Assignment: NUR 117 Asthma Diagnosis

Assignment: NUR 117 Asthma Diagnosis

4. A nurse is caring for a school-age child who was diagnosed with asthma and reports chest pain. Which of the following actions should the nurse take first?

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The diagnosis of asthma is established primarily by the history; and this clinical history should
include the following points:
• Ask specifically about the following, and try to quantify the frequency of each per week, and
the duration:
− Episodes of wheezing
− Sensation of tightness in the chest or chest pain (especially in children)
− Shortness of breath when resting, or with mild exercise
− Cough, dry or productive
− Frequent colds or upper respiratory infections (URI), especially with URI that take >10
days to resolve
• Symptoms that worsen at night, especially cough
• Possible factors that may be triggering asthma episodes, such as:
– Viral respiratory infection (URI)
– House dust (mites)
– Plant pollens

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Assignment: NUR 117 Asthma Diagnosis
– Exercise
– Exposure to smoke (cigarettes, cigars, indoor heaters)
– Environmental irritants such as air pollution, perfumes
– Latex particles (especially noted in medical personnel using latex gloves or tubing)
– Animals and animal dander
– Specific medications (such as aspirin or NSAID medications)
– Emotional stress
– Occupational factors such as chemical fumes
– Food allergies (note that these are much less frequent as a cause of asthma than most
inhalant allergies or irritants)
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• Symptoms of gastro-esophageal reflux (GERD)
• Presence of allergic rhinitis or atopic dermatitis (50-80% of patients with atopic dermatitis
will develop asthma or allergic rhinitis)
• Family history, with special focus on close relatives with asthma, allergic rhinitis, atopic
dermatitis, or chronic sinusitis
• Recent episode of acute respiratory infection
• History of medications, especially B-Blockers, Non-steroidal anti-inflammatory drugs
(NSAID), Aspirin
• Other clinical problems

Assignment: NUR 117 Asthma Diagnosis

Physical Examination
A targeted physical examination is essential and should include at a minimum the following:
General examination should assess:
• Degree of dyspnea
− Assessment of speech – is it interrupted by the effort to breathe?
− Presence of cyanosis
− Anxiety or restlessness
− Use of accessory muscles of respiration
• Respiratory and pulse rate (See Annex 2 for normal values by age)
• Blood pressure (ELEVATED BP often accompanies the anxiety of respiratory distress;
DECREASED BP can indicate severe cardiac decompensation with respiratory failure)
• Presence of pulsus paradoxicus – an INCREASE in the strength of the pulse with inspiration
• Differentiation between inspiratory stridor and expiratory wheezing (especially in children)
Ear, Nose and Throat:
• Possible otitis, acute or chronic, especially in children. Refer if any question of diagnosis.
• Nasal abnormalities, including:
− Degree of mucous congestion and character of mucous – clear or purulent
− Hypertrophy of nasal mucosa
− Presence of nasal polyps
• Throat – possible upper airway obstruction with tonsillar hypertrophy or infection