inhaler- two puffs, however it is "lost" -antihistamine
Albuterol MDI 90 mcg 1-2 puffs every 2-4 hours during breathin stress (Missing, needs refills) Flovent HFA (fluticasone propionate) MDI 44 mcg 2 puffs twice Occasional antihistamine if experiencing allergy symptoms Occasional Rx cream treatment for eczema
Past Medical History
-past hospitalization last year due to asthma -pt. is not exposed to second hand smoke -pt. has eczema
Mild persistent asthma step 2 since age 5 No previous surgeries
Social History
-Parent reports that too much exercise could trigger an asthma attack -pt. reports that exercising makes his asthma worse -pt. and mother live in an apartment -pt. is in third grade and goes to school -pt. goes to afterschool clubs and sometimes spends the night with his grandparents
Gabriel is in 3rd grade. He lives with his mom, Yvonne, in an apartment. Yvonne works at a law firm. He attends after-schoo programs during the school year, and has expressed an interes being more active or playing more sports. He enjoys playing vid games and spending time with his grandparents. Yvonne was concerned that he couldn’t do sports because of his asthma, bu provided some education around activities that are good for ch with asthma. Gabriel denies alcohol or tobacco use.
Review of Systems
-Pt. reports heart beating really fast -Pt. reports occasional rashes on elbows or hands -pt. reports feeling "mad" about having asthma
CARDIOVASCULAR: Heart is racing, possible albuterol side ef INTEGUMENTARY: No skin issues, but occasionally experienc eczema MENTAL HEALTH: Reports some frustration with asthma diagn
Family Medical History
-maternal grandfather has heart disease -maternal uncle has diabetes
No family history of asthma or other respiratory illness.
Comments
If your instructor provides individual feedback on this assignment, it will appear here.
Description: Gabriel experiences elevated heart rates and jitters when he uses his rescue inhaler. His discomfort and frustration led him to throw away the inhaler, making it harder to control this exacerbation.
did you use an inhaler (Clarified to: Do you use an inhaler to control your asthma?) Que 03:49 PM
Yeah. I have a regular inhaler that I use every day. I used to have another one, just for emergencies, but I hated it and I didn't need it anymore, so I threw it away when my mom made me clean out my backpack. It made me feel really weird when I had to take it. (Clarified to: if I use an inhaler)
Using you inhaler can help prevent asthma exacerbations Edu 03:50 PM
I guess that makes sense.
Model Statement: "Some medications, like your rescue inhaler, can cause side effects that feel bad or make you uncomfortable. Even though it feels bad, it is only temporary and this medication is important to help prevent asthma attacks like you had today."
Description: Ms. Martinez is a dedicated single parent with a full-time job. She at times expresses frustration about not being able to keep track of Gabriel at all moments, especially not knowing that he had thrown his rescue inhaler away.
who watches him while you work Que 05:22 PM
I work 55 hours a week. Gabriel goes to after-school clubs, so I pick him up around 5:30. He's really close to my parents, so sometimes on the weekends he spends the night with his Lito and Lita.
can you tell me about any relevant family medical history Que 05:23 PM
There's nothing like asthma in the family. But my father has heart disease and my brother has diabetes.
thank you for sharing Empa 05:25 PM
Thanks, I appreciate that.
Model Statement: "Raising a child on your own is not easy. No one is questioning your abilities. In fact, you’re doing a great job, and it’s obvious Gabriel loves and appreciates you. Children Gabriel’s age have a lot of energy and kids just lose things sometimes and it’s no one’s fault."
Description: Ms. Martinez, out of concern for Gabriel’s health, has restricted his physical activity. However, regular exercise can actually help children with asthma.
does exercise affect gabriel's asthma (Clarified to: How does exercise affect your son’s asthma?) Que 03:57 PM
Too much exercise could trigger an asthma attack. He knows the rules. He can walk, but he isn't supposed to run. (Clarified to: how exercise impacts my sons asthma)
does exercising affect your asthma (Clarified to: Does exercise make your asthma worse?) Que 03:58 PM
2 Medication Adherence Followed U
3 Single Parenting Followed U
4 Benefits of Exercise in Asthma Patients Not Followed
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Model Statement: "Activities that do not require prolonged, rapid breathing, such as baseball, taekwondo, volleyball, and swimming, will rarely trigger an asthma exacerbation. With proper adherence to his medication Gabriel can safely enjoy regular activity and live a full and normal life. In fact, a lack of physical activity can actually cause Gabriel’s asthma worsen. By having a regular exercise routine, you and Gabriel may see an improvement in Gabriel’s breathing and reduce the chances for future exercise-induced exacerbations."
Comments
If your instructor provides individual feedback on this assignment, it will appear here.
