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

Sample Answer for iHuman Case Study – HEENT and Respiratory Infections: NSG 6435 Week 4 Discussion Included After Question

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

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

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?

A Sample Answer for the Assignment: iHuman Case Study – HEENT and Respiratory Infections: NSG 6435 Week 4 Discussion

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

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).

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.

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

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For the iHuman Case Study – HEENT and Respiratory Infections assignment, make sure you post your initial response to the Discussion Area by Saturday, August 19, 2017.

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 the iHuman Case Study – HEENT and Respiratory Infections assignment by Wednesday, August 23.

For the iHuman Case Study – HEENT and Respiratory Infections 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.

iHuman Case Study – HEENT and Respiratory Infections

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 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.

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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).

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