Case Study 1 A 3-year-old male presents to his pediatrician
Case Study 1 A 3-year-old male presents to his pediatrician with a… Case Study 1A 3-year-old male presents to his pediatrician with a complaint of coughing at night for 2 weeks. His parents have been using a decon-gestant/antihistamine syrup. Initially the cough improved, but it worsened over the last 3 days. He is noted to have morning sneezing and nasal congestion. He has had similar episodes in the past, but this episode is worse. His past history is notable for eczema and dry skin since infancy. He is otherwise healthy. His father and brother have a history of asthma; there are no smokers or pets in the home. At this time his vital signs are as follows: heart rate 98 beats per minute, respiratory rate 26 breaths per minute, blood pressure 84/65 mm Hg, temperature 38.1°C, and oxygen saturation 99% on room air. He is alert, cooperative, chest excursion is symmetrical, and no retractions are noted. His chest has an increased AP diameter and it is hyperresonant to percussion. Rhonchi and occasional wheezes are heard on auscultation. His skin is dry, with no evidence of eczema. The initial impression was an acute exacerbation of asthma. He is treated with nebulized albuterol. His physician prescribed nebulized albuterol and nebulized corticosteroids, in addition to an antihistamine at night to reduce his morning allergy symptoms.1. This patient will be receiving albuterol and an inhaled corticosteroid by jet nebulizer at home. During patient/family educa-tion on the medication and use of the delivery device, what information should the respiratory therapist provide the family about nebulization time and the residual volume? 2. What information should the family receive regarding cleaning the jet nebulizer?3. Would an MDI be an appropriate alternative to a jet nebulizer for medication delivery in this patient? Provide the rationale for your response. CHAPTER 24 CASE STUDIES Case Study 2A 2-year-old female with spinal muscular atrophy type 1 presented to the emergency department in moderate respiratory distress. Phys-ical exam showed a bell-shaped configuration of thorax and ribs, and moderate intercostal and substernal retractions. The patient was receiving bilevel positive airway pressure (BiPAP) at home with the following settings: spontaneous mode, pressure 18/10 cm H2O, room air, with 4-hour sprints twice a day. BiPAP was initiated on the following settings: spontaneous/timed mode rate of 22, pressure 20/10 cm H2O, and FIO2 0.40. Albuterol and hypertonic saline were administered by jet nebulizer and an aggressive secretion clearance regimen was ordered. Chest radiograph revealed diffuse left lung opacification consistent with left lower lobe pneumonia, clear visualization of the diaphragm, and left upper lobe atelectasis. The right lung was clear. The patient was transferred to the pediatric intensive care unit (PICU). Due to increased work of breathing, the patient settings were increased to BiPAP 24/12 × 28 60% FiO2 around the clock for impending respiratory failure. Albuterol treatments were increased to Q2 hours followed by chest percussion, postural drainage, and cough assist.The patient’s respiratory status continues to deteriorate. She was intubated and mechanical ventilation initiated. A vibrating mesh nebu-lizer was used to deliver medicated aerosol therapy inline with the ventilator circuit. 1. What is different about the vibrating mesh nebulizer versus a jet nebulizer?2. Why was the vibrating mesh nebulizer selected when the patient was intubated and switched from a noninvasive ventilator to an ICU ventilator?3. Would a metered dose inhaler be an appropriate medication delivery choice for the patient during noninvasive ventilation? Health Science Science Nursing SCIENCE /RSPT
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