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 auscultation 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. What respiratory treatment considerations would you recommend at this time?

   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.

Answer 1

Treatment cobsiderations will be based on the assessment.

Inspection of the chest itself shows the use of acessory muscles for breathing .hence required to assist the baby in respirations providing supplemental oxygen to decrease the work load and stress on muscles that leading to lethargy and weakening of muscles.

Tachypnea can also be controlled by supplemental oxygen.on auscultation and palpitation its clear that there is thick secretions in the chest cavity..hence nebulisation with bronchodialtors will be useful.also chest physio therapy can help to loosen the secretion and can be suctioned out easily.positioning can be given as per the pooled secretions.since there is increased temperature there is chance of infection ,hence antibiotics can be given.