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Do you recommend a limited or an involved use of antibiotics in treatment of these diseases and other unconfirmed bacterial illnesses and why? What are the standards regarding the use of antibiotics in pediatric population, and what assessment findings would warrant prescribing an antibiotic for Asthma symptoms?

Asthma is a chronic, inflammatory respiratory disease causing reversible airway constriction and hyperresponsiveness of the bronchi. With the inflammation, there is a simultaneous narrowing of the airways and increased mucus production. Symptoms range from occasional and mild, to severe and debilitating. According to Rohde, G. G. (2017), patients with acute asthma who require admission to hospital are often treated with antibiotics, in case the underlying cause of the attack is a bacterial infection since they help in their breathing through improving their lung functioning. (Rohde, 2017). Other than this case that should be confirmed with sputum culture it is not highly recommended; guidelines should be followed in the treatments of asthma.

The American Academy of Pediatrics (AAP), in collaboration with the Centers for Disease Control and Prevention, offers updated guidance on treating respiratory tract infections in children, with the goal of reducing unnecessary antibiotics prescriptions. The clinical report advises practitioners to use strict diagnostic criteria to distinguish between viral and bacterial infections. The report focuses on three of the most common pediatric upper respiratory infections: ear infections, sinus infections and strep throat (Hersh, Jackson, Hicks, & Committee on Infectious Diseases, 2013).

Using national guidelines and evidence-based literature, develop an Asthma Action Plan for this patient.

Develop a written asthma action plan: explain to parents and children how to manage asthma

Mild intermittent Symptoms less than 2 days per week or less than 2 nights per month

Treatment includes: Short-acting bronchodilator (Maria, 2016).

Mild persistent Symptoms more than 2 times per week, but not daily; or 3-4 times per

month at nighttime. Treatment includes: Low dose inhaled corticosteroids

Alternative treatment: cromolyn, LTRA, nedocromil or theophylline

Short-acting bronchodilator: for exacerbations (Maria, 2016).

Moderate persistent Daily symptom or more than 1 night per week but not nightly

Treatment includes: Low dose inhaled steroid plus either LTRB, LABA,

or theophylline or medium dose inhaled steroid. Short-acting

bronchodilator: for exacerbations (Maria, 2016).

Severe persistent Symptoms throughout the day; often 7 nights per week

Treatment includes: High dose inhaled corticosteroids plus LABA and if

needed, oral corticosteroids (2 mg/kg/day not to exceed 60 mg/ day)

Alternative treatment: high dose inhaled steroid plus either LTRA or

Theophylline or high dose inhaled steroid plus LABA plus oral systemic

glucocorticoids. Short-acting bronchodilator: for exacerbations

(Maria, 2016).

Do the etiology, diagnosis, and management of a child who is wheezing vary according to the child’s age? Why or why not? Which objective of the clinical findings will guide your diagnosis? Why? When is a chest x-ray indicated in this case?

Wheezing occurs during the prolonged expiratory phase by the rapid passage of air through airways that are narrowed to the point of closure. Children wheeze more often than adults because of physical differences. Infants’ and young children’s bronchi are small, resulting in higher peripheral airway resistance. As a result, diseases that affect the small airways have a proportionately greater impact on total airway resistance in these patients. Infants also have less elastic tissue recoil and fewer collateral airways, resulting in easier obstruction and atelectasis (Hesselmar, Saalman et al., 2017).

Retractions, nasal flaring, and murmuring can signal respiratory distress. A non-productive cough is the earliest symptom, expiratory wheezing, shortness of breath, tachypnea, tachycardia, hyper-resonance, prolonged expiratory phase, accessory muscle use is present in a severe asthma attack, sudden nocturnal dyspnea, and decreased exercise tolerance. Auscultation can identify the presence and location of wheezing, stridor, and crackles; however, these physical findings may be absent in children who are unable to take a deep breath (Hesselmar, Saalman et al., 2017).

Chest x-ray is indicated in children who present with unexplained wheezing that is unresponsive to bronchodilators or with recurrent
wheezing (Weiss, 2013).

References

Hersh, A. L., Jackson, M. A., Hicks, L. A., & Committee on Infectious Diseases. (2013). Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics, 132(6), 1146-1154.

Hesselmar, B., Saalman, R., Wennergren, G., Åmark, M., Wold, A. E., Adlerberth, I., & Åberg, N. (2017). An index to predict asthma in wheezing young children produced promising initial results. Acta Paediatrica.

Maria Kenneally, D. N. P. (2016). Provider Adherence to Evidence-Based Asthma Guidelines in a Community Health Center. Journal of Doctoral Nursing Practice, 9(1), 128.

Rohde, G. G. (2017). Antibiotics in acute exacerbation of asthma and COPD. Anti-infectives and the Lung: ERS Monograph 75, 75, 150.

Weiss, L. N. (2013). The diagnosis of wheezing in children. American family physician, 77(8).

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