Bruce Jenkins is a 7 year old who presents with his mom and grandma to your office for the first time. You are the nurse today and you start your assessment prior to being evaluated by the provider....

Extracted text: Bruce Jenkins is a 7 year old who presents with his mom and grandma to your office for the first time. You are the nurse today and you start your assessment prior to being evaluated by the provider. You note Bruce to be coughing every few minutes, wheezing, and crying unsuccessfully. His mother tells you that his crying has minimized over the last few hours and she feels that he is breathing worse now. You examined him and note inspiratory wheezing and urticaria on his cheeks and hands. As part of your evaluation, the mother tells you that he was born at 33weeks gestation and was never diagnosed of with a respiratory illness. She tells you that these wheezing episodes frequently at 3least times a week and some nights, he wakes up coughing. On your physical exam, you find a 7-year-old who is under his ideal weight, his lungs consistent with inspiratory and expiratory wheezing, you also note frequent cough spells but no cyanosis. The child is sitting sits and is leaning forward and supporting the upper body with hands on the examination table. A few minutes later, you begin to note his wheezing diminishing with his ribs retracting. His mother tells you that he is unable to play with the other kids because he starts to wheeze. As the provider is finishing with the last patient, his grandmother tells you she needs to step out to smoke. His vitals are as follows Bp 100/60 HR 133bpm Respirations 30 Pain 7/10 SaO2 at 89% Answer the following questions based on the scenario. 1. What medical diagnoses do you think Bruce is exhibiting? What if he was 3 years old and presented in a similar fashion, how will your suspected diagnoses change? 2. What is your first course of action when the child presents this way? 3. What does the type of wheezing (inspiratory/expiratory) signify? 4. What are risks factors for Bruce for having this condition? 5. What are clinical signs that Bruce's condition is worsening? 6. What is the implication of the child's position? 7. How does his medical history contribute to his risk factors? 8. What would be the first line medication the provider will prescribe and what is the side effects you are going to watch for. 9. The doctor prescribes a inhaler spacer for them and the mother asks you what the benefit is because she does not want to buy "extra things for no reason." What is your education point for her? 10. What are the different asthma exacerbations and how is it determined? What would you say Bruce's exacerbation level is and why? 11. Name 5 rigorous teaching points for the family 12? Is there any concerns with his vitals? Why or why not? 13. What is the difference between short-acting, long acting bronchodilators, from cromolyn?