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Placement challenge: Asthma exacerbation

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What would you do in this situation?

Jacob is admitted to A&E under your care. He is a 17 year old boy sent from his school swimming lesson with an episode of breathlessness.

He has been told that he has asthma before but rejects his diagnosis and is very agitated.

How do you manage this frightened teenager entering the unit?

  • What would you initial approach include?

Your initial assessment with Jacob may be more successful if you can establish a good rapport. Teenagers do not always like to be told what to do, informed decision making is crucial. Your first task is to settle Jacob and to try and get a peak flow. If a parent or teacher is with Jacob it is also important to reassure them and to ensure their company is helping Jacob in a positive manner. Any stress may further exacerbate his breathlessness.

  • How might your assessor manage Jacob?

This will depend upon his severity but assuming Jacob has characteristics of an acute exacerbation (resps 25min/p 110 PEF <50% predicted) – a high dose of bronchodilator and prednisolone may be given. Lots of encouragement may be needed to monitor regular peak flows.

If Jacob is not admitted for observation how will you and your mentor ensure a safe discharge?

Try and ensure Jacob is aware of his inhalers and what they are prescribed for. Checking his inhaler technique for ALL of the devices is crucial. Jacob may also need more than the usual asthma self management plan that patients with asthma are given and encouraged to use.

Perhaps he needs more careful handling and a short course of counselling? Is his GP aware of his lack of acceptance of his diagnosis? Does Jacob understand the severity of his condition?

Understanding, and acting upon the patient’s needs is the safest way to manage patients with asthma. The condition is life threatening.

 

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