NSG 6435 Week 4 Discussion: iHuman Case Study – HEENT and Respiratory Infections

NSG 6435 Week 4 Discussion: iHuman Case Study – HEENT and Respiratory Infections

NSG 6435 Week 4 Discussion: iHuman Case Study – HEENT and Respiratory Infections

Related: NSG 6435 Week 4 Discussion: iHuman Case Study – Katherine Harris

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area.
To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. Complete your participation for this assignment.
For this assignment, you will complete an iHuman case study based on the course objectives and weekly content. iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.
The iHuman assignments are highly interactive and a dynamic way to enhance your learning. Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.
Here you can view information on how to access and navigate iHuman.
This week, complete the iHuman case titled “Katherine Harris.”
Apply information from the iHuman Case Study to answer the following questions:
Do you recommend a limited or an involved use of antibiotics in treatment of these diseases and other unconfirmed bacterial illnesses and why? What are the standards regarding the use of antibiotics in pediatric population, and what assessment findings would warrant prescribing an antibiotic for Asthma symptoms?
Using national guidelines and evidence-based literature, develop an Asthma Action Plan for this patient.
Do the etiology, diagnosis, and management of a child who is wheezing vary according to the child’s age? Why or why not? Which objective of the clinical findings will guide your diagnosis? Why? When is a chest x-ray indicated in this case?

iHuman Case Study – HEENT and Respiratory Infections: NSG 6435 Week 4 Discussion

SAMPLE PAPER ONLY

Do you recommend a limited or an involved use of antibiotics in treatment of these diseases and other unconfirmed bacterial illnesses and why? What are the standards regarding the use of antibiotics in pediatric population, and what assessment findings would warrant prescribing an antibiotic for Asthma symptoms?

More than 70% of antibiotics are prescribed in ambulatory pediatrics for respiratory conditions; 23% of the prescribed antibiotics are for conditions without an indication for antibiotic treatment, such as asthma (Burns, Dunn, Brady, Starr, & Blosser, 2017). The frequent use of antimicrobials in pediatric patients has led to significant increase in multidrug resistant bacterial infections among children (Nichols, Stoffella, Meyers, & Girotto, 2017). Antimicrobial stewardship programs serve as advocates to decrease the misuse of antibiotics with efforts to curtail and optimize the use of antibiotics (Nichols et al., 2017). I do not recommend antibiotic treatment at this point because there is no clear evidence of bacterial infection. Overprescribing antibiotics increments the risk of antibiotic resistance, which may further spread drug-resistant bacteria posing serious risks to patients with asthma (The American Journal of Pharmacy Benefits, 2017). Antibiotics should be used when signs and symptoms of bacterial infection is suspected or confirmed. For example, in the case of upper respiratory tract infections and bronchiolitis, there is no evidence that proves antibiotics are helpful; hence, they should not be prescribed (CDC, 2017). Moreover, a recent study evaluating the efficacy of adding antibiotics to standard treatment for asthma exacerbations proved that there was no significant therapeutic benefit and that there was no measurable impact on lung function (Boyles, 2016).

Using national guidelines and evidence-based literature, develop an Asthma Action Plan for this patient.

According to the classifying severity of asthma exacerbations, the patient is exhibiting mild-moderate symptoms of asthma (Burns et al., 2017). Treatment for quick relief includes Albuterol HFA 90 mcg/puff, 4-8 puffs every 20 minutes for 3 doses, then Q 1-4 hours (Burns et al., 2017). For maintenance, she should use 2 puffs Q 4-6 hours PRN (Burns et al., 2017). A 5-day course of methylprednisolone should be given alongside to establish initial control (Burns et al., 2017).  Reassessment is important to ensure an adequate response and to further assess asthma severity (Burns et al., 2017). Education will be provided to family and child on self-care management. The teach-back technique should be used to ensure effective understanding (Burns et al., 2017). A written action plan should be given to parent and child.

Do the etiology, diagnosis, and management of a child who is wheezing vary according to the child’s age? Why or why not? Which objective of the clinical findings will guide your diagnosis? Why? When is a chest x-ray indicated in this case?

