Question

please type :)

Diagnosis: bronchiolitis, Ventricular septal defect, Acute respiratory defect

patient age: 7 weeks

risk factors;

Age- discuss how age of the this patient may impact his/her health, medical medical condition/diagnosis and response to care and treatment

what are the factor specific to these disease?

what could be the physical finding?

Answer 1

1-

Diagnosis

Tests and X-rays are not usually needed to diagnose bronchiolitis. The doctor can usually identify the problem by observing your child and listening to his or her lungs with a stethoscope. However, it may take more than one or two visits to distinguish the condition from a cold or the flu.

If your child is at risk of severe bronchiolitis, if symptoms are worsening or if another problem is suspected, your doctor may order tests, including:

• Chest X-ray. Your doctor may request a chest X-ray to look for signs of pneumonia.
• Viral testing. Your doctor may collect a sample of mucus from your child to test for the virus causing bronchiolitis. This is done using a swab that's gently inserted into the nose.
• Blood tests. Occasionally, blood tests might be used to check your child's white blood cell count. An increase in white blood cells is usually a sign that the body is fighting an infection. A blood test can also determine whether the level of oxygen has decreased in your child's bloodstream.

Your doctor may also ask you about signs of dehydration, especially if your child has been refusing to drink or eat or has been vomiting. Signs of dehydration include sunken eyes, dry mouth and skin, sluggishness, and little or no urination.

Treatment

Bronchiolitis typically lasts for two to three weeks. The majority of children with bronchiolitis can be cared for at home with supportive care. It's important to be alert for changes in breathing difficulty, such as struggling for each breath, being unable to speak or cry because of difficulty breathing, or making grunting noises with each breath.

Because viruses cause bronchiolitis, antibiotics — which are used to treat infections caused by bacteria — aren't effective against it. If your child has an associated bacterial infection, such as pneumonia, your doctor may prescribe an antibiotic for that.

Drugs that open the airways (bronchodilators) haven't been found to be routinely helpful. But your doctor may elect to try a nebulized albuterol treatment to see if it helps.

Oral corticosteroid medications and pounding on the chest to loosen mucus (chest physiotherapy) have not been shown to be effective treatments for bronchiolitis and are not recommended.

Lifestyle and home remedies

Although it may not be possible to shorten the duration of your child's illness, you may be able to make your child more comfortable. Here are some tips to try:

• Humidify the air. If the air in your child's room is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing.
• Keep your child upright. Being in an upright position usually makes breathing easier.
• Have your child drink. To prevent dehydration, give your child plenty of clear fluids to drink, such as water or juice. Your child may drink more slowly than usual, because of the congestion.
• Try saline nose drops to ease congestion.You can purchase these drops over-the-counter (OTC). They're effective, safe and nonirritating, even for children.
• Maintain a smoke-free environment.Smoke can aggravate symptoms of respiratory infections. If a family member smokes, ask him or her to smoke outside of the house and outside of the car.
• Cause - Bronchiolitis is usually caused by a viral infection. ... They may only get mild symptoms, but in severe cases it can cause bronchiolitis or pneumonia.Bronchiolitis is contagious. Viral infections spread through droplets in the air, so you can contract it the same way you get infected with colds or flus.

• 2- Diagnosis of ventricular septal defect-

  Ventricular septal defects (VSDs) often cause a heart murmur that your doctor can hear using a stethoscope. If your doctor hears a heart murmur or finds other signs or symptoms of a heart defect, he or she may order several tests including:

• Echocardiogram. In this test, sound waves produce a video image of the heart. Doctors may use this test to diagnose a ventricular septal defect and determine its size, location and severity. It may also be used to see if there are any other heart problems. Echocardiography can be used on a fetus (fetal echocardiography).
• Electrocardiogram (ECG). This test records the electrical activity of the heart through electrodes attached to the skin and helps diagnose heart defects or rhythm problems.
• Chest X-ray. An X-ray image helps the doctor view the heart and lungs. This can help doctors see if the heart is enlarged and if the lungs have extra fluid.
• Cardiac catheterization. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at the groin or arm and guided through the blood vessels into the heart. Through cardiac catheterization, doctors can diagnose congenital heart defects and determine the function of the heart valves and chambers.
• Pulse oximetry. A small clip on the fingertip measures the amount of oxygen in the blood.

• Treatment

  Many babies born with a small ventricular septal defect (VSD) won't need surgery to close the hole. After birth, your doctor may want to observe your baby and treat symptoms while waiting to see if the defect closes on its own.

  Babies who need surgical repair often have the procedure in their first year. Children and adults who have a medium or large ventricular septal defect or one that's causing significant symptoms may need surgery to close the defect.

  Some smaller ventricular septal defects are closed surgically to prevent complications related to their locations, such as damage to heart valves. Many people with small VSDs have productive lives with few related problems.

  Babies who have large VSDs or who tire easily during feeding may need extra nutrition to help them grow. Some babies may require tube feeding.

• Causes

  Congenital heart defects arise from problems early in the heart's development, but there's often no clear cause. Genetics and environmental factors may play a role. VSDs can occur alone or with other congenital heart defects.

  During fetal development, a ventricular septal defect occurs when the muscular wall separating the heart into left and right sides (septum) fails to form fully between the lower chambers of the heart (ventricles).

• Risk factors

  Ventricular septal defects may run in families and sometimes may occur with other genetic problems, such as Down syndrome. If you already have a child with a heart defect, a genetic counselor can discuss the risk of your next child having one.

Diagnosing acute respiratory defect-

Acute respiratory failure requires immediate medical attention. You may receive oxygen to help you breathe and to prevent tissue death in your organs and brain.

After your doctor stabilizes you, he or she will take certain steps to diagnose your condition, such as:

• perform a physical exam
• ask you questions about your family or personal health history
• check your body’s oxygen and carbon dioxide levels level with a pulse oximetry device and an arterial blood gas test
• order a chest X-ray to look for abnormalities in your lungs

Treating acute respiratory failure

Treatment usually addresses any underlying conditions you may have. Your doctor will then treat your respiratory failure with a variety of options.

• Your doctor may prescribe pain medications or other medicines to help you breathe better.
• If you can breathe adequately on your own and your hypoxemia is mild, you may receive oxygen from an oxygen tank to help you breathe better. Portable air tanks are available if your condition requires one.
• If you can’t breathe adequately on your own, your doctor may insert a breathing tube into your mouth or nose, and connect the tube to a ventilator to help you breathe.
• If you require prolonged ventilator support, an operation that creates an artificial airway in the windpipe called a tracheostomy may be necessary.
• You may receive oxygen via an oxygen tank or ventilator to help you breathe better.

Causes--. There can be many causes of respiratory distress in children. Usually it is caused by infections, chronic illness or a blocked airway. ... When your child has to work hard to breathe, it can mean he or she is not getting enough oxygen to the lungs or is starting to get an infection.