NURS 6541: Primary Care of Adolescents and Children | Week 5

NURS 6541: Primary Care of Adolescents and Children | Week 5

NURS 6541: Primary Care of Adolescents and Children | Week 5: Evaluation and Management of Respiratory, Cardiovascular, and Genetic Disorders

NURS 6541: Primary Care of Adolescents and Children | Week 5

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.

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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.

Learning Objectives (NURS 6541: Primary Care of Adolescents and Children | Week 5)

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

Discussion: Diagnosis and Management of Respiratory, Cardiovascular, and Genetic Disorders

Discussion board posting assignments are assigned alphabetically by FIRST NAME to ensure all cases are covered and discussed.

  • Case Study 1: A-D
  • Case Study 2: E-I
  • Case Study 3: J-M
  • Case Study 4: N-R
  • Case Study 5: S-V
  • Case Study 6: W-Z

Case Study 1:

HPI: A 14-month-old Native American boy brought in by his mom due to cough, low grade fever and runny nose for the past 2 days. This morning, the mother noted that her son was breathing quickly and “it sounds like he has rice cereal popping in his throat.” Mom is worried because her son seems to have a lot of “bouts of colds”. Per mom, his oral intake is decreased. He didn’t want to eat this morning.

PE: Smiling, alert Native American boy.
VS: Temp of 99.9, pulse 112, respiratory rate is 58, Pulse ox 96%
HEENT: There is moderate, thick, clear rhinorrhea and postnasal drip.
CV: His capillary refill is less than 3 seconds
PULM: lung sounds are diminished in the bases, he has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields.

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 albuteral 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.

Case Study 3:

HPI: A father brought his 7-year-old son with a 3-day history of cough. Dad states that his son is coughing up yellow mucus. The boy is afebrile and is sleeping through the night, but the father’s sleep is disturbed listening to his son coughing. Dad says he thinks his son has bronchitis and is requesting treatment.

PE: VS: Temp 98.4, Pulse 76, respiratory rate 18, pulse ox 99%.
HEENT: there is no cervical adenopathy, nasal turbinates are slightly enlarged, and there is moderate clear rhinorrhea.
PULM: lungs are clear to auscultation, patient is able to take deep breaths without coughing.

Case Study 4

HPI: Miguel is a Latino 15-year-old male who presents for a sports physical. He is a healthy adolescent with no complaints. He plays basketball.

PE: He is 6 feet 5 inches tall and weighs 198 pounds.
MS: You note long arms and long thin fingers. He has joint laxity in his wrists, shoulders, and elbows.

Case Study 5:

HPI: Trina’s mother is concern that her daughter is a picky eater and refuses to eat fruits and vegetables. Her physical activity includes soccer practice for 1 hour a week with one game each weekend from September through November.

FMH: negative for myocardial infarction, but both parents take medication for dyslipidemia.
PE: Trina is a Native American 10-year-old female very engaging when answering questions. Vital signs are as follows: BP 122/79, P 98, R 20. Wt. 110, Ht. 4’11

Case Study 6:

HPI: You see a 2-month-old for a well-child visit. She is breastfed and nurses every 2 to 3 hours during the day, but her mother reports she is not nursing as vigorously as before. She sleeps one 4-hour block at night. PMH: Birth weight was 7 pounds 5 ounces. Weight gain over the last 2 weeks reveals gain of 5 ounces per week.

PE: Fussy two-month-old Chinese infant.
PULM: lung sounds are clear
CV: a new III/VI systolic ejection murmur is noted along the left lower sternal border, cap refill is brisk, skin is pink and moist.
ABD: bowel sounds noted in all quadrants. NURS 6541: Primary Care of Adolescents and Children | Week 5

To prepare:

  • Review “Respiratory Disorders,” “Cardiovascular Disorders,” and “Genetic Disorders” in the Burns et al. text.
  • Review and select one of the six provided case studies. Analyze the patient information.
  • Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
  • Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
  • Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.

By Day 3

Post an analysis of your assigned case by using the following:

    • What additional questions will you ask?
      • 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?
    • Provide medication treatment and symptomatic care.
    • 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:
    • Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
    • Include any socio-cultural barriers that might impact the treatment and management plans.
    • 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?

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to a colleague who chose one of the first three case studies and a second colleague who chose one of the last three case studies. Choose colleagues who selected a different case study than you did.

  • Explain how culture might impact the diagnosis, management, and follow-up care of patients with the respiratory, cardiovascular, and/or genetic disorders your colleagues discussed.
  • Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives. NURS 6541: Primary Care of Adolescents and Children | Week 5


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