A 7 year old female came into the ER with her mother. Mother said that child has had a persistant cough for the last 2 weeks, but recently has yellow sputum. Teachers from school have stated that the child has had frequent bathroom visits while at school with abdominal cramping and diarrhea. Mother was called by [[#|school nurse]] to come pick up the child for persistent cough and shortness of breath. Mother is concerned because her child is frequently sick with a cold. Mother stated recently the child had a salty taste when she kissed her.
PHYSICAL EXAM
Patient appears to be slighty underweight, looked malnourished, with a pale skin color. Patient appears to have shortness of breath. BP- 98/58; HR- 170; RR- 45. Temp- 38.7 degrees C. Patient has a productive cough with yellow sputum. On auscultation, coarse crackles and wheezes throughout all lung fields and diminished bilateral in the bases. ABG results pH- 7.41; PaCO2- 40; PaO2- 60; HCO3- 24. Her [[#|oxygen saturation]] was measured from a pulse ox at 90%. Chest X-Ray noted that there is thickend bronchial walls, hyperinflation and [[#|consolidation]] bilaterally in the bases.
SOAP
S: Patient said chest was hurting and she couldn't stop coughing.
O: Vital Signs: BP 98/58, HR: 170 (tachycardic), RR 45, Temp 38.7 ( febrile), Skin pale,Spo2 90%, ABG, results pH- 7.41; PaCO2- 40; PaO2- 60; HCO3- 24 , thickend bronchial walls and consolidation bilateral in the bases
A: Increased WOB (vital signs) discoloration of sputum possible infection? thickended walls and hyperinflation possible Cystic Fibrosis? consolidation in bases, possible pneumonia? (CXR) , febrile , ABG normal
P: Request sweat chloride test, [[#|apply]] oxygen via nasal cannula 2 lpm, obtain sputum culture, request chest physiotherapy and additional bronchial hygiene therapy, [[#|albuterol]] Q4 for wheezing, submit up to pediatric floor for further treatment
Questions
1. What type of bacteria would be most commonly found in Cystic Fibrosis patients? Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas aeruginosa produces mucin and this mucoid form is found almost exclusively in the airways of CF patients.
2. What is a definitive level of a sweat chloride test for a child and adult patient with Cystic Fibrosis. Greater than 60 mEq/L for a child and greater than 80 mEq/L for an adult.
3. Why are the ABG's normal on this patient? This patient is a child and patients with a longer disease process such as adults with cor pulmonale have abnormal ABGs
4. What is a universal finding in Cystic Fibrosis? Bronchiecatsis
Cystic Fibrosis
Group Members:
Cystic Fibrosis
ADMITTING HISTORY
A 7 year old female came into the ER with her mother. Mother said that child has had a persistant cough for the last 2 weeks, but recently has yellow sputum. Teachers from school have stated that the child has had frequent bathroom visits while at school with abdominal cramping and diarrhea. Mother was called by [[#|school nurse]] to come pick up the child for persistent cough and shortness of breath. Mother is concerned because her child is frequently sick with a cold. Mother stated recently the child had a salty taste when she kissed her.
PHYSICAL EXAM
Patient appears to be slighty underweight, looked malnourished, with a pale skin color. Patient appears to have shortness of breath. BP- 98/58; HR- 170; RR- 45. Temp- 38.7 degrees C. Patient has a productive cough with yellow sputum. On auscultation, coarse crackles and wheezes throughout all lung fields and diminished bilateral in the bases. ABG results pH- 7.41; PaCO2- 40; PaO2- 60; HCO3- 24. Her [[#|oxygen saturation]] was measured from a pulse ox at 90%. Chest X-Ray noted that there is thickend bronchial walls, hyperinflation and [[#|consolidation]] bilaterally in the bases.
SOAP
S: Patient said chest was hurting and she couldn't stop coughing.
O: Vital Signs: BP 98/58, HR: 170 (tachycardic), RR 45, Temp 38.7 ( febrile), Skin pale,Spo2 90%, ABG, results pH- 7.41; PaCO2- 40; PaO2- 60; HCO3- 24 ,
thickend bronchial walls and consolidation bilateral in the bases
A: Increased WOB (vital signs) discoloration of sputum possible infection? thickended walls and hyperinflation possible Cystic Fibrosis? consolidation in bases, possible pneumonia? (CXR) , febrile , ABG normal
P: Request sweat chloride test, [[#|apply]] oxygen via nasal cannula 2 lpm, obtain sputum culture, request chest physiotherapy and additional bronchial hygiene therapy, [[#|albuterol]] Q4 for wheezing, submit up to pediatric floor for further treatment
Questions
1. What type of bacteria would be most commonly found in Cystic Fibrosis patients?
Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas aeruginosa produces mucin and this mucoid form is found almost exclusively in the airways of CF patients.
2. What is a definitive level of a sweat chloride test for a child and adult patient with Cystic Fibrosis.
Greater than 60 mEq/L for a child and greater than 80 mEq/L for an adult.
3. Why are the ABG's normal on this patient?
This patient is a child and patients with a longer disease process such as adults with cor pulmonale have abnormal ABGs
4. What is a universal finding in Cystic Fibrosis?
Bronchiecatsis