Question

E.M., a 5-month-old girl, has been admitted for respiratory distress, hypoxia, and fever. Her viral respiratory panel shows that she has respiratory syncytial virus (RSV). in the emergency department (ED), her Sao2 was 78% on room air, and she was placed on 1.5 L oxygen (O2). On admission to the floor, the patient is fussy and difficult to console. Vital signs (VS) are 130/72, 188, 83, 38.4C (rectal), and Sao2 94% on 1.5 L O2.

1. Based on the patient's diagnosis, what else would be important ta assess?

2. You provide nasopharyngeal suction for the patient and obtain a moderate amount of thick secretion. Aftrer allowing the patient to recovery, you reassess the patient's respiratory status. The respiratory rate and retractions have not changed significantly. The breath sounds are less coarse, but they are diminished in the bases. The Sa02 is now 90% on 1.5L O2. E.M.'s mother asks if she can feed the patient, since she has not eaten much for past 3 days. You tell her that with patient's respiratory rate greater than 65 breaths/min, she should not be fed. What is the rationale for holding feeds?

3. When you call the primary care provider (PCP), you are given orders for an albuterol nebulizer trial, IV bolus, and acetaminophen for fever. What is the rationale for the albuterol trial?

4. How will an IV bolus improve E.M's respiratory status?

5.Prioritize the following doctor's orders, and give your rationale:

a. acetaminophen 60mg PO for fever

b. D5LR 80 ml IV bolus

c. albuterol 2.5mg inhaled

6. Mrs. M asks why the physician is not prescribing anabiotics. What would you tell her?

Case study progress:

After the albuterol treatment, the respiratory rate is 23 breaths/minute, and the retractions have increased. The Sao2 is 89% on 2L of O2. E.M is pale and listless and does not cry when the IV is placed.

7. Why is the respiratory rate significant lower even though other signs of respiratory distress have increased?

Case study progress:

the PCP orders a portable chest X-ray (CXR) and capillary blood gas (CBG). The CXR is consistent with bronchiolitis with atelectasis. The CBG was pH 7.31, Pco2 72 mm Hg, HCO2 29 mEq/L.

8. Is the patient in acidosos or alkalosis? Respiratory or metabolic? Explain the results based on the patient's condition.

Answer 1

Based on the patient's diagnosis, what else would be important ta assess?

Complete history and physical examination to rule out the symptoms is essential to treat the infant. Blood tests and x-rays usually not necessary as test to identify the virus is positive here as mentioned. It is generally recommended that infant to be closely monitored with adequate oxgen and intravenous fluid support.

respiratory rate greater than 65 breaths/min, she should not be fed. What is the rationale for holding feeds?

Usually in infants with tachypnea have difficulty or cessation of breathing and uses their oral cavity for breathing. Hence, it is advised to have intravenous fluid and nutrition

When you call the primary care provider (PCP), you are given orders for an albuterol nebulizer trial, IV bolus, and acetaminophen for fever. What is the rationale for the albuterol trial?

Sometimes, it may cause wheeze and difficulty breathing immediately after inhaling. so it is essential to have a albuterol trial