Discussion: iHuman Case Study – HEENT and Respiratory Infections NSG 6435
Discussion: iHuman Case Study – HEENT and Respiratory Infections NSG 6435
Discussion: iHuman Case Study – HEENT and Respiratory Infections NSG 6435
Do you recommend limited or involved the use of antibiotics in the treatment of these diseases and other unconfirmed bacterial illnesses and why? What are the standards regarding the use of antibiotics in the pediatric population, and what assessment findings would warrant prescribing an antibiotic for Asthma symptoms?
Asthma is a reversible respiratory chronic condition which involves inflammation of the airways, increased mucus production and edema, which may trigger coughing, shortness of breath and wheezing. It can be a lifestyle limiting health condition with no cure but requires close monitoring and adequate management of the symptoms. Childhood asthma, on the other hand, has been classified by most treatment guidelines as mild, moderate and persistent, depending on the severity and persistence of the symptoms, of which differ in the type of medication that is recommended for the management of the symptoms (Baan et al., 2018). A diagnosis of asthma was made based on the findings from the pulmonary function tests that were conducted on Katherine Harris. According to the CDC, the triggers of asthma include indoor or outdoor allergens, medications, mold, pets, exercise, infections, pets and tobacco smoke among others.
The clinical report recommends that clinicians should use the most appropriate diagnostic criteria for pediatrics before deciding on what medication to prescribe. For instance, certain instances as acute bacterial sinusitis, pharyngitis, and acute otitis media will benefit from antibiotic therapy. The guideline by the American Academy of Pediatrics (AAP) recommends that acute otitis media be diagnosed based on the evidence of two main condition, that is, evidence of middle ear effusion, which is demonstrated by a moderate to severe bulging of the tympanic membrane or a new onset of otorrhea, which is not attributable to otitis externa. However, patients who display more severe symptoms, bilaterally involved and of young age have a higher likelihood of benefiting from antibiotic therapy. Watchful waiting is recommended for older patients with mild symptoms, which are unilaterally involved. Consequently, antibiotic therapy is also recommended for cases involving acute bacterial sinusitis with symptoms, which have persisted for more than 10 days or worsen as a result of a new onset of daytime cough, nasal discharge or fever after the improvement of a typical viral upper respiratory tract infection (Sheldon, Heaton, Palmer, & Paul, 2018). Diagnostically confirmed pharyngitis with β-hemolytic GAS also require antibiotic therapy appropriately prescribed in terms of dosage and frequency for the shortest time possible. Using antibiotics excessively or inappropriately leads to antibiotic resistance which makes it hard to treat other infections in the future.
Using national guidelines and evidence-based literature, develop an Asthma Action Plan for this patient.
The action plan for this patient will include the daily treatment, long-term control of asthma, how to deal with a worsening state of asthma or an attack, and when it is necessary to seek medical attention in the course of treatment (Tesse et al., 2018).
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Classification of Asthma
Symptom frequency
Treatment
Patient education
Seek medical attention
Mild intermittent
Less than 2 days in a week
Bronchodilators which are short – 2 puffs of Albuterol after every 4-6 hours PRN.
Provide information on how to take the medication, proper inhaler techniques, and environmental triggers to avoid.
In case the symptoms persist for more than twice in a week or the patient has used short-acting beta antagonists (SABA)for more than 2 to 3 weeks.
Mild persistent
More than 2 days in a week and use of SABA for more than 2 to 3 weeks.
Low dose corticosteroid inhaler – 80-240 mcg/day beclomethasone or 180-600 mcg/day Pulmicort. SABA PRN for exacerbations.
Provide information on how to take the medication, proper inhaler techniques, and environmental triggers to avoid.
If daily use of SABA is required
Moderate persistent
Symptoms occur daily or for more one night in a week but not every night.
Low dose steroid inhaler, plus LABA, LTRB, or theophylline or medium dose steroid inhaler. SABA PRN for exacerbations.
Provide information adherence to daily prescription, proper inhaler techniques, and environmental triggers to avoid.
When symptoms persist.
Severe persistent
Symptoms occur all through the day and 7 nights in a week.
High dose corticosteroid inhaler plus, LABA and oral corticosteroid if needed – 2 mg/kg/day but should not exceed 60 mg/ day. SABA PRN for exacerbations.
Provide information adherence to daily prescription, proper inhaler techniques, and environmental triggers to avoid.
When symptoms persist.
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?
Wheezing is associated with breathing difficulties as a result of narrowing of the airways and is characterized by a high pitch whistling sound that is heard during respiration. As such, any complication or infection of the airways might have a significant impact that might lead to a total restriction of the airways in such a patient. Nasal flashing, murmurs and retractions are signals indicating distress in respiration. The earliest symptom is a nonproductive cough, followed by expiratory wheezing, tachypnea, and shortness of breath, tachycardia, prolonged expiratory phase, and hyper-resonance (Hudgins et al., 2019). The use of accessory muscles is a sign of severe asthmatic attack that is accompanied by decreased exercise tolerance and sudden nocturnal dyspnea. Through auscultation, the physician can identify the location and presence of crackles, stridor, and wheezing. However, it might be hard for these physical findings to be realized in pediatric patients who are unable to take deep breaths. Most research has revealed that localized wheezing might not be an indication of asthma, and hence recommend further investigations. It is also recommended that pediatric patients who present with localized wheezing be given bronchodilators such as albuterol as trial treatment (Horak et al., 2016). In case the drug does not help to stop the wheezing, then the patient is not suffering from asthma, but other underlying pathological conditions of the large central airway. A chest x-ray is indicated for children who present with symptoms of unexplained wheezing, which is not responsive to bronchodilators or is recurrent.
Discussion: iHuman Case Study – HEENT and Respiratory Infections NSG 6435 References
Baan, E.J., Janssens, H.M., Kerckaert, T., Bindels, P.J.E., Jongste, J.C., Sturkenboom, M.C.J.M., & Verhamme, K.M.C. (2018). Antibiotic use in children with asthma: cohort study in UK and Dutch primary care databases. BMJ Open 8(11), ,.
Hudgins, J. D., Neuman, M. I., Monuteaux, M. C., Porter, J., & Nelson, K. A. (January 07, 2019). Provision of Guideline-Based Pediatric Asthma Care in US Emergency Departments. Pediatric Emergency Care.
Horak, F., Doberer, D., Eber, E., Horak, E., Pohl, W., Riedler, J., Szepfalusi, Z., … Studnicka, M. (August 01, 2016). Diagnosis and management of asthma – Statement on the 2015 GINA Guidelines. Wiener Klinische Wochenschrift, 128, 541-554.
Tesse, R., Borrelli, G., Mongelli, G., Mastrorilli, V., & Cardinale, F. (January 01, 2018). Treating pediatric asthma according to guidelines. Frontiers in Pediatrics, 6.
Sheldon, G., Heaton, P. A., Palmer, S., & Paul, S. P. (January 01, 2018). Nursing management of pediatric asthma in emergency departments. Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association, 26(4), 32-42.
Week 4
discussion
iHuman Case Study – HEENT and Respiratory Infections
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 by the due date assigned.
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.
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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 by the end ot the week.
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.
Click here for information on how to access and navigate
iHuman.
This week, complete the iHuman case titled “Katherine
Harris V3.1 PC.”
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?
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