Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Indicators for Assessment of Acuity

Indicators for Assessment of Acuity

Before children can receive appropriate treatment for uncontrolled asthma, it is essential to assess accurately the severity of their symptoms. The following clinical indicators should be assessed and documented:

  • Accessory muscle use – Look for the presence of indrawing; subcostal or intercostals muscle retractions (see Figure 2).
  • Dyspnea – The impression of the nurse that the child is breathless or having a difficult time breathing such as too breathless to complete a sentence or to feed.
  • Increased respiratory rate when child is afebrile.
  • Cerebral function – The child may display increased agitation or a decreased level of consciousness.
  • Lung function for children 5 years and older – If possible, objective lung function measurements should be determined by spirometry (Forced Expiratory Volume in one second) or peak expiratory flow rates. A value < 50% requires medical attention.
  • Decrease in oxygen saturation – If a pulse oximeter is available, the level of oxygen saturation should be determined. An acceptable level of oxygen saturation is >92%.

If the child exhibits any of the above symptoms, they should be referred for immediate medical