Pediatric – week 4 discussion 1st reply

Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.  

MB Discussion:

Do you recommend a limited or an involved use of antibiotics in treatment of these disease(s) 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 medical condition that causes inflammation of the airways which obstructs airflow to the lungs (Burns et al., 2019). It is typically intermittent and reversible. This is caused when the airway becomes hyper responsive or inflamed causing bronchoconstriction. It can be aggravated by a viral or bacterial infection (Castro-Rodriguez et al., 2016). The signs and symptoms include shortness of breath, coughing, wheezing, and chest tightness. Pharmacological management in determined by the age and weight of the child and typically include steroids and bronchodilators. I would not recommend the use of antibiotics for this case or an unconfirmed bacterial case. Prescribing antibiotics for a patient without a confirmed bacteria or related symptoms would expose them to unnecessary medication and increase the risk of antibiotic resistance (Adams et al., 2018). Antimicrobial resistance is continuing to growth especially in the pediatric population. The cause derives from providers prescribing antibiotics to treat viral infections instead of antibacterial. The standards for prescribing pediatric antibiotics come from The Center for Disease Control and Prevention (CDC) and The American Academy of Pediatrics (AAP). These guidelines recommend that prescribing antibiotics should be done for the following diagnosis: acute rhinosinusitis, urinary tract infection, common cold, otitis media, bronchiolitis, and pharyngitis (CDC, 2020).  The assessment finding of a bacterial infection would warrant antibiotic use such as fever, coughing up discolored, sputum, and crackles (Adams et al., 2018). In addition, laboratory test can be obtained to confirm an infection.

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

 Asthma is divided into four categories: intermittent, mild persistent, moderate persistent, and severe persistent. The symptoms for intermittent involves symptoms occurring less than two days and nights a week. This type does not affect activities of daily living and resolves with the use of a short-acting beta agonists less than twice per week (Adams., et al 2018). The mild persistent symptoms occur more than twice a week. This requires a low dose inhale corticosteroids to relieve the symptoms. Moderate persistent involves symptoms that are daily and nighty. An inhaled corticosteroids and a long-acting beta agonist are utilized for relief. The final category severe persistent involves continuous symptoms day and night (Castro-Rodriguez et al., 2016). The treatment consists of high doses of inhaled corticosteroids, oral corticosteroids, LABA, leukotriene, and theophylline. This patient has daily symptoms with one night waking per week. In addition to a daily need of SABAs with limitations to her activities of daily living, her FEV1 is ≥60 and <80 and these are consistent with moderate persistent asthma (Castro-Rodriguez et al., 2016). The treatment would include low-doses or a medium-dose of an inhaled glucocorticoid and a LABA. The patient education would be consistent of proper hand hygiene, drinking plenty of fluids, reduce stress, identify trigger agents, and maintaining a balance (Burns et al., 2019).

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, in particular and pediatric population, in general?

            The etiology, diagnosis, and management of wheezing does vary according to the child’s age. Wheezing is a common respiratory symptom found in infants and children. It can be caused by several different respiratory conditions. The provider would need to obtain a history and physical, the onset of the wheezing, pattern, and note and all symptoms. Children under the age of two years have viral wheezing which is indicative of respiratory tract infections (Adams et al., 2018). These can be treated with salbutamol, and more than half these children grow out of this type of medical condition after the age of six. Children older than 2 years with a wheeze, cough, and a response to bronchodilators is indicative of asthma (Castro-Rodriguez et al., 2016). The airway is different in pediatrics, they are nose breathers, have larger tongues, and smaller airways. If the airway becomes inflamed, it can be very dangerous, uncomfortable, and obstructed easily compared to an adolescent or adult (Burns et al., 2019). Therefore, it is important to not overlook wheezing in children. The objective clinical finding would include spirometry results, expiratory and inspiratory wheezing, cough, nasal flaring, and decreased oxygen saturation. A chest x-ray would be necessary if the wheezing is unexplainable and if bronchodilators are ineffective (Adams et al., 2018). This would necessitate further investigation and an assessment in the emergency department.

References

Abrams, E. M., Becker, A. B., & Szefler, S. J. (2018). Current state and future of biologic           therapies in the treatment of asthma in children. Pediatric allergy, immunology, and        pulmonology, 31(3), 119-131.

Burns, C., Dunn, A., Brady, M., Starr, N., Blosser, C. (2019). Burns’ pediatric primary care (7th           ed.). Saunders. ISBN: 9780323581967

Castro-Rodriguez, J. A., Custovic, A., & Ducharme, F. M. (2016). Treatment of asthma in        young children: evidence-based recommendations. Asthma research and practice, 2(1),      5.

Centers for Disease Control and Prevention. (2021). Pediatric Treatment Recommendations.     Retrieved from https://www.cdc.gov/antibiotic-use/community/for     hcp/outpatienthcp/pediatric-treatment-rec.html