Normal Breathing Expiratory wheezing Inspiratory wheezing Diminished breath sounds
Inspected Chest - Pre-Intervention 1 of 1 poin
Sites Of Retraction (1/1 point)
No visible abnormal findings Supraclavicular Supersternal Substernal Subcostal Intercostal
Assess Dyspnea - Pre-Intervention 1 of 1 poin
Speech Characteristics (1/1 point)
Speaks full sentences Speaks partial sentences Speaks short phrases OR single words
Assessed PAS - Pre-Intervention 1 of 1 poin
Score (Severity) (1/1 point)
<7 (Mild Exacerbation) 8-11 (Moderate Exacerbation) >11 (Severe Exacerbation)
Assessed Vitals 0 of 1 poi
Temperature (1/5 point)
Normothermic Hyperthermic Hypothermic
Blood Pressure (No point) Normotensive Hypertensive Hypotensive
Heart Rate (1/5 point)
No abnormal findings Tachycardia Bradycardia
Respiratory Rate (1/5 point) No abnormal findings Tachypnea Bradypnea
Oxygen Saturation (1/5 point)
No abnormal findings Hypoxemia
Auscultated Breath Sounds 1 of 1 poin
Breath Sounds (1/1 point)
Normal breathing Expiratory wheezing Inspiratory wheezing Diminished breath sounds
Inspected Chest 1 of 1 poin
Symmetry (1/3 point)
Symmetric Asymmetric
Appearance (1/3 point) No visible abnormal findings Rash
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Barrel chest Excessive use of accessory muscles while breathing Skin growths (freckles or moles)
Sites Of Retractions (1/3 point) No visible abnormal findings Supraclavicular Supersternal Substernal Subcostal Intercostal
Assess Dyspnea 1 of 1 poin
Speech Characteristics (1/1 point) Speaks full sentences Speaks partial sentences Speaks short phrases OR single words
Assessed PAS 0 of 1 poin
Score (Severity) (No point) < 7 (Mild Exacerbation) 8-11 (Moderate Exacerbation) >11 (Severe Exacerbation)
Comments
If your instructor provides individual feedback on this assignment, it will appear here.
Home Medications Patient
Social History Patient
Review of Relevant Systems Patient
History of Present Illness Guardian
Home Medications Guardian
Followed up on rescue inhaler adherence Reports carrying rescue inhaler with him in the past Reports throwing away the rescue inhaler a few weeks ago Reports disliking rescue inhaler because of side effects
Asked about side effects of rescue inhaler Reports rescue inhaler made him feel shaky Reports rescue inhaler made his heart beat fast
Asked about exercise Reports being mostly sedentary
Asked about living situation Reports living with mother in an apartment
Asked about patient's substance use Denies alcohol use Denies using tobacco products
Asked about education Reports being in 3rd grade
Asked about cardiovascular system Reports heart is racing
Asked about integumentary system Denies current skin problems Reports using prescription cream to treat skin
Asked about mental health Reports frustration with diagnosis
Followed up on patient's asthma diagnosis Reports patient has mild asthma Reports patient was diagnosed at age 5
Asked guardian to elaborate on severity of symptoms
Reports peak flow meter readings at home were 55%, 59%, and 60%
Asked guardian about pharmacological relieving factors for current exacerbation
Reports giving patient an extra dose of daily maintenance inhaler
Confirms home medications with guardian Confirms patient is prescribed a rescue inhaler Confirms patient is prescribed a maintenance inhaler
Past Medical History Guardian
Social History Guardian
Followed up on rescue inhaler Reports rescue inhaler is albuterol Reports rescue inhaler dose is two puffs as needed
Followed up on maintenance inhaler Reports maintenance inhaler is fluticasone propionate Reports patient takes 2 puffs twice a day
Asked about medication adherence Reports patient takes maintenance inhaler as directed Reports patient has not needed rescue inhaler in the past year
Asked about over the counter medications Reports occasional antihistamine use for allergy symptom treatment
Asked about patient's general allergies Denies patient has food allergies Denies patient has a latex allergy Denies patient has medication allergies Reports environmental allergies
Followed up on environmental allergies Reports patient has allergies to tree pollen, pet dander, and dust mites
Followed up on impact of allergies on asthma Reports allergies have caused previous exacerbations Reports high pollen count traditionally worsens asthma symptoms
Asked about previous hospitalizations Reports one previous hospitalization for moderat asthma exacerbation Reports hospitalization was one year ago
Followed up on factors leading to prior hospitalization
Reports patient had been exposed to smoke the night before hospitalization Reports rescue inhaler was not effective in managing symptoms
Asked about patient's activity level Reports preventing patient from performing aerobic exercise
Asked about patient's exposure to secondhand smoke
Denies using tobacco products
Asked about childcare Reports working around 55 hours per week Reports utilizing after-school programs during the school year Reports patient's maternal grandparents care for him once a weekend
Shadow Health Asthma Exacerbation Gabriel Martinez
Course: Child and families (NURS 430)
University: Shepherd University
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