Page 1030 - Saunders Comprehensive Review For NCLEX-RN

6. Precipitants may trigger an asthma attack (Box 35-4).

7. Status asthmaticus is the most severe form of

an asthma attack that is unresponsive to repeated
courses of beta-agonist therapy; this is a medical
emergency that can result in respiratory failure and
death if not recognized and vigorously treated.
B. Assessment

1. Child has episodes of dyspnea, wheezing,

breathlessness, chest tightness, and cough,
particularly at night or in the early morning or both.
2. Acute asthma attacks
a. Episodes include progressively
worsening shortness of breath, cough,
wheezing, chest tightness, decreases in
expiratory airflow secondary to
bronchospasm, mucosal edema, and
mucus plugging; air is trapped behind
occluded or narrow airways, and
hypoxemia can occur.

b. The attack begins with

irritability, restlessness, headache,
feeling tired, or chest tightness; just
before the attack, the child may present
with itching localized at the front of
the neck or over the upper part of the
back.
c. Respiratory symptoms include a
hacking, irritable, nonproductive
cough caused by bronchial edema.
d. Accumulated secretions stimulate the
cough; the cough becomes rattling, and
there is production of frothy, clear,
gelatinous sputum.
e. The child experiences retractions.
f. Hyperresonance on percussion of the
chest is noted.
g. Breath sounds become coarse and loud,
with crackles, coarse rhonchi, and
inspiratory and expiratory wheezing;
expiration is prolonged.
h. Child may be pale or flushed, and the
lips may have a deep, dark-red color
that may progress to cyanosis (also
observed in the nail beds and skin,

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