UNIVERSITY OF THE SOUTHERN CARIBBEAN

MARACAS ROYAL ROAD, MARACAS, ST. JOSEPH.

Study Case
Presented in Partial Fulfilment
Of the Requirements for the Course
NUCP203 : Clinical Placements
INSTRUCTOR: Reona Bootkoon

By:
Keturah Francois,steonia lessey, Kerena Campbell, Riann James Parris, Klyncia Guerra, Olivia
Jagroop
7th June 2021

Approval………………………
Tetralogy of Fallot

Anatomy & Physiology:

Signs and symptoms:

Pathophysiology:

Nursing management:

Interventions:

Interventions for patients suffering from tetralogy of Fallot is to assess the heart rate and blood
pressure, note the skin colour, temperature and moisture. Check for peripheral pulse, including
capillary refill and assess for reports of fatigue and reduced activity tolerance. You would want to
inspect fluid balance and weight gain, assess the heart sounds for gallops (S3,S4), monitor
electrocardiogram (ECG) for rate, rhythm, and ectopy, and provide adequate rest periods.
Position the child in semi-fowler’s position and administer oxygen therapy as prescribed (Martin,
2019).

Pharmacological management:

Care plan:
References

Martin, P. B. (2019, April 10). 5 Congenital Heart Disease Nursing Care Plans. Retrieved

June 27, 2021, from

https://nurseslabs.com/5-congenital-heart-disease-nursing-care-plans/

Paediatric

James, 9 years old, is seen in the A&E department because of worsening shortness of breath. His
parents say that he is often wheezy but never this bad. His GP diagnosed asthma in the summer
and prescribed him salbutamol as a dry powder inhaler, which James felt helped his symptoms
considerably. James has a baby sister who is well. Both his parents suffer from hay fever, and his
father had bad eczema as a child (needing hospital treatment). Neither parents smoke, but his
grandparents continue smoking when he stays with them. His parents are aware of the dangers of
passive smoking, but are a bit hazy about the evidence for saying that it ‘causes’ such childhood
problems. They do not want to upset his grandparents, needing them to look after him. In A&E,
James is having difficulty speaking, his chest is “quiet” on auscultation, and his peripheral
oxygen saturation is 86% on an oximeter. The FY2 asks James to blow into a peak flow meter,
but the triage nurse suggests that this may exacerbate his condition and gives him a nebulizer.
Following this, he is able to talk more easily and has a clear wheeze heard throughout his chest.
He is given 40mg of soluble prednisolone and transferred to the ward. On the way, he has a chest
X-ray. This is reported as showing marked hyperinflation but no evidence of collapse or
consolidation. After two days on the ward, he has made a good recovery and is able to go home.
He and his mother see an asthma nurse specialist, who discusses his new medication (regular
inhaled corticosteroid delivered through a large volume spacer and a bronchodilator to use as
required), and gives him a plan for managing his asthma at home. Outpatient follow-up is
arranged with the asthma nurse specialist in six weeks.

1. Discuss the factors that contribute to childhood Asthma.

Second and third hand smoking as a factor of Asthma

Environmental tobacco smoke (ETS) is also called “secondhand smoke.” This refers to the
smoke that is released in the air when a smoker exhales. It also refers to the smoke released from
a burning cigarette, cigar or pipe.

Secondhand smoke can trigger an

asthma attack in a child, because their lungs are smaller and more delicate, and are still
developing. Children who live with people who smoke have higher rates of asthma than children
living with people who do not smoke, and their asthma is triggered more often.

How do secondhand smoking cause Asthma?

Smoke exposure irritates the airways, making them swollen, narrow, and filled with sticky mucus
— these are the same things that happen during an asthma flare-up, reducing the likelihood of
achieving good asthma control and reducing the effectiveness of preventer medications.
(Asthma, children and smoking - Better Health Channel, 2019)

Thirdhand smoke is residue from tobacco smoke. When a cigarette is smoked, chemicals in the
smoke stick to surfaces and dust for months after the smoke is gone. The chemicals in the residue
then react to other pollutants in the air, like ozone, to create harmful particles you can easily
inhale.

Thirdhand smoke particles are extremely tiny, easily making their way into your lungs. These
particles can stick to skin and clothing. Children then breathe in the residue or absorb it through
their skin or mouth.
(Tobacco Smoke and Asthma | AAFA.org, 2017)

In this case any interaction that the grandparents may have with James especially after smoking
can have an impact on James health.

Reference

Aafa.org. 2017. Tobacco Smoke and Asthma | AAFA.org. [online] Available at:
<https://www.aafa.org/secondhand-smoke-environmental-tobacco-asthma/> [Accessed 17 June
2021].

Betterhealth.vic.gov.au. 2019. Asthma, children and smoking - Better Health Channel. [online]
Available at:
<https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/asthma-children-and-smoki
ng> [Accessed 17 June 2021].

● A Family history of asthma

According to Fletcher J (2019), a person is more likely to develop asthma if they have a family
history of the condition. This means that asthma can be genetic. Some researchers describe it as a
“highly heritable diseaseTrusted Source.”

According to a 2014 review studyTrusted Source, genetic factors account for around 70 percent
of a person’s risk of developing asthma, meaning that genes play a large role in whether or not a
person develops the condition.

However, genetics are not the only cause of asthma. Some people develop it when they have no
family history of the condition. Likewise, a person may have a genetic tendency toward asthma
but never actually develop it.
Genetics play less of a role in asthma development later in life, so adult-onset asthma and
occupational asthma are slightly less dependent on genes. A person can also develop asthma
without any genetic predisposition for the condition.

References

Fletcher, J. (2019, February 14). Does asthma run in the family? Retrieved June 18, 2021,

from https://www.medicalnewstoday.com/articles/324447

Kerena

Olivia Jagroop
Respitory infection

Klyncia Guerra

https://www.medicalnewstoday.com/articles/325486#stress-and-asthma

Keturah
Second hand smoking
Steonia

Although allergens do not cause asthma, they do have a direct link to the trigger. Allergies are
aberrant immune system reactions to stimuli that most people consider to be safe. When a person
is allergic to anything, the immune system incorrectly believes the substance is causing harm to
the body, seeing it as an invader and attempting to fight it off (Smallwood, 2016). This can result
in a variety of symptoms, ranging from unpleasant to serious and even life-threatening. allergens
that may trigger one’s allergy are Dust, pollen, and molds Cockroaches and pets, as well as cows,
milk, eggs, fish, and other foods. Smallwood (2016)
The nature and intensity of allergy symptoms vary from one allergy to the next and from one
person to another. Itchy eyes, sneezing, stuffy nose, throat tightness, problems breathing,
vomiting, and even fainting or passing out are all symptoms of allergies. 2021 (James)
Allergy susceptibility is commonly inherited, meaning it can be handed down through the
generations from parents to their children. Therefore, the family history of allergies is a major
risk factor for allergic asthma.
Because his parents had hay fever and other allergies it also increases their child's risk of
developing asthma. (James, 2021)

James, l. (2021, may 14). Allergies and asthma: They often occur together. Retrieved
from mayo clinic:
https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/allergies-and-ast
hma/art-20047458
Smallwood, J. C. (2016, october). All About Allergies. Retrieved from kids health:
https://kidshealth.org/en/parents/allergy.html