Medical 3-year-old “Thomas”, has just been transferred to the Paediatric Ward, presenting with a 2-day history of reduced oral intake, reduced wet nappies, tachypnoea, cough and wheeze

Case Study 1- Medical 3-year-old “Thomas”, has just been transferred to the Paediatric Ward, presenting with a 2-day history of reduced oral intake, reduced wet nappies, tachypnoea, cough and wheeze. He has been diagnosed with acute asthma. Thomas’ older brothers have also been unwell with a cold. His mother, Tanya, has primary care of Thomas and his siblings, with his father caring for the children on weekends. Thomas is up to date with his immunisations. Thomas was born at 32 weeks’ gestation via c- section. He was hospitalised in Special Care Nursery until 34 weeks, for hyperbilirubinaemia and poor feeding. After many hospital and doctors’ visits during his life so far, Thomas has been diagnosed recently with Cerebral Palsy. Thomas currently has moderately increased work of breathing and requires 1 litre of oxygen via nasal prongs for oxygen saturation of 88%. Thomas is irritable and keeps pulling the oxygen tubing off. He has been ordered a once-only medication of Salbutamol via MDI, spacer and mask, every 20 minutes for 1 hour STAT. He cries and pushes the mask off each time the nurse tries to administer it. His mother cries and leaves the room when the nurses administer the salbutamol, saying she is too upset to watch, which makes Thomas more distressed.