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You are working in a large urban pediatric clinic after hours. A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify

You are working in a large urban pediatric clinic after hours.

A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions.

  • The child is in less than 10th percentile of weight and has a cardiac history of Patent DuctusArteriosus (PDA).
  • The child is in less than 10th percentile of weight and has a cardiac history of patent ductus arteriosus (PDA).
  • Born at 36 weeksgestation.
  • Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
  • Temperature: 102.1F, pulse: 140 beats/minute, respirations: 40 breaths/minute, blood pressure: 83/58mmHg, pulse oximeter 96% on room air.
  • A swab for respiratory syncytial virus (RSV) is positive.

Doctor orders – Nasal bulb suction and nasal saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, albuterol nebulizer in office and encourage oral fluids as tolerated.

After the albuterol nebulizer treatment, respirations are 36 breaths/minute and oxygen saturation is 100% on room air. 

Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that client has a nebulizer at home and can return to pediatric after-hours clinic or ER if needed.

Client is discharged with these orders:

  • Methylprednisolone0.4 mg/kg oral BID for 3
  • Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and then Q6 hours as needed. Call doctor if needed prior to the Q4 dose.
  • Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 hours while awake.
  • Return for re-evaluation in 3 days.

Instruction

  • Describe the pathophysiology for bronchiolitis, including the most common causative organism.
  • Analyze risk factors associated with bronchiolitis.
  • Choose diagnostic testing for bronchiolitis and support with rationale.
  • Explain signs and symptoms of bronchiolitis, including specific examples from the scenario.
  • Describe the pathophysiology of PDA, including why this is significant for this scenario.
  • Describe the rationale for use and contraindications for each of the prescribed medications.
  • Select two priority nursing diagnoses for this scenario, including supporting rationale for your choices.
  • Write two SMART goals for each nursing diagnosis.
  • Choose two interventions for each goal, including supporting rationale for your choices.
  • Describe potential short and long-term complications, including specific examples and supporting rationale.
  • Apply information from the scenario to create a plan for discharge teaching.

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