SABRINA VASQUEZ-VSIM.
PATIENT HISTORY
Patient Introduction
Sabina Vasquez is a 5-year-old Hispanic girl admitted today from the emergency room with a
diagnosis of pneumonia. She has a history of asthma and has had several episodes requiring use of
an albuterol inhaler at home.
Sabina has had an upper airway infection for the past few days. Earlier today she developed a
fever of 39°C (102.2°F), so her mother brought her to the emergency room. She was placed on
oxygen via nasal cannula at 2 L/min. She received a 380-mL bolus of normal saline and an
albuterol nebulizer treatment at 5:00 PM. This improved her oxygen saturation to 94%. The chest
x-ray revealed right lower lobe pneumonia with effusion. An intravenous infusion of D5 ½NS is
infusing at 61 mL/hr. Sabina just got settled in bed, and her mother is at the bedside.
Pediatric Nursing Care
1. Ricci, S., Kyle, T., and Carman, S. (2017). Maternity and Pediatric
Nursing, 3rd Edition.
2. Asthma, Chapter 40, pp. 1500-1508
3. Pneumonia, Chapter 40, pp. 1491-1493
4. Variations in Pediatric Anatomy and Physiology, Chapter 40, pp. 1468-1470
5. Common Medical Treatments, 40.1 Chapter 40, p. 1471
6. Enhancing Communication, Chapter 30, pp. 1117-1119
7. Teaching Children and Families, Chapter 30, pp. 1120-1122
8. Rapid Cardiopulmonary Assessment, Chapter 51, pp. 1989-1990
9. Intravenous Therapy, Chapter 35, pp. 1272-1278
10. Pneumococcal Vaccine, Chapter 31, pp. 1146-1147
Pharmacology
1. Albuterol sulfate
2. Azithromycin
3. Acetaminophen
4. Cefuroxime axetil
, 5. Dextrose
6. Sodium chloride
Pediatric Nursing Care
1. Expert Clinical Content from Lippincott Advisor
2. Asthma, pediatric Asthma, pediatric
3. Pneumonia, pediatric Pneumonia, pediatric
Name of Drug: Albuterol sulfate
Therapeutic Class: Bronchodilators
Pharmacologic Class: Adrenergics
Therapeutic Level: 1.4 to 3.2 ng/mL
Indication for Use: To prevent or treat bronchospasm in patients with reversible
obstructive airway disease
Used as a bronchodilator to control and prevent reversible airway obstruction caused by asthma
or COPD. Inhaln:Used as a quick-relief agent for acute bronchospasm and for prevention of
exercise-induced bronchospasm. PO: Used as a long-term control agent in patients with
chronic/persistent bronchospasm.
The nursing interventions associated with each drug are:
Assess lung sounds, pulse, and BP before administration and during peak of medication. Note
amount, color, and character of sputum produced.
● Monitor pulmonary function tests before initiating therapy and periodically during therapy.
● Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication
and notify health care professional immediately.
Patient Education:
, Instruct patient to take albuterol as directed. If on a scheduled dosing regimen, take missed dose
as soon as remembered, spacing remaining doses at regular intervals. Do not double doses or
increase the dose or frequency of doses. Caution patient not to exceed recommended dose; may
cause adverse effects, paradoxical bronchospasm (more likely with first dose from new canister),
or loss of effectiveness of medication.
● Instruct patient to contact health care professional immediately if shortness of breath is not
relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain.
● Instruct patient to prime unit with 4 sprays before using and to discard canister after 200
sprays. Actuators should not be changed among products.
Instruct patient to notify health care professional of all Rx or OTC
medications, vitamins, or herbal products being taken and to consult health
care professional before taking any OTC medications
Inform patient that albuterol may cause an unusual or bad taste.
● Inhaln: Instruct patient in the proper use of the metered- dose inhaler or nebulizer
● Advise patients to use albuterol first if using other inhalation medications and allow 5 min to
elapse before administering other inhalant medications unless otherwise directed.
● Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth and
clean the mouthpiece with water at least once a week.
Drug may decrease sensitivity of spirometry used for diagnosis of asthma.
Syrup contains no alcohol or sugar and may be taken by children as young as
age 2.
In children, syrup may rarely cause erythema multiforme or SJS.
Monitor patient for effectiveness. Using drug alone may not be adequate to
control asthma in some patients. Long-term control medications may be needed.
Potential Nursing Diagnoses for each drug:
Ineffective airway clearance (Indications)