The etiology, diagnosis, and management of a child who is wheezing varies according to the child’s age. A presentation of wheezing in a child has differential diagnoses depending on the child’s age. The exact cause of wheezing can be unclear in children, particularly those under pre-school age (Oo & Souef, 2015). In younger children wheezing may indicate bronchiolitis and/or RSV while in the older child wheezing may indicate asthma. Differential diagnoses include: viral pneumonia, bacterial pneumonia, and bronchitis among others.  Patient had a 3-week history of a cough with a 3-day history of SOB with exertion. The following objective findings guided my diagnosis: wheezes identified bilaterally, tachypnea, and decreased oxygen saturation. A chest x-ray would be indicated if pneumonia is suspected (The American Journal of Pharmacy Benefits, 2017). Moreover, children with hypoxia, fever, and/or localized rales should receive imaging (Burns et al., 2017).

References

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G. (2017). Pediatric Primary Care, 6th Edition. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780323243384/

Boyles, S. (2016). Antibiotic Shows no Benefit in Asthma Exacerbation. Retrieved from https://www.medpagetoday.com/pulmonology/asthma/60323

Centers for Disease Control and Prevention. (2017). Pediatric Treatment Recommendations. Retrieved from https://www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/pediatric-treatment-rec.html

Nichols, K., Stoffella, S., Meyers, R., & Girotto, J. (2017). Pediatric Antimicrobial Stewardship Programs. The Journal of Pediatric Pharmacology and Therapeutics, 22(1), pp. 77-80. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341537/

Os, S., Souef, P. L. (2015). The Wheezing Child- An Algorithm. Australian Family Physician, 44(6), pp. 360-364. Retrieved from https://www.racgp.org.au/afp/2015/june/the-wheezing-child-an-algorithm/

The American Journal of Pharmacy Benefits. (2017). Pediatric Patients with Asthma overprescribed Antibiotics. Retrieved from http://www.ajpb.com/news/pediatric-patients-with-asthma-overprescribed-antibiotics

iHuman Case Study – HEENT and Respiratory Infections Sample

Question Description

16 years

5′ 5″
150 pounds

Katherine Harris

Chief complaint:
cough and difficulty breathing

Below is the breakdown of the grading rubric for your case: Note you will be allowed to push the Interview Progress Button and receive feedback on your history questions 6 times.

a) % required history questions you asked (35% of grade)

b) % required physical exam performed (35% of grade)

c) differential diagnoses list (20%)

d) ranking differential diagnoses list (5%)

e) laboratory tests ordered (5%)

iHuman Case Study – HEENT and Respiratory Infections

Case study i-human- Katherine Harris

Chief Complaint:  Cough and Difficulty in breathing

History:

Miss Katherine Harris is 16 years of age is an understudy who presents with dynamic shortness of breath for a few days now. Her concern started four days prior when she got a bug. Her “cold” comprised of a sore throat, rhinorrhea and myalgia. Her tutoring compels her to go to classes even in the harsh elements and moist air. At first, she just felt tired yet later she built up a cough* and shortness of breath. At first, the cough was dry yet within 24 hours of beginning, it delivered plentiful yellow-green sputum. She states, “I cough up a measure of this stuff each day”. She didn’t think much about a cough since she consistently coughs amid the winter of every year. Her mom expresses that she “hacks and spits up” each morning when she gets up from the bed.

The shortness of breath has compounded so she can scarcely talk now. She likewise has torment in the left half of her chest when she coughs. She turns out to be exceptionally worn out subsequent to strolling up a flight of stairs amid a coughing spell. She denies hemoptysis, night sweats, chills, and paroxysmal nighttime dyspnea. Nonetheless, she complains of swelling of her lower legs: “I’ve had this for over a year.”

Ms. Katherine has been dealt with for hypertension, pneumonia and diseases of her hands. She has been dealt with for comparable scenes of coughing and shortness of breath amid the previous two years. When she was hospitalized because “I was drinking excessively and my pancreas misbehaved.” A past specialist gave her nitroglycerin.

ORDER NOW FOR AN ORIGINAL PIECE OF WORK

Physical Examination:

The patient seems considerably older than her expressed age of 16 years. She is a stocky fellow who seems rough, worn out and on edge. She talks about trouble, rapidly getting to be winded. There is cyanosis which heightened amid coughing spells. Pulse is 146/82 mmHg. Apical heart rate is 96 moment and customary. Respiratory rate is 28/minute. Temperature is 100.2o F.

