NR 602 Sick Child Case Study

NR 602 Sick Child Case Study

NR 602 Sick Child Case Study

Thank you to those who commented on the presentation. Focus this week was a sick child case study presentation.  I was fortunate enough to see my patient in the initial office visit and then again two days later at a follow up appointment.

H.H. is a 2 mo. female who presents with mother who was seen for bronchiolitis.  Her initial visit revealed this diagnosis. Over the following two day she appeared to improve her eating and urine output.  Her mother followed the after-visit instructions to care for the patient.  However, she developed a fever and continued with a cough.  Her concerned mother brought her back in for a follow up visit. In the office H.H. was noted to be tachypnea. She was also noted to have erythematous bilateral tympanic membranes and expiratory wheezes throughout. H.H. was diagnosed with acute bronchiolitis due to respiratory syncytial virus.

Acute bronchiolitis due to respiratory syncytial virus (J21.0)-Bronchiolitis is a common lower respiratory tract infection in infants and young children, and respiratory syncytial virus (RSV) is the most common cause of this infection. RSV is transmitted through contact with respiratory droplets either directly from an infected person or self-inoculation by contaminated secretions on surfaces. The exact mechanism of action is unclear; however, it is likely that direct viral cytotoxic injury has a role in the pathogenesis of RSV infections. This leads to necrosis of the epithelial cells of the small airways, and the sloughed cells and mucus cause plugging of the bronchioles that leads to hyperinflation and atelectasis (Smith, Seales, & Bduzik, 2017).

Although increased mucus secretion is a common consequence of RSV and other respiratory virus infections of the larger airway regions, the relative absence of secreted mucins in the obstructed bronchiolar airways infected by RSV likely reflects the limited cellular sources of secreted mucins, ie submucosal glands and mucin-containing goblet cells, in distal airway regions especially those of infants ( Pickles & DeVincenzo, 2015).

Patients with RSV bronchiolitis usually present with two to four days of upper respiratory tract symptoms such as fever, rhinorrhea, and congestion, followed by lower respiratory tract symptoms such as increasing cough, wheezing, and increased respiratory effort.

H.H. was prescribed the following medications:

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Although the other diagnosis was very good Acute bronchiolitis due to respiratory syncytial virus is the diagnosis. Due to all of the three are viruses it’s hard to distinguish

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References

American Academy of Pediatrics. (2015). Bronchiolitis. Retrieved from healthychildren.org: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Bronchiolitis.aspx

Farley, R., Spurling, G., Eriksson, L., & Del Mar, C. (2014). Antibiotics for bronchiolitis in children under two years of age. Cochrane Database of Systematic Reviews(10). doi:10.1002/14651858.CD005189.pub4

Pickles, R. J., & DeVincenzo, J. P. (2015). Respiratory syncytial virus (RSV) and its propensity   for causing bronchiolitis. The Journal Of Pathology, 235(2), 266–276. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1002/path.4462

Smith, D. K., Seales, S., & Bduzik, C. (2017). Respiratory syncytial virus bronchiolitis in children. American Family Physician, 95(2), 94-99. Retrieved from https://www.aafp.org/afp/2017/0115/p94.html

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Zhou, L., Xiao, Q., Zhao, Y., Huang, A., Ren, L., & Liu, E. (2015). The impact of viral dynamics on the clinical severity of infants with respiratory syncytial virus bronchiolitis. Journal of Medical Virology, 87(8), 1276. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=103002600&site=eds-live&scope=site (Links to an external site.)Links to an external site.

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Doucette, A., Jiang, X., Fryzek, J., Coalson, J., McLaurin, K., & Ambrose, C. S. (2016). Trends in Respiratory Syncytial Virus and Bronchiolitis Hospitalization Rates in High-Risk Infants in a United States Nationally Representative Database, 1997–2012. PLoS ONE, 11(4), 1–15. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1371/journal.pone.0152208 (Links to an external site.)Links to an external site.

Rey-Jurado, E., & Kalergis, A. M. (2017). Immunological features of respiratory syncytial virus-caused pneumonia–Implications for vaccine design. International Journal of Molecular Sciences, 18(3), 1–19. https://doi-org.chamberlainuniversity.idm.oclc.org/10.3390/ijms18030556 (Links to an external site.)Links to an external site.

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Hollier, A. (2016). Clinical guidelines in primary care (2nd ed.). Scott, LA: Advanced Practice Education Association, Inc.