Case Studies 1–3
Respiratory disorders such as pneumonia and asthma are among the leading causes of hospitalization in pediatric patients (U.S. Department of Health and Human Services, 2011). With such severe implications associated with many respiratory disorders, advanced practice nurses must be able to quickly identify symptoms, diagnose patients, and recommend appropriate treatment. For this Discussion, consider potential diagnoses and treatments for the patients in the following three case studies.
Case Study 1:
A 14-month-old female presents with a 4-day history of nasal congestion and congested cough. This morning, the mother noted that her daughter was breathing quickly and “it sounds like she has rice cereal popping in her throat.” Oral intake is decreased. Physical examination reveals the following: respiratory rate is 58, lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields, and her tympanic membranes are normal. There is moderate, thick, clear rhinorrhea and postnasal drip. Her capillary refill is less than 3 seconds, and she is alert and smiling. Her RSV rapid antigen test is positive.
Case Study 2:
Brian is a 14-year-old known asthmatic with a 2-day history of worsening cough and shortness of breath. He reports using a short-acting beta agonist every 3 hours over the previous 24 hours. He has a long-acting inhaled corticosteroid, but the prescription ran out, and he forgot to get it refilled. He says he came today because he woke up at 2 a.m. coughing and couldn’t stop, thus preventing him from going back to sleep. Over-the-counter cough suppressants don’t help. He denies cigarette smoking, but his clothing smells like smoke. His respiratory rate is 18 and he has prolonged expiration and expiratory wheezes in all lung fields. There are no signs of dyspnea. All other exam findings are normal.
Case Study 3:
A father presents his 9-year-old with a 3-day history of cough. Dad states that his son is coughing up yellow mucus. The boy is afebrile and is sleeping through the night, but the father’s sleep is disturbed listening to his son coughing. Dad says he thinks his son has bronchitis and is requesting treatment. Physical examination reveals the following: respiratory rate is 18, lungs are clear to auscultation, patient is able to take deep breaths without coughing, there is no cervical adenopathy, nasal turbinates are slightly enlarged, and there is moderate clear rhinorrhea.
Case Studies 4–6
Assessing, diagnosing, and treating pediatric patients for many cardiovascular and genetic disorders can be challenging. As an advanced practice nurse who facilitates care for patients presenting with these types of disorders, you must be familiar with current evidence-based clinical guidelines. Because of the clinical implications, you have to know when to treat patients with these disorders and when to refer them for specialized care. In this Discussion, you examine the following case studies and consider appropriate treatment and management plans.
Case Study 4:
Miguel is a 15-year-old male who presents for a sports physical. He is a healthy adolescent with no complaints. He plays basketball. He is 6 feet 5 inches tall and weighs 198 pounds. You note long arms and long thin fingers. He has joint laxity in his wrists, shoulders, and elbows.
Case Study 5:
Trina is a 9-year-old female who weighs 110 pounds. Vital signs are as follows: BP 122/79, P 98, R 20. Her mother reports she is a picky eater and refuses to eat fruits and vegetables. Her physical activity includes soccer practice for 1 hour a week with one game each weekend from September through November. Family history is negative for myocardial infarction, but both parents take medication for dyslipidemia.
Case Study 6:
You see a 2-month-old for a well-child visit. She is breastfed and nurses every 2 to 3 hours during the day, but her mother reports she is not nursing as vigorously as before. She sleeps one 4-hour block at night. Birth weight was 7 pounds 5 ounces. Weight gain over the last 2 weeks reveals gain of 5 ounces per week. Physical examination reveals the following: HEENT exam is benign, lung sounds are clear, a new III/VI systolic ejection murmur is noted along the left lower sternal border, cap refill is brisk, skin is pink and moist, and abdominal exam is benign.
To prepare:
Review “Respiratory Disorders,” “Cardiovascular Disorders,” and “Genetic Disorders” in the Burns et al. text.
Review and select one of the six provided case studies. Analyze the patient information.
Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.
By Day 3
Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder.
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Case Study 1:
The differential diagnosis for the 14-month-old female with nasal congestion, congested cough, rapid breathing, wheezes, diminished lung sounds, and positive RSV rapid antigen test includes respiratory syncytial virus (RSV) bronchiolitis, bronchial foreign body, and reactive airway disease.
Based on the symptoms, physical examination findings, and the positive RSV rapid antigen test, the most likely diagnosis for the patient is RSV bronchiolitis. RSV bronchiolitis is a common viral infection that affects the lower respiratory tract, especially in infants and young children. It is characterized by nasal congestion, cough, wheezing, increased respiratory rate, and signs of respiratory distress, such as intercostal and subcostal retractions. The positive RSV rapid antigen test confirms the presence of the RSV virus.
The treatment and management plan for RSV bronchiolitis in this patient may include supportive care to alleviate symptoms and promote recovery. This can involve providing hydration, maintaining adequate oxygenation, and ensuring proper nutrition. Since the patient has decreased oral intake, intravenous fluids may be necessary. Nasal saline drops and suctioning can help relieve nasal congestion. Inhaled bronchodilators may be considered to relieve wheezing, but their efficacy in RSV bronchiolitis is limited. Ribavirin, an antiviral medication, is sometimes used in severe cases, but its use is controversial and generally reserved for immunocompromised patients.
Strategies for educating the patient’s family on the treatment and management of RSV bronchiolitis include:
Providing information about the nature of RSV bronchiolitis, its common course, and expected duration.
Educating the family about the importance of maintaining good hydration, ensuring adequate nutrition, and monitoring for signs of respiratory distress.
Instructing the family on proper administration of medications, if prescribed, including any potential side effects.
Advising the family on infection control measures to prevent the spread of RSV to others, such as frequent handwashing, covering coughs and sneezes, and avoiding close contact with high-risk individuals (e.g., infants, elderly).
Encouraging the family to follow up with healthcare providers if the child’s condition worsens or if they have any concerns or questions.
Overall, the focus of education should be on supportive care measures, symptom management, and when to seek further medical attention if necessary.
(Note: Dosages of specific medications would depend on the individual patient’s age, weight, and other factors,)