Examination of the head and neck uncovers the utilization of extra muscles amid breath. Jugular veins are enlarged to 5 cm. with a conspicuous “a” wave.

Examination of the chest uncovers utilization of extra respiratory muscles. The front-back measurement of the chest is expanded. Breath rate is expanded; respiratory is standard and longer in termination. Fremitus is diminished and the lung fields are hyper-resounding (diffusely) with percussion. Percussion additionally uncovers diminished outing of the stomach (reciprocal). Breath sounds are reduced respectively. Coarse crackles, rhonchi and expiratory wheezes are heard reciprocally. A large portion of these sounds clear with coughing.

Examination of the cardiovascular system uncovers soft heart sounds: S2 is part and louder than S1. The P2 segment appears loader than A2 and is heard best at the base of the heart. An S4 is heard best along the left lower sternal fringe. A mumble isn’t recognized.

The stomach area is round however soft. Inside sounds are not heard. The liver edge is round, somewhat delicate and discernable 2 cm. underneath the privilege costar edge in the mid-clavian line. The prostate is developed and nodular on rectal exam.

Both feet show hallux valgus. There is pitting edema of the ankles.

Laboratory Tests:

The patient is first found in the emergency room. The accompanying information reflects the underlying tests.

CBC:

Leukocytes check is 12,500/mm3, 58% neutrophils, 7% groups, 28% lymphocytes, 6% monocytes, 1% eosinophils. Hemoglobin = 19.8 g/dL; Hematocrit = 60%; Platelet check = 320,000/mm3.

Chem:

Glucose 112 mg/dL (non-fasting); BUN 16 mg/dL, Creatinine 1 mg/dL; Cholesterol 240 mg/dL; Aspartate aminotransferase (AST) 18 U/L, Alanine aminotransferase (ALT) 32 U/L, Creatine kinase 72 U/L; Sodium 130 mEq/L, Potassium 4.8 mEq/L; Chloride 90 mE1/L, Bicarbonate 33 mEq/L.

ABGs*:

PH 7.38, Pa 02 44 mmHg, PaC02 58 mmHg, HCO3 31 mEq/L.

Electrocardiogram:

Chest x-ray PA and parallel perspectives

Sputum culture results are pending.

The patient is hospitalized. Spirometry is performed. The stream volume circle and results are as per the following:

FEV1 = 0.5L, Predicted = 2.9L, Percent of Predicted = 17%

FVC = 1.7L, Predicted = 3.9L, Percent of Predicted = 43%

FEV1/FVC = 29%

iHuman Case Study – HEENT and Respiratory Infections- SAMPLE PAPER ONLY

Do you recommend a limited or an involved use of antibiotics in treatment of these diseases and other unconfirmed bacterial illnesses and why? What are the standards regarding the use of antibiotics in pediatric population, and what assessment findings would warrant prescribing an antibiotic for Asthma symptoms?

More than 70% of antibiotics are prescribed in ambulatory pediatrics for respiratory conditions; 23% of the prescribed antibiotics are for conditions without an indication for antibiotic treatment, such as asthma (Burns, Dunn, Brady, Starr, & Blosser, 2017). The frequent use of antimicrobials in pediatric patients has led to significant increase in multidrug resistant bacterial infections among children (Nichols, Stoffella, Meyers, & Girotto, 2017). Antimicrobial stewardship programs serve as advocates to decrease the misuse of antibiotics with efforts to curtail and optimize the use of antibiotics (Nichols et al., 2017). I do not recommend antibiotic treatment at this point because there is no clear evidence of bacterial infection. Overprescribing antibiotics increments the risk of antibiotic resistance, which may further spread drug-resistant bacteria posing serious risks to patients with asthma (The American Journal of Pharmacy Benefits, 2017). Antibiotics should be used when signs and symptoms of bacterial infection is suspected or confirmed. For example, in the case of upper respiratory tract infections and bronchiolitis, there is no evidence that proves antibiotics are helpful; hence, they should not be prescribed (CDC, 2017). Moreover, a recent study evaluating the efficacy of adding antibiotics to standard treatment for asthma exacerbations proved that there was no significant therapeutic benefit and that there was no measurable impact on lung function (Boyles, 2016).