Wheezing Wanda — Asthma Exacerbation
A silent chest is worse than a loud one
Wanda's chest whistles all the way to triage. Then, halfway through her second treatment, the whistling stops — and that silence is the most dangerous sound in the room.
Wanda's airways narrow and swell. Expiratory wheeze, prolonged expiration and a falling peak flow. Short-acting albuterol first, then steroids. If the wheezing stops but she is worse, air is not moving at all — that is a respiratory arrest waiting to happen.
Read Wheezing Wanda's full story →The story arc
The setup
Cat dander at a friend's house, plus a rescue inhaler she has been using six times a day for a week.
The turn
Loud expiratory wheeze, prolonged expiration, peak flow at 45% of her personal best.
The crisis
After two treatments the wheezing fades — but she is drowsy, cannot speak in words and her SpO₂ is 88%.
The save
Continuous nebulized albuterol with ipratropium, IV corticosteroids, magnesium, and intubation readiness.
NCLEX study section — Asthma Exacerbation
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Respiratory
Take this chapter into practice questions on the same topic.