Which finding would alert a nurse that a hospitalized 6-year-old child is at risk for a severe asthma exacerbation?
A. Absence of intercostals or substernal retractions
B. Oxygen saturation of 95%
C. Mild work of breathing
D. History of steroid-dependent asthma
Correct Answer: D. History of steroid-dependent asthma
A history of steroid-dependent asthma, a contributing factor to this client’s high-risk status, requires the nurse to treat the situation as a severe exacerbation regardless of the severity of the current episode. Because of severe adverse effects of steroids, these patients are in need of therapies that can minimize their steroid requirements and control their asthma.
Option A: Intercostal retractions are due to reduced air pressure inside the chest. This can happen if the upper airway (trachea) or small airways of the lungs (bronchioles) become partially blocked. Therefore, the absence of these findings indicates normal airways.
Option B: Although an SpO2 <95% is considered abnormal in the CTAS and in most asthma and pneumonia guidelines, there is no description of the standard value. Furthermore, although conventional wisdom states that pulse oximetry levels ?95% should be considered normal, data from previous studies suggest that the normal oxygen saturation range should lie between 97% and 100%. Therefore, oxygen saturation levels of 95% and 96% in school-aged children may correlate with an increased risk of an underlying clinical disease.
Option C: Mild work of breathing is a normal finding. During acute exacerbations, children may have significantly increased work of breathing or audible wheezing, which may be appreciated by caregivers and prompt presentation for further evaluation.