A 4-year-old female presents to your clinic with her parents.The chief complaint per the father is that the 4-year-old has nighttime coughing for 3…
Question Answered step-by-step A 4-year-old female presents to your clinic with her parents. Thechief complaint per the father is that the 4-year-old has nighttime coughing for 3 days. She has not exhibited a fever. Her past medical history is significant for atopic dermatitis (uses topical hydrocortisone), as well as multiple visits for wheezing episodes which respond well to nebulized albuterol. Gastroesophageal reflux had been explored at previous clinic visits and ruled out based on history. The family history is positive for maternal, paternal and sibling asthma. She and her family are recent immigrants from Central American and she may not have had all her immunizations.Physical exam findings: Exam: VS T37.0, P110, R40, BP 100/60, oxygen saturation 97% in RA. All growth parameters are at the 10th percentile. She is somewhat tired and clingy but alert. HEENT is significant for mild nasal congestion. Heart regular without murmurs. Extensive and diffuse biphasic wheezing is auscultated in the lungs. Occasional coughing is heard in the office during the clinic visit. No flaring, retractions or cyanosis is observed. She has lichenified skin over her extremities.Critical Thinking Questions: 1. What additional information should you obtain from the history and physical exam?2. What is your priority three differential diagnosis? Provide rationale.3. What outpatient diagnostic tests would you order?Some parents have refused pertussis vaccine for their children because of its adverse effects. And many parents believe that herd immunity will protect their children.5. What is the current evidence-based guidelines for immunization prevention of pertussis in children (Tdap vaccine)?6. What are the diagnostic criteria for pertussis?7. What is the recommended treatment of pertussis in the pediatric population? Cite the most current clinical practice guidelines. Health Science Science Nursing NURSING NU 315 Share QuestionEmailCopy link Comments (0)
