Discussion question: Joshua Martin is a 5-year-old boy who started kindergarten this year. Joshua’s wheezing intensifies after he lies on the floor mats in his classroom for a nap. Joshua receives albuterol (a β2-agonist) treatments four to five times a year in the emergency department for this condition and experiences temporary relief of symptoms. The school nurse’s observations of Joshua include the following: absence of fever or sore throat, persistent dry cough, wheezing, exercise intolerance, and a history of resolution of symptoms after β2-agonists treatments. After a pulmonary function test is done at his pediatrician’s office, it is determined that Joshua has moderate persistent asthma and allergic rhinitis. 

• Which of the school nurse’s observations are consistent with the diagnosis of asthma?
• How would you explain the purposes and expected results of a pulmonary function test?
• In providing education to Joshua and his mother, how would you incorporate the use of a peak flow meter and what developmentally appropriate instructions would you give?
• In developing plan of care goals, the school nurse recognizes what level of activity is appropriate for children with asthma?
• The school nurse recognizes that Joshua is using correct inhaler technique by observing which demonstrations? What would you use for a child unable to use a MDI correctly?

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