Week 5: Evaluation and Management of Respiratory, Cardiovascular, and Genetic Disorders
Baby Eden was only 1 month old when she presented with difficulty breathing, a high fever, and wheezing. Eden’s mother thought her daughter had a common cold, but the baby’s illness quickly led to admission to the pediatric intensive care unit. A diagnosis of respiratory syncytial virus (RSV) resulted in a weeklong hospital stay with antibiotic treatments (Azar, 2012). Like RSV, many respiratory disorders such as asthma and pneumonia also present symptoms often identified with common cold and flu viruses. As an advanced practice nurse, you must be able to distinguish between the various respiratory disorders to appropriately diagnose and treat pediatric patients. This is essential because, similarly to RSV, many disorders can quickly develop into a serious health issue.
An advanced practice nurse must know when to diagnose and treat, when to gather additional information prior to a diagnosis, and when to refer for specialized care. Consider 5-year-old Cristian Serrano. After waking up one morning with a fever and rash that covered his body, Cristian’s mother took him to his health care provider for examination. He was immediately diagnosed with scarlet fever and sent home with antibiotics. However, Cristian had not been properly diagnosed; his illness was actually the result of Kawasaki disease. Fortunately, the misdiagnosis was discovered quickly enough that there was no long-term damage to his heart’s arteries (Pritchett, 2011). With Kawasaki disease and other cardiovascular and genetic disorders, diagnostics and continued patient observation are sometimes necessary prior to determining diagnoses. In your role, you must be able to identify patient situations that require different approaches than the more typical diagnosis and treatment response.
This week you explore respiratory disorders in pediatric patients, as well as pediatric cardiovascular and genetic disorders, including the pathophysiology, epidemiology, and patient presentation. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.
By the end of this week, students will:
• Assess pediatric patients for respiratory disorders
• Assess pediatric patients for cardiovascular and genetic disorders
• Evaluate differential diagnoses for pediatric respiratory disorders
• Evaluate differential diagnoses for pediatric cardiovascular and genetic disorders
• Analyze treatment and management plans for pediatric patients with respiratory disorders
• Analyze treatment and management plans for pediatric patients with cardiovascular and genetic disorders
• Analyze strategies for educating patients and families on the treatment and management of respiratory disorders
• Analyze strategies for educating patients and families on the treatment and management of cardiovascular and genetic disorders
• Evaluate the impact of culture on the treatment and management of respiratory disorders
• Evaluate the impact of culture on the treatment and management of disorders (D/A)
• Understand and apply key terms, principles, and concepts related to respiratory disorders in pediatric patients
• Analyze the pathophysiology and epidemiology of disorders
• Analyze protocols for the management of disorders in pediatric patients
• Assess pediatric patients with signs of cardiovascular and genetic disorders
• Assess pediatric patients with signs of dermatologic disorders*
• Assess pediatric patients with signs of eye, ear, nose, and throat disorders*
• Evaluate diagnoses for pediatric patients
• Evaluate treatment and management plans
*These Learning Objectives support assignments that are due this week but were assigned in Weeks 5–6.
Case Study 2:
HPI: Brian is a 14-year-old known asthmatic with a 2-day history of worsening cough and shortness of breath. He reports using his albuterol inhaler every 3-4 hours over the previous 24 hours. He has a long-acting inhaled corticosteroid. He can’t recall which one. He said he ran out a few weeks ago and has not had time to obtain a refill. He denies cigarette smoking, but his clothing smells like smoke.
PE: Patient is sitting by himself. His parents are in the room during the visit. No purse lip breathing noted. Occasional nonproductive coughing during the interview.
PULM: You note prolonged expiration and expiratory wheezes in all lung fields. There are no signs of dyspnea.
Post an analysis of your assigned case by using the following:
• What additional questions will you ask?
o Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds, and so forth that might be pertinent in arriving to your differential diagnoses)
• What additional examinations or diagnostic tests, if any will you conduct?
• What are your differential diagnoses? What historical and physical exam
features support your rationales? Provide at least 3 differentials.
• What is your most likely diagnosis and why?
• How will you treat this child?
o Provide medication treatment and symptomatic care.
o Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.
• Patient Education, Health Promotion & Anticipatory guidance:
o Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
o Include any socio-cultural barriers that might impact the treatment and management plans.
o Health Promotion:
What immunizations should this child have had?
Based on the child’s age, when is the next well visit?
At the next well visit, what are the next set of immunizations?
What additional anticipatory guidance should be provided today?