Question

A 3-month-old female presents with a 4-day history of cough, rhinorrhea, congestion, and fevers. Today her mother noticed she was breathing faster and looked like she was having difficulty breathing. She has been taking less formula than normal. Her 3-year-old sister had a cold last week. On physical evaluation her temperature is 39.0°C, heart rate is 150 beats per minute, respiratory rate is 70 breaths per minute, and blood pressure is 90/50 mm Hg. Her oxygen saturation is 90%. She appears alert but agitated and is tachypneic and coughing with nasal congestion with a lot of secretions. She has significant work of breathing, with subcostal and intercostal retractions. On auscul- tation of her lungs, breath sounds are decreased and wheezing is heard on both inspiration and expiration. A prolonged expiratory phase is also noted. The wheezing has a “wet” quality to it. Sputum culture was sent at this time, patient is RSV+.

1. You are requested to assess the child.

   The patient is admitted to the inpatient floor, where she received oxygen therapy by heated high-flow nasal cannulaat an FIO2 of 0.36. The patient required Q1 to Q2 hours suctioning for thick secretions. An IV was placed for decreased feeds and dehydration. The patient was weaned from heated high flow nasal cannula therapy to room air. Feeds improved, and she was discharged 2 days later.

2. What are specific diagnostic tests for confirming RSV infection?

Answer 1

Laboratory tests are generally not prescribed unless the child is desaturating, poor feeding or dehydration.

Monitoring vital signs (temperature, pulse rate, respiratory rate)

Assessing the oxygen saturation in the blood.

Auscultating the lungs.

In sick children

Complete blood count

Serum electrolytes.

Arterial blood gase analysis.

Chest xray.

Urinanalysis.

Specific RSV tests indication.

These specific tests are done to take any major decision regarding treatment, for isolating the child, practice barrier nursing techniques and for parent education.

Sputum culture

Antigen revealing tests

Molecular tests like multiplex PCR assays.