Case Study 1 A 2-year-old boy presents to the emergency department…

Case Study 1 A 2-year-old boy presents to the emergency department… Case Study 1A 2-year-old boy presents to the emergency department with a 3-day history of cold symptoms and a CC of waking in the night with trouble breathing. Upon arrival the paramedics report a respiratory rate of 48 breaths per minute, a heart rate of 160 beats per minute, a blood pressure of 60/40 mm Hg, and an oxygen saturation of 90%. A simple oxygen mask with 6 L/min flow is in place. Evaluation of the child begins using the Pediatric Assessment Triangle. The child is awake, alert, and pink in color but is easily agitated. Assessment of work of breathing reveals moderate to severe suprasternal, substernal, and intercostal retractions, high-pitched stridor when upset, and nasal flaring. Additional assessment determines that the child’s trachea is midline and chest expansion is symmetrical. Based on the assessment category, treatment should be quickly initiated, including increasing the level of supplemental oxygen to maintain an oxygen saturation >92%, corticosteroids to reduce inflammation, and nebulized racemic epinephrine to treat upper airway obstruction or narrowing.1. What is the purpose of the PAT and how quickly should it be performed?2. Which of the vital signs are outside normal limits for this child’s age?3. What components of the respiratory examination are suggestive of obstruction or narrowing of the upper airway?    Case Study 2A 35-day-old female presents to the emergency department with a 1-day history of slow breathing and decreased feeding. She was well the previous day, breastfeeding 5 to 6 times per day and has had 6 to 8 wet diapers daily. She has been constipated since birth, passing 1 stool every 4 days, and, at the time of presentation, she had not had a bowel movement in 6 days. She was a term infant born via spon-taneous vaginal delivery with Apgar scores of 7 at 1 minute and 9 at 5 minutes. The infant is afebrile, with a heart rate of 154 beats per minute, respiratory rate of 20 breaths per minute, blood pressure of 70/50 mm Hg in the right upper extremity, and oxygen saturation of 89% on room air. Her length, weight, and head circumference are in the 60th percentile. Femoral pulses are palpable with capillary refill of 2 seconds. Respiratory examination reveals grunting on exhalation and slow, shallow, and irregular breathing, without wheezing or retractions. Her pupils are small but reactive. The remainder of the physical examination, including cardiac assessment, is normal.1. What components of the examination are considered normal for this infant?2. What components of the evaluation indicate respiratory distress?3. What immediate interventions does this infant need?     Health Science Science Nursing SCIENCE / RSPT Share EmailCopy link Comments (0)

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