\u2022\tAnswer questions # 1, 2, 3 Based on this case study<\/p>\n
Chief Complaint
\n\u201cMy daughter has had a bad fever, and now she is having trouble breathing, and albuterol doesn\u2019t help.\u201d
\nHPI
\nTerri Collins is an 8-year-old African-American girl who presents to the ED with a 2-day history of fevers, malaise, and nonproductive cough. The mother gave acetaminophen and ibuprofen to help control the fever. Mother stated that \u201ca lot of other kids in her class have been sick this fall, too.\u201d Terri started having trouble breathing the morning of admission, and the mother gave her albuterol, 2.5 mg via nebulization twice within an hour. Terri still sounded wheezy to the mother after the albuterol, and Terri stated it was \u201chard to breathe.\u201d Terri was previously well controlled regarding asthma symptoms. Previous clinic notes reported symptoms during the day only with active play at school or at home and rare nighttime symptoms. She uses PRN albuterol to help with symptoms after playing. Her assessment in the emergency department revealed Terri to have labored breathing, such that she could only complete four- to five-word sentences. She had subcostal retractions, tracheal tugging with tachypnea at 54 breaths\/min. Her other vital signs were a heart rate of 160 bpm, blood pressure of 115\/59, temperature of 38.8\u00b0C, and a weight of 22.7 kg. The initial oxygen saturation was 88%, and she was started on oxygen at 1 L\/min via nasal cannula. Bilateral expiratory and inspiratory wheezes were noted on examination. A chest x-ray revealed a right lower lobe consolidation consistent with pneumonia and possible effusion. After receiving three albuterol\/ipratropium nebulizations, her Terri had trouble breathing, and the doctor in the emergency room found that she could only speak in four- to five-word sentences. She had subcostal retractions, tracheal tugging, and 54 breaths per minute of tachypnea. Her weight was 22.7 kg, and her heart rate was 160 beats per minute. Her blood pressure was 115\/59, and her temperature was 38.8\u00b0C.breath sounds and oxygenation did not improve, so she was started on albuterol via continuous nebulization at 10 mg\/hr and her oxygen was titrated to 3 L\/min. She was also given a dose of 25 mg IV methylprednisolone and a dose of 600 mg IV magnesium sulfate. Terri was then transferred to the PICU for further treatment and monitoring.
\nPMH
\nAsthma; last hospitalization 4 years ago, and has had two courses of oral corticosteroids in the past year
\nFH
\nAsthma on father\u2019s side of the family
\nSH
\nLives with mother, father, and two siblings, both of whom have asthma. There are two cats and a dog in the home. Father is a smoker but states that he tries to smoke outside and not around the kids. She is in the second grade and is very active on the playground.
\nMeds
\nAlbuterol 2.5 mg nebulized Q 4\u20136 H PRN wheezing
\nFluticasone propionate 44 mcg MDI two puffs BID
\nAcetaminophen 160 mg\/5 mL\u201410 mL Q 4 H PRN fever
\nIbuprofen 100 mg\/5 mL\u201410 mL Q 6 H PRN fever
\nAll
\nNKA
\nROS
\n(+) Fever, cough, increased work of breathing
\nPhysical Examination
\nGen
\nAlert and oriented but in mild distress with difficulty breathing
\nVS
\nBP 125\/69, P 120, T 37.9\u00b0C, RR 40, O2 sat 94% on 3 L\/min nasal cannula
\nSkin
\nNo rashes, no bruises
\nHEENT
\nNC\/AT, PERRLA
\nNeck\/LN
\nSoft, supple, no cervical lymphadenopathy
\nChest
\nWheezes throughout all lung fields, still with subcostal retractions
\nCV
\nRRR, no m\/r\/g
\nAbd
\nSoft, NT\/ND
\nExt
\nNo clubbing or cyanosis
\nNeuro
\nA&O, no focal deficits
\nLabs
\n| Download (.pdf) | Print
\nNa 141 mEq\/L\tWBC 34.2 \u00d7 103\/mm3
\nK 3.1 mEq\/L\t\u2003Neut 91%
\nCl 104 mEq\/L\t\u2003Lymph 5%
\nCO2 29 mEq\/L\t\u2003Mono 4%
\nBUN 16 mg\/dL\tRBC 5.07 \u00d7 106\/mm3
\nSCr 0.52 mg\/dL\tHgb 13 g\/dL
\nGlu 154 mg\/dL\tHct 41%
\nPlt 310 \u00d7 103\/mm3
\nRespiratory viral panel nasal swab: positive for influenza A
\nChest X-Ray
\nRLL consolidation
\nAssessment
\nAsthma exacerbation with viral pneumonia
\nQuestions
\n1. What additional information is needed to fully assess this patient?
\n2. What nondrug therapies might be useful for this patient?
\n3. Develop a plan for follow-up that includes appropriate time frames to assess progress toward achievement of the goals of therapy.<\/p>\n","protected":false},"excerpt":{"rendered":"
\u2022 Answer questions # 1, 2, 3 Based on this case study Chief Complaint \u201cMy daughter has had a bad fever, and now she is\u2026<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9022,9020,9021,9023,9018,9024,7392,9019],"tags":[1400,613,142,7594,1394,7598,7595,7593,7597,7599,7601,7590,7596,133,7655,7656,7591,7592],"class_list":["post-106371","post","type-post","status-publish","format-standard","hentry","category-assessment-assignment-help","category-coursework-help","category-homework-assignment","category-homework-help","category-i-need-help","category-research-essay","category-write-a-paper","category-write-an-essay","tag-best-custom-essay-writing-services","tag-best-dissertation-writing-services-uk","tag-best-online-essay-writing-services","tag-cheap-custom-essay-writing-services","tag-custom-research-paper-writers","tag-custom-research-papers-writing-service","tag-essay-writer-websites","tag-essay-writing-service-quality-cheap","tag-free-research-paper-writing-service","tag-help-me-write-a-research-paper","tag-i-need-help-with-my-dissertation","tag-professional-dissertation-writing-service","tag-quick-essay-writing-service","tag-research-paper-writing-service-cheap","tag-service-writing-my-essay-write-custom","tag-someone-to-write-my-paper","tag-top-rated-dissertation-writing-services","tag-top-uk-dissertation-writing-services"],"_links":{"self":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/106371","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/comments?post=106371"}],"version-history":[{"count":0,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/106371\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/media?parent=106371"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/categories?post=106371"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/tags?post=106371"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}