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 Ductus Arteriosus (PDA).
- Born at 36 weeks gestation.
- Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
- T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96%
- A swab for respiratory syncytial virus (RSV) is positive.
Doctor orders - Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated.
After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed.
Client is discharged with these orders:
- methylprednisolone 0.4 mg/kg oral BID for 3
- Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed.
- Call if needed prior to the Q4 dose.
- Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake.
- Return for re-evaluation in 3 days
- Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.
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