NSG 6005 Week 4 Discussion Question.docx - Johnathan is a 7-year-old child weighing 45 pounds with a history of mild intermittent asthma His mother

NSG 6005 Week 4 Discussion Question.docx - Johnathan is a...

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Johnathan is a 7-year-old child weighing 45 pounds with a history of mild intermittent asthma. His mother reports of him experiencing symptoms of a viral upper respiratory infection for the past 2 to 3 days, which started with a runny nose, cough, and low-grade fever of 101.0 F. Despite the administration of an albuterol via metered-dose inhaler (MDI) at bedtime and early morning, his cough and wheezing appear worse and his mother states that he is experiencing difficulty taking deep enough breaths to inhale his albuterol despite using the spacer. This is noted to be his first exacerbation of the school year. Currently he is afebrile, respiratory rate 36 bpm with diffused expiratory wheezes and mild retractions. Pulse oximetry readings are 93% on room air. With exception of breath sounds, his examination is within normal limits. What is the appropriate pharmacological therapies to be prescribed for Johnathan? Since Jonathan is 7-years-old, Prior to pharmacological therapy it might be helpful to obtain a measurement of lung function either by FEV1 or PEF at presentation and again at 30 to 60 minutes after pharmacological therapy to assess severity of the exacerbation (Camargo, 2009). Initially, an inhaled short-acting beta2-agonist (SABA) such as albuterol via MDI would be administered. 4 to 8 puffs every 20 minutes for 3 doses, if he responds to this then Johnathan would be instructed to take 4 to 8 puffs every 1 to 4 hours as needed (Camargo, 2009). If this therapy has minimal or sub-optimal results then adding a systemic corticosteroid is recommended. An oral administration of prednisone has shown to be effective. According to Woo and Robinson (2016), When there is an increase for using a short-acting bronchodilator or a decrease in PEF (20% or greater), a reduction in activity tolerance, and increased nocturnal symptoms; a short burst of oral prednisone of 1 to 2 mg/kg up to 60 g/d for 3 to 10 days in children is often effective in returning the PEF to normal and improvement of symptoms.
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