Student Response: I would instruct Tina to have her cousin see a medical professional if she has trouble breathing for further evaluation. Since asthma is related to lower social economical status as well as exposure to specific irritants a you children and infants.factors that concern me related to compliance are are educational as welll as transportation to appointments and insurance. Younger patients diagnosed with bronchial asthma are treated with the same medications as adults, dosages are based on the weight of the child usually lower than the adult dose. Pediatric patients usually use a spacer between the inhaler and after a puff, he or she must be instructed to breathe in and out for 10 times. There is an option to use nebulizer to give the medication but for pediatric patients they are usually afraid of the nebulizer, this is less effective The provider should advise the parents to always have her carry a rescue inhale in school for sudden asthma attacks and give them a note allowing her to have an inhaler in school. The parents should be educated on the importance of having an inhaler close to her at all times to use it as needed.

Model Note: Younger patients with asthma are treated with the same medication as adults. Some medication dosages are based on weight. She should use an inhaler with a spacer attached for proper medication administration and her caregiver should always assist her. Studies have shown that nebulizer treatments are a less efficient way to administer medication. The provider should acknowledge that she may have an asthma attack while in school, and therefore needs a note to allow her to use it as needed. The patient and her caregiver should be educated about the importance of having her inhaler close-by and how to use it.

Student Response: Tina’s uncle likely has decreased breath sound on auscultation due to emphysema changes due to smoking , as the alveolar gets damaged from chronic inflammation and irritation the surface area is decreased thus leading to less area for gas exchange and decreased oxygen saturation his body adjust to the chronic oxygen deprivation one must pay attention to how much oxygen supplementation will be needed.

Model Note: He likely has decreased breath sounds on auscultation due to emphysematous changes to his lungs from smoking. As alveoli get destroyed from chronic inflammation and irritation, the surface area in the lungs is decreased. This leads to less area for gas exchange and subsequent decreased oxygen saturation. As his body adjusts to chronic oxygen deprivation, attention must be given to how much supplemental oxygen is given. The goal with someone with severe COPD is to keep oxygen saturation 88% to 92%. If he is given too much oxygen his drive to breathe with be decreased and puts him at risk for death.