Problem
Tahnee is a 32-year-old, who has had asthma since she was a child. She lives with her mother in Nowra and works at a private aged care facility. Tahnee's father died of complications from asthma when he was 40 years old, her mother is in good health, with mild hypertension.
Tahnee's general health is good, with a past history of an appendectomy when she was 16 years old. Her asthma is well controlled with a daily inhalation of fluticasone inhaler. When she has the occasional common cold she also requires salbutamol to relieve her asthma symptoms, in addition, she has a yearly flu injection.
This morning Tahnee experienced wheezing, cough and chest tightness. She adopted her asthma rescue plan but continued to deteriorate. Her mother took her to the ED.
On assessment, Tahnee's temp is 37 C, pulse 115, 32 respirations, BP 150/85, SaO2 91% Room air (RA)
Tahnee was using her accessory muscles to help her breathe and on auscultation, she has decreased breath sounds and both inspiratory and expiratory wheeze.
Thinking about the clinical reasoning cycle- What other cues would you need to collect to help you understand Tahnees current condition? Why?