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Nursing QUESTION #9259
Question 1
A 7-year-old child with known asthma presents to emergency with: RR 36/min, SpO₂ 88%, unable to complete sentences, accessory muscle use, and PEFR 35% of predicted. This attack is classified as:
  • Mild intermittent asthma
  • Moderate acute asthma
  • Severe acute asthma
  • Life-threatening asthma✔️
Correct Answer Explanation

Acute Asthma Severity Classification in Children (GINA/BTS):

FeatureModerateSevereLife-Threatening
PEFR50–75% predicted33–50% predicted<33% predicted
SpO₂≥92%<92%<92%
SpeechSentencesPhrasesWords or silent
RR (child)Increased>30/minBradypnea (exhaustion)
Accessory musclesMildMarkedParadoxical movement

This child: PEFR 35% (<33–50%) + SpO₂ 88% (<92%) + unable to complete sentences = Severe/Life-threatening. PEFR 35% places in severe range.

Management of severe asthma:

  • High-flow O₂ to maintain SpO₂ \(\geq 94\%\)
  • Salbutamol (back-to-back nebulization) \(2.5{-}5\,\text{mg}\) every 20 minutes
  • Ipratropium bromide \(0.25\,\text{mg}\) nebulized (add for severe)
  • Systemic corticosteroids: prednisolone \(1{-}2\,\text{mg/kg}\) oral or IV hydrocortisone
  • IV MgSO₄ \(40\,\text{mg/kg}\) (max 2 g) in life-threatening asthma
  • ICU referral if deteriorating