9.17 Clinical Judgment: Case Study

A 13-year-old client comes to the emergency department with breathing difficulties. The client is accompanied by their father and has a history of asthma, diagnosed four years ago. On arrival, the client’s symptoms include increased work of breathing, shortness of breath, coughing, and wheezing. Vital signs: respiration rate: 30 breaths per minute, heart rate: 118 beats per minute, O2 saturations: 91%, blood pressure: 110/60 mm Hg, and tympanic temperature: 38.1 °C/100.5 °F. The client reports the symptoms are not related to usual triggers (e.g., over-exercising, playing in cold air, scented products). The father says the child was up all night coughing and is therefore very fatigued this morning. Upon auscultation, decreased air entry bilaterally to bases, wheezing in the upper quadrants. No accessory muscle tugging. The client states their chest feels tight when coughing and that they started to feel nauseous this morning. Diaphoresis noted on face and neck areas. Slight gray discoloration around lips.