The nurse working on a pediatric unit is caring for a client newly diagnosed with asthma.Which assessment data indicates exhaustion and the need for immediate intervention? Select all that apply.
A) Shallow respirations
B) Slightly diminished breath sounds
C) Decreased wheezing
D) Increased crackles
E) Increased respiratory rate

Question

Quizplus · Accepted Answer

A) Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of exhaustion. An increased respiratory rate indicates respiratory compromise, but not exhaustion.
B) Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of exhaustion. An increased respiratory rate indicates respiratory compromise, but not exhaustion.
C) Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of exhaustion. An increased respiratory rate indicates respiratory compromise, but not exhaustion.
D) Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of exhaustion. An increased respiratory rate indicates respiratory compromise, but not exhaustion.
E) Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of exhaustion. An increased respiratory rate indicates respiratory compromise, but not exhaustion.

The Nurse Working on a Pediatric Unit Is Caring for a Client