# A 10-year-old child with asthma is experiencing an acute exacerbation. The child is using accessory muscles to breathe, has audible wheezing, and appears anxious. The peak flow meter reading is 40% of the child's personal best. What is the most appropriate immediate nursing intervention?

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> subject: Adult Health

## 문제

A 10-year-old child with asthma is experiencing an acute exacerbation. The child is using accessory muscles to breathe, has audible wheezing, and appears anxious. The peak flow meter reading is 40% of the child's personal best. What is the most appropriate immediate nursing intervention?

## 보기

1. Encourage the child to lie flat and rest to conserve energy
2. Administer prescribed short-acting beta-2 agonist (albuterol) via nebulizer **✔ 정답**
3. Administer prescribed oral corticosteroids and schedule follow-up in 24 hours
4. Apply oxygen via nasal cannula at 6 L/min and monitor vital signs

**정답: 2**

## 해설

For acute asthma exacerbation with peak flow at 40%, immediate bronchodilation with albuterol is the most appropriate intervention to relieve obstruction. Other options are less urgent or contraindicated in this acute setting.

## 심화 해설

Understanding the Clinical Scenario

The child is presenting with classic signs of a moderate-to-severe acute asthma exacerbation: use of accessory muscles, audible wheezing, anxiety, and a critically reduced peak expiratory flow rate (PEFR) at 40% of personal best. This PEFR value places the exacerbation firmly in the severe category (typically defined as

## 임상 시나리오

Pediatric Acute Asthma Exacerbation ManagementImmediate Nursing Priority for Severe Distress
In a severe exacerbation with PEFR ≤ 40% of personal best, the immediate priority is to reverse bronchoconstriction using a short-acting beta-2 agonist (SABA) like albuterol via nebulizer or MDI with spacer.

Position the child in an upright or semi-Fowler's position to optimize lung expansion. Lying flat can worsen dyspnea and should be avoided.

CautionWhile oxygen therapy is given for hypoxia and systemic corticosteroids reduce inflammation, neither acts as rapidly as inhaled SABAs to relieve the immediate life-threatening bronchospasm. Do not delay bronchodilator administration.

## 핵심 개념

- **Short-acting beta-2 agonist (SABA)** — A rescue bronchodilator medication, such as albuterol, that provides rapid relief of acute bronchospasm by relaxing airway smooth muscle.
- **Peak Expiratory Flow Rate (PEFR)** — A measure of how fast a person can exhale; used to classify asthma severity, with a value of 40% of personal best indicating a severe exacerbation.

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