Week 5: Evaluation and Management of Respiratory, Cardiovascular, and Genetic Disorders
Baby Eden was only 1 month old when she presented with difficulty breathing, a high fever, and wheezing. Eden’s mother thought her daughter had a common cold, but the baby’s illness quickly led to admission to the pediatric intensive care unit. A diagnosis of respiratory syncytial virus (RSV) resulted in a weeklong hospital stay with antibiotic treatments (Azar, 2012). Like RSV, many respiratory disorders such as asthma and pneumonia also present symptoms often identified with common cold and flu viruses. As an advanced practice nurse, you must be able to distinguish between the various respiratory disorders to appropriately diagnose and treat pediatric patients. This is essential because, similarly to RSV, many disorders can quickly develop into a serious health issue.
An advanced practice nurse must know when to diagnose and treat, when to gather additional information prior to a diagnosis, and when to refer for specialized care. Consider 5-year-old Cristian Serrano. After waking up one morning with a fever and rash that covered his body, Cristian’s mother took him to his health care provider for examination. He was immediately diagnosed with scarlet fever and sent home with antibiotics. However, Cristian had not been properly diagnosed; his illness was actually the result of Kawasaki disease. Fortunately, the misdiagnosis was discovered quickly enough that there was no long-term damage to his heart’s arteries (Pritchett, 2011). With Kawasaki disease and other cardiovascular and genetic disorders, diagnostics and continued patient observation are sometimes necessary prior to determining diagnoses. In your role, you must be able to identify patient situations that require different approaches than the more typical diagnosis and treatment response.
This week you explore respiratory disorders in pediatric patients, as well as pediatric cardiovascular and genetic disorders, including the pathophysiology, epidemiology, and patient presentation. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.
Learning Objectives
By the end of this week, students will:
Assess pediatric patients for respiratory disorders
Assess pediatric patients for cardiovascular and genetic disorders
Evaluate differential diagnoses for pediatric respiratory disorders
Evaluate differential diagnoses for pediatric cardiovascular and genetic disorders
Analyze treatment and management plans for pediatric patients with respiratory disorders
Analyze treatment and management plans for pediatric patients with cardiovascular and genetic disorders
Analyze strategies for educating patients and families on the treatment and management of respiratory disorders
Analyze strategies for educating patients and families on the treatment and management of cardiovascular and genetic disorders
Evaluate the impact of culture on the treatment and management of respiratory disorders
Evaluate the impact of culture on the treatment and management of disorders (D/A)
Understand and apply key terms, principles, and concepts related to respiratory disorders in pediatric patients
Analyze the pathophysiology and epidemiology of disorders
Analyze protocols for the management of disorders in pediatric patients
Assess pediatric patients with signs of cardiovascular and genetic disorders
Assess pediatric patients with signs of dermatologic disorders*
Assess pediatric patients with signs of eye, ear, nose, and throat disorders*
Evaluate diagnoses for pediatric patients
Evaluate treatment and management plans
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (Eds.). (2017). Pediatric primary care (6th ed.). St. Louis, Missouri: Elsevier.
Chapter 31, “Cardiovascular Disorders” (pp. 756-793)
This chapter reviews normal cardiac structure and function in infants, toddlers, school-age children, and adolescents. It then covers assessment and management strategies for cardiovascular disorders including congenital and acquired heart diseases.
Chapter 32, “Respiratory Disorders” (pp. 794-832)
This chapter covers the anatomy and physiology of the upper and lower respiratory tracts. It then explores assessment and management strategies for respiratory disorders including upper respiratory tract disorders, extrathoracic and intrathoracic airway disorders, and pectus deformity.
Chapter 41, “Genetic Disorders” (pp. 1148-1169)
This chapter explores the scope of genetic screening, genetic variation, and genetic disorders. It also provides assessment and management strategies for health care providers caring for children and families with genetic disorders.
Bradley, J. S., Byington, C. L., Shah, S. S., Alverson, B., Carter, E. R., Harrison, C., Swanson, J. T. (2011). The management of community-acquired pneumonia in infants and children older than 3 months of age: Clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clinical Infectious Diseases, 53(7), e25–e76.
