Case Study Help!

[Rick Sanchez]

3 y/o girl presents with severe respiratory distress

She has been hospitalized many times for severe reactive airway disease.

She developed a nonproductive cough and wheezing the previous night, which has since become progressively worse.

Upon physical exam:

Very anxious

Vitals: 220, 157/115, 62, 100F rectal 

Acrocyanosis,enlarged tonsils 

Inspiratory and expiratory accessory muscle use

Auscultation: rhonchi and wheezing throughout

Hepatomegaly and splenomegaly

Urticaria

SpO2 75%

ABG: on 2 lpm NC, 7.17/71/47/22

Background from mom that she forgot to mention earlier.

Little Katie likes to eat dirt and has an old hound dog

She complains of stomach aches in the evenings and has trouble sleeping because of it.

She was born premature (24 weeks gestation) and was on a ventilator until she was 3 months old.

She has always snored but it must be genetic cause her dad does too!

She wets the bed.

She is hyperactive and they are considering the probability of attention-deficit syndrome

* I feel like she has undiagnosed asthma but I also feel like that is such an obvious answer and want to know what else it could possibly be. Her ABG shows that she has respiratory acidosis. I also feel that her eating dirt is another sign of something. Please help a student! Thank you*

 

[Wuzzie]

What do you want to know?

[hppygr8ful, ASN, RN, EMT-I]

3 hours ago, Rick Sanchez said:

3 y/o girl presents with severe respiratory distress

She has been hospitalized many times for severe reactive airway disease.

She developed a nonproductive cough and wheezing the previous night, which has since become progressively worse.

Upon physical exam:

Very anxious

Vitals: 220, 157/115, 62, 100F rectal 

Acrocyanosis,enlarged tonsils 

Inspiratory and expiratory accessory muscle use

Auscultation: rhonchi and wheezing throughout

Hepatomegaly and splenomegaly

Urticaria

SpO2 75%

ABG: on 2 lpm NC, 7.17/71/47/22

Background from mom that she forgot to mention earlier.

Little Katie likes to eat dirt and has an old hound dog

She complains of stomach aches in the evenings and has trouble sleeping because of it.

She was born premature (24 weeks gestation) and was on a ventilator until she was 3 months old.

She has always snored but it must be genetic cause her dad does too!

She wets the bed.

She is hyperactive and they are considering the probability of attention-deficit syndrome

* I feel like she has undiagnosed asthma but I also feel like that is such an obvious answer and want to know what else it could possibly be. Her ABG shows that she has respiratory acidosis. I also feel that her eating dirt is another sign of something. Please help a student! Thank you*

 

 

[chare]

What exactly are you being asked to do with this?

[Rick Sanchez]

11 hours ago, Wuzzie said:

What do you want to know?

How to break it down and the ABG portion I'm struggling with.

4 hours ago, chare said:

What exactly are you being asked to do with this?

It was sent to us and just said to interpret it.

[macawake, MSN]

2 hours ago, Rick Sanchez said:

How to break it down and the ABG portion I'm struggling with.

It was sent to us and just said to interpret it.

Since you came here I’m guessing you are a nursing student? What semester and how much pathophysiology have you studied? It just seems odd that your teachers would just send you this and tell you to interpret it. This is a complex scenario and you need quite a lot of knowledge to try to decipher it. The vitals, saturation and blood gas are horrible. No blood drawn/labs?

It’s possible that the child in this hypothetical case has undiagnosed astma seeing as they’ve previously been hopitalized for reactive airway disease and was born very prematurely. But there’s definitely more going on with this child.

On a side note, I was kind of amused by the inherited snoring gene… I can think of a couple of more likely reasons. They’re in your post. 
 

Based on the available information I could guess at a couple of possible diagnoses, but that’s not going to help you learn. 

What do you think might be the cause of the hepatosplenomegaly?

This is something for you to look at and think about:

 

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https://www.slideshare.net/sunilagrawal9693/approach-to-a-child-with-hepatosplenomegaly

 

Good luck!

[nursej22, MSN, RN]

Are you expected to make a medical diagnosis? That seems odd for a nursing student.

If I remember correctly the nursing process is ADPIE, so what are your nursing diagnoses (yeah, yeah, I hate them too) and what is your plan and intervention. 

And always prioritize what is going to kill you first. 

For what it's worth my dear daughter used to eat all kinds of weird things: potting soil, house plants, Ben Gay, toothpaste, dog food, raw meat, perfume. She eventually out grew it, but not without giving me a few scares. Hmm, but she does have ADHD....