Pediatric Asthma FUNDAMENTAL
Reasoning - Jared Johnson, 25 years
old / Pediatric Asthma History of
Present Problem: Jared Johnson is a
25 year-old African-American boy
with a history of moderate persistent
asthma.(complete answered solution)
Pediatric Asthma
UNFOLDING Reasoning
Jared Johnson, 25 years old
Primary Concept
Gas Exchange
Interrelated Concepts (In order of emphasis)
1. Inflammation
2. Clinical Judgment
3. Patient Education
4. Communication
5. Collaboration
UNFOLDING Reasoning Case Study: STUDENT
Pediatric Asthma History
of Present Problem:
Jared Johnson is a 25-year-old African American with a history of moderate persistent asthma. He is being admitted to the
hospital from the walk-in clinic with an acute asthma exacerbation. Jared has an increased chest tightness and shortness of
breath one day prior to admission. He has been at 50 percent of his personal best measurement for his peak expiratory
flow (PEF) meter reading which did not improve with the use of albuterol metered dose inhaler (MDI) (per his written
asthma management plan).
In the walk-in clinic Jared is alert, speaking in short sentences due to breathlessness at rest. He has coarse expiratory
wheezes throughout both lung fields with decreased breath sounds at the right base. His oxygen saturation on room air is
90%. His color is ashen, and he has dark circles under his eyes. He is sitting upright and using his accessory chest muscles
to breath and has moderate intercostal and substernal retractions. He is complaining of tightness in his chest. Jared was
diagnosed with asthma at age 6 years. He has three prior hospitalizations for asthma with one admission to the intensive
care unit within the last 5 years. He has never had to be intubated with these episodes.
Personal/Social History:
He is accompanied by his mother and 16-year-old sister. Jared lives with his mother, maternal grandmother, and sister in
an older housing development in the inner city. He is a good college student despite two to three absences per school year
for his asthma. He likes to ride his bike and is the goalie on the soccer team. He says that he has lots of friends at school
and likes his teacher, Mr. Bates, who is also his soccer coach. Both Jared and his mother deny tobacco smoke at home.
What data from the histories are important and RELEVANT; therefore, it has clinical significance to the nurse?
© 2016 Keith Rischer/www.KeithRN.com
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