1700 – 12-year-old male arrives with his parents after playing outside with friends and suddenly developing shortness of breath. The client’s mother believes he is having an asthma attack. He has a medical history of asthma, insulin dependent diabetes mellitus and is current on all immunizations. No known allergies.

Oral Temperature 99^o F (37.2^o C)

Pulse 114/minute

Respirations 26/minute

Blood pressure 107/76 mm Hg

Oxygen saturation 89%

Client is alert and fully oriented. Anxious and unable to respond in full sentences. Appears in significant distress. Peripheral pulses were palpable. Skin was cool and dry to touch. Respirations were labored with audible wheezes and expiratory stridor. Tachypnea and use of accessory muscles. Frequent, non-productive cough. Active bowel sounds in all quadrants. Client reported no pain.

• Albuterol via nebulizer
• 4 liters of nasal cannula oxygen
• 40 mg of solumedrol intravenous (IV) push
• Establish peripheral vascular access
• Continuous cardiac monitoring