Chelsea is a 6-year-old female living with her mother and father in

Chelsea is a 6-year-old female living with her mother and father in a townhouse complex in a neighborhood adjacent to an active steel mill. Chelsea has had a two-month history of sporadic wheezing cough combined with shortness of breath.  Currently, she presents the following vitals and no noticeable signs of labored breathing or respiratory distress.

  • P: 102bpm
  • R: 20 rpm
  • BP: 105/60
  • T: 37.4 (tympanic)
  • O2 Sat: 98% (RA)

You do a psychosocial assessment of the family and find that both Chelsea’s parents are smokers, and there are two cats living in the home.  Her parents state that she seems to have these “breathing attacks” mostly when she is playing, or, attempting to help her parents around the house with activities of daily living.

You are about to conclude your assessment and relay your findings to the physician when Chelsea’s father approaches and asks: “Do you think she’s having trouble breathing because we smoke?”


1)   Review the case scenario (read it multiple times)

Explore the scenario from both the nursing, health and psychosocial perspectives.

2)  Generate relevant and timely actions and recommendations to assist the patient and their family in the situation to obtain the highest level of wellness possible.

3)  Discuss your process of finding, retrieving, and analyzing best practice information to develop an approach to a care plan for the patient and their family in the given case narrative.

4)   Include a discussion of at least one College of Nurses of Ontario Practice Standard or Guideline (, and how the Standard or Guideline is relevant to the case scenario.



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