PRACTICUM 3: ASTHMA CASES .Implementation of Case A child has a severe fever, and now has breathing problems in the form of shortness of breath even though he has been given albuterol. History of Current Illness: The patient is an 8 year old SA child who has been experiencing fever, mailse and nonproductive cough since two days ago. The child's mother gave him paracetamol and ibuprofen to control his fever. From the information provided by the child's mother, "many other children at his school also experienced the same symptoms." SA started experiencing difficulty breathing in the form of shortness of breath in the morning when he was taken to the hospital, his mother then gave him Albuterol 2.5 mg via nebulizer 2 times an hour. SA experiences shortness of breath (wheezing), but SA feels difficulty breathing. SA previously had a history of asthma and her symptoms were well controlled using albuterol. Based on previous reports, the symptoms experienced by SA only occurred during the day when SA was actively playing at school or at home and rarely occurred at night. Albuterol was used before PRN when symptoms occurred after SA play. From the results of the assessment carried out in the ER, it was discovered that SA was experiencing shortness of breath where he could only speak 4 to 5 words in a sentence. SA was reported to be experiencing tachypnea with a RR of 54x/minute. Other vital signs show HR 160x/minute, blood pressure 115/59, temperature 38.8oC, weight 22.7kg. At the initial examination the patient's oxygen saturation was 88% so he was immediately given 3L oxygen/minute. The x-ray results showed consolidation in the right lower lobe. After receiving 3x Albuterol/Ipratropium nebulasi, his breath sounds were noisy and his oxygenation did not improve; so SA was started to be given albuterol via continuous nebulization at 10 mg/hour, and oxygen was titrated3L/min. SA was also given methylprednisolone 25mg IV and magnesium sulfate 600mg IV. SA was then transferred to the PICU for further treatment and monitoring. History of previous illness Asthma; was last hospitalized 4 years ago, and underwent 2 previous treatments with corticosteroids Family History - His father has asthma Social history - Lives with parents, with two brothers. At home there is a cat. Dad smokes. The last treatment given Albuterol 2.5 mg every 4-6 hoursPRN during an attack Fluticasonepropionate 44 mcg MDI 2 puffs BID Paracetamol 160 mg/5 mL-10 mL every 4 hours PRN fever Ibuprofen 100 mg/5 mL-10 mL every 6 hours PRN fever Physical examination:Difficulty breathing Vital Signs:TD 125/69, T37.9oC, RR 40, O saturation294% at 3L/min vianasal cannula Laboratory Na 141 mEq/L Scr 0.52 mg/dL K 3.1 mEq/L Glu 154 mg/dL Cl 104 mEq/L WBC 34.2x 103/mm3 CO2 29 mEq/L RBC 5.07x106/mm3 BUN 16 mg/dL HCT 41% X-Ray Examination:RLL (rightlowerlobe) consolidation Assessment:Asthma exacerbation with viral pneumonia