Note: Retrieved from the Walden Library databases.
This article examines diagnosis, management, and treatment strategies for infants and children with community-acquired pneumonia. It also presents site-of-care management decisions and prevention strategies.
National Heart, Lung, and Blood Institute. (2007). Expert panel report 3 (EPR3): Guidelines for the diagnosis and management of asthma. Retrieved from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
These reports provided by the National Heart, Lung, and Blood Institute present guidelines for the diagnosis and management of asthma in children from infancy through adolescence. The pathophysiology of asthma, measures of assessment and monitoring, control of environmental factors, and medication are also covered.
Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis by Ralston, S.L., Lieberthal ,A.S., Meissner, H.C., Alverson, B.K., Baley, J.E., Gadomski ,A.M., Johnson, D.W., Light, M.J., Maraqa, N.F., Mendonca ,E.A., Phelan, K.J., Zorc ,J.J., Stanko-Lopp, D., Brown, M.A., Nathanson ,I., Rosenblum, E., Sayles, S. 3rd, & Hernandez-Cancio, S. in Pediatrics, 134(5), 1474-1502.
Copyright 2014 by American Academy of Pediatrics – Journals. Reprinted by permission of American Academy of Pediatrics – Journals via the Copyright Clearance Center.
This article examines the diagnosis, management, and prevention of bronchiolitis. It also examines treatment options appropriate for children and provides recommendations for minimalizing the spread of infection.
Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis by Keeney, G.E., Gray, M.P., Morrison, A.K., Levas, M.N., Kessler, E.A., Hill, G.D., Gorelick, M.H., & Jackson J.L. in Pediatrics, 133(3): 493–499.
Copyright 2014 by American Academy of Pediatrics – Journals. Reprinted by permission of American Academy of Pediatrics – Journals via the Copyright Clearance Center.
Mold, J.W., Fox, C., Wisniewski, A., Lipman, P.D., Krauss, M.R., Harris, D.R., Aspy, C., Cohen, R.A., Elward, K., Frame, P., Yawn, B.P., Solberg, L.I., & Gonin, R. Implementing asthma guidelines using practice facilitation and local learning collaboratives: a randomized controlled trial. Annals of family Medicine, 12(3), 233-
Discussion: Diagnosis and Management of Respiratory, Cardiovascular, and Genetic Disorders
Case Study 3:
HPI: A father brought his 7-year-old son with a 3-day history of cough. Dad states that his son is coughing up yellow mucus. The boy is afebrile and is sleeping through the night, but the father’s sleep is disturbed listening to his son coughing. Dad says he thinks his son has bronchitis and is requesting treatment.
PE: VS: Temp 98.4, Pulse 76, respiratory rate 18, pulse ox 99%.
HEENT: there is no cervical adenopathy, nasal turbinates are slightly enlarged, and there is moderate clear rhinorrhea.
PULM: lungs are clear to auscultation, patient is able to take deep breaths without coughing.
. To prepare:
Review “Respiratory Disorders,” “Cardiovascular Disorders,” and “Genetic Disorders” in the Burns et al. text.
Review and select one of the six provided case studies. Analyze the patient information.
Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.
By Day 3
Post an analysis of your assigned case by using the following:
What additional questions will you ask?
Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds, and so forth that might be pertinent in arriving to your differential diagnoses)
What additional examinations or diagnostic tests, if any will you conduct?
What are your differential diagnoses? What historical and physical exam
features support your rationales? Provide at least 3 differentials. •What is your most likely diagnosis and why?
How will you treat this child?
Provide medication treatment and symptomatic care.
Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.
Patient Education, Health Promotion & Anticipatory guidance:
Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
Include any socio-cultural barriers that might impact the treatment and management plans.
Health Promotion:
What immunizations should this child have had?
Based on the child’s age, when is the next well visit?
At the next well visit, what are the next set of immunizations?
What additional anticipatory guidance should be provided today?
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