Question

Case Study # 3 Pediatric patient with asthma Zack’s mother called the office nurse this morning and reported, “My son has been coughing and wheezing for the past 24 hours”. She was told to come in to see the NP. Zack, age 6, presents to the office with symptoms of worsening cough and wheezing for the past 24 hours. He is accompanied by his mother, who is a good historian. She reports that her son started having symptoms of a viral upper respiratory infection 2 to 3 days ago, beginning with a runny nose, low-grade fever of 100.5ºF orally, and loose cough. Wheezing started on the day before the visit, so Zack’s mother administered albuterol metered-dose inhaler (MDI) two puffs before bed and then two puffs at around 2 a.m. The cough and wheezing appear worse today, according to the mother. Zack had difficulty taking deep-enough breaths to inhale this morning’s dose of albuterol. Zack has been a patient at the clinic since birth and is up to date on his immunizations. His growth and development have been normal, and he has been generally healthy except for mild intermittent asthma. His asthma has been precipitated by a viral upper respiratory infection in the past. He has required oral prednisone an average of two or three times per year for the past 3 years. He has an albuterol MDI at home with a spacer, which his parents are comfortable using. He is in first grade. This is the first asthma exacerbation of the school year, and his mother expresses a concern about sending him to school with an inhaler. Assessment Zack is afebrile with a respiratory rate of 36 and a tight cough every 1 or 2 minutes. He weighs 45 pounds. The examination is all within normal limits except for his breath sounds. He has diffuse expiratory wheezes and mild retractions. Pulse oximeter readings indicate oxygen saturation of 93%. Peek flow is 70 L/min. 1. Describe the initial management plan for Zack’s respiratory condition, specifically regarding pharmacological therapies, patient/parent education, and follow-up plan. (Provide generic name of drugs and dose.) 2. What should be added to Zack’s therapy to better control his asthma symptoms and decrease exacerbations? (Provide name of drug and dose.)

Answer 1

1) Initial mangement paln for Zacks respiratory condition is supplementing oxygen via pediatric non breathing mask and inhaled beta2 agonists and systemic corticosteriods and the dose depends on the age and weight and severrity of the condition depending on the Zackr weight that is 20kg so the inhaled short acting beta agonists to be taken 3mg every 20minutes for 3 doses and then 3mg every 1-4hours as neede or 3mg (0.5mg/kg/h by continous nedulization) etc ( systemic corticosteriods prednisone or methylpredisonlone ) or inhaled ipraptropium bromide. 2) asthma education for patient /parent is asthma symtoms and various triggers and how to manage them and medications available and they help asthma and asthma symptoms control and how to achieve it and device technique and written asthma action plans and asthma firstaid and about foods exacerabate the condition and also food intake etc, c) follow up plan : should go for follow up visits at periodic intervals in order to assess their asthma control and modify treatment, by periodic monitoring of asthma control through clinical visits is essential to step up therapy as necessary step down therapy etc, d) the drug therapy to better control his asthma symptoms and decrease exacerbation:prevention and long term control are key in stopping asthma attacks before they start , long term asthma control mediccation includes inhaled corticosterios( like flonase, or flunisolide and arnuity) leukotriene modifiers( singulair, or accolate etc) long term acting beta agonists( serevant, formoterol) etc, quick relief medication include short acting beta agonists( ventolin hfa etc) ipratropium(atrovent) , oral and introvenous corticsterios ( prednisone and methylprednisolone) etc