It is January & the height of the flu season. Mrs. Gibbs brings Tommy, age 8, to the local Urgent Care Center.



It is January & the height of the flu season.  Mrs. Gibbs brings Tommy, age 8, to the local Urgent Care Center.  He has a history of Asthma, diagnosed at age 4.  He has no other medical problems.  He is up to date on all immunizations & received the flu vaccine in October. The COVID Vaccine is not approved for children yet.  Mrs. Gibbs reports that Tommy has had a fever, cough, chills, & general malaise for 2 days. 


He has an albuterol inhaler that he uses as needed & a nebulizer machine at home.  He takes no other medications.


Tommy used the albuterol nebulizer several times yesterday & then last night the nebulizer didn’t seem to help.  Mrs. Gibbs put Tommy in the shower & the steam of the shower helped.  But this morning he was short of breath, wheezing & having a hard time talking.


Of note both Mr. & Mrs. Gibbs are cigarette smokers.


Assessment today

Vital Signs:  BP 130/72, HR 142, RR 38, POX 87% RA, Temp 98.6, Weight 110 lbs (50 kg)

Physical Assessment:  Neuro A & O x3; Lungs breath sounds diminished, faint expiratory wheeze; Heart sounds regular, tachycardic, S1,S2, no murmurs appreciated; Abd soft, nontender, non-distended, bowel sounds +; Extremities PP+, no edema.


A rapid COVID-19 test was negative for the coronavirus.  The Health Care Provider asks the nurse to place Tommy on nasal 02 & titrate to POX of 92% & if needed to maintain adequate POX use non-breather mask, obtain IV access & routine labs, place on the cardiac monitor, & give an albuterol nebulizer treatment stat & solumedrol 100 mg IV stat.


Respond to Questions:

  • Review the pathophysiology of this acute event & what may have contributed to it?
  • Explain why the specific treatments & medications were ordered.  How will they help Tommy? 
  • What is the Health Care Provider trying to prevent?

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