Posted: September 12th, 2022

Terri Collins is an 8-year-old African-American girl

• Reply questions # 1, 2, three Primarily based on this case research

Chief Criticism
“My daughter has had a foul fever, and now she is having bother respiratory, and albuterol doesn’t Help.”
HPI
Terri Collins is an 8-year-old African-American girl who presents to the ED with a 2-day historical past of fevers, malaise, and nonproductive cough. The mom gave acetaminophen and ibuprofen to Help management the fever. Mom acknowledged that “plenty of different youngsters in her class have been sick this fall, too.” Terri began having bother respiratory the morning of admission, and the mom gave her albuterol, 2.5 mg by way of nebulization twice inside an hour. Terri nonetheless sounded wheezy to the mom after the albuterol, and Terri acknowledged it was “arduous to breathe.” Terri was beforehand properly managed concerning bronchial asthma signs. Earlier clinic notes reported signs through the day solely with lively play at college or at residence and uncommon nighttime signs. She makes use of PRN albuterol to Help with signs after enjoying. Her Assessment within the emergency division revealed Terri to have labored respiratory, such that she may solely full four- to five-word sentences. She had subcostal retractions, tracheal tugging with tachypnea at 54 breaths/min. Her different important indicators had been a coronary heart price of 160 bpm, blood stress of 115/59, temperature of 38.eight°C, and a weight of 22.7 kg. The preliminary oxygen saturation was 88%, and he or she was began on oxygen at 1 L/min by way of nasal cannula. Bilateral expiratory and inspiratory wheezes had been famous on examination. A chest x-ray revealed a proper decrease lobe consolidation in step with pneumonia and potential effusion. After receiving three albuterol/ipratropium nebulizations, her Terri had bother respiratory, and the physician within the emergency room discovered that she may solely communicate 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 coronary heart price was 160 beats per minute. Her blood stress was 115/59, and her temperature was 38.eight°C.breath sounds and oxygenation didn’t enhance, so she was began on albuterol by way of steady nebulization at 10 mg/hr and her oxygen was titrated to three L/min. She was additionally 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 additional remedy and monitoring.
PMH
Bronchial asthma; final hospitalization four years in the past, and has had two programs of oral corticosteroids prior to now 12 months
FH
Bronchial asthma on father’s aspect of the household
SH
Lives with mom, father, and two siblings, each of whom have bronchial asthma. There are two cats and a canine within the residence. Father is a smoker however states that he tries to smoke outdoors and never across the youngsters. She is within the second grade and is very lively on the playground.
Meds
Albuterol 2.5 mg nebulized Q four–6 H PRN wheezing
Fluticasone propionate 44 mcg MDI two puffs BID
Acetaminophen 160 mg/5 mL—10 mL Q four H PRN fever
Ibuprofen 100 mg/5 mL—10 mL Q 6 H PRN fever
All
NKA
ROS
(+) Fever, cough, elevated work of respiratory
Bodily Examination
Gen
Alert and oriented however in gentle misery with problem respiratory
VS
BP 125/69, P 120, T 37.9°C, RR 40, O2 sat 94% on three L/min nasal cannula
Pores and skin
No rashes, no bruises
HEENT
NC/AT, PERRLA
Neck/LN
Tender, supple, no cervical lymphadenopathy
Chest
Wheezes all through all lung fields, nonetheless with subcostal retractions
CV
RRR, no m/r/g
Abd
Tender, NT/ND
Ext
No clubbing or cyanosis
Neuro
A&O, no focal deficits
Labs
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Na 141 mEq/L WBC 34.2 × 103/mm3
Okay three.1 mEq/L  Neut 91%
Cl 104 mEq/L  Lymph 5%
CO2 29 mEq/L  Mono four%
BUN 16 mg/dL RBC 5.07 × 106/mm3
SCr zero.52 mg/dL Hgb 13 g/dL
Glu 154 mg/dL Hct 41%
Plt 310 × 103/mm3
Respiratory viral panel nasal swab: optimistic for influenza A
Chest X-Ray
RLL consolidation
Assessment
Bronchial asthma exacerbation with viral pneumonia
Questions
1. What extra info is wanted to totally assess this affected person?
2. What nondrug therapies is perhaps helpful for this affected person?
three. Develop a plan for follow-up that features acceptable time frames to evaluate progress towards achievement of the objectives of remedy.

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