Running head: IHUMAN CASE STUDY 1

iHuman Case Study _ Katherine Harris

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1. Do you recommend limited or involved the use of antibiotics in the

treatment of these diseases and other unconfirmed bacterial illnesses

and why? What are the standards regarding the use of antibiotics in

the pediatric population, and what assessment findings would

warrant prescribing an antibiotic for Asthma symptoms?

Asthma is a reversible respiratory chronic condition which involves inflammation of the

airways, increased mucus production and edema, that may trigger coughing, shortness

of breath and wheeze. it can be a lifestyle limiting health condition with no cure but

requires close monitoring and adequate management of the symptoms. Childhood

asthma, on the other hand, has been classified by most treatment guidelines as mild,

moderate and persistent, depending on the severity and persistence of the symptoms, of

which differ in the type of medication that is recommended for the management of the

symptoms (Baan et al., 2018). a diagnosis of asthma was made based on the findings

from the pulmonary function tests that were conducted on Katherine Harris. According

to the CDC, the triggers of asthma include indoor or outdoor allergens, medications,

mold, pets, exercise, infections, pets and tobacco smoke among others.

The clinical report recommends that clinicians should use the most appropriate

diagnostic criteria for pediatrics before deciding on what medication to prescribe. For

instance, certain instances as acute bacterial sinusitis, pharyngitis, and acute otitis

media will benefit from antibiotic therapy. The guideline by the American Academy of

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IHUMAN CASE STUDY 2

Pediatrics (AAP) recommends that acute otitis media be diagnosed based on the

evidence of two main condition, that is, evidence of middle ear effusion, which is

demonstrated by a moderate to severe bulging of the tympanic membrane or a new

onset of otorrhea which is not attributable to otitis externa. However, patients who

display more severe symptoms, bilaterally involved and of young age have a higher

likelihood of benefiting from antibiotic therapy. Watchful waiting is recommended for

older patients with mild symptoms which are unilaterally involved. Consequently,

antibiotic therapy is also recommended for cases involving acute bacterial sinusitis with

symptoms which have persisted for more than 10 days or worsen as a result of a new

onset of daytime cough, nasal discharge or fever after the improvement of a typical viral

upper respiratory tract infection (Sheldon, Heaton, Palmer, & Paul, 2018).

Diagnostically confirmed pharyngitis with β-hemolytic GAS also require antibiotic

therapy appropriately prescribed in terms of dosage and frequency for the shortest time

possible. Using antibiotics excessively or inappropriately leads to antibiotic resistance

which makes it hard to treat other infections in the future.

2. Using national guidelines and evidence-based literature, develop an

Asthma Action Plan for this patient.

The action plan for this patient will include the daily treatment, long term control of

asthma, how to deal with a worsening state of asthma or an attack, and when it is

necessary to seek medical attention in the course of treatment (Tesse et al., 2018).

Classification

of Asthma

Symptom

frequency

Treatment Patient

education

Seek medical

attention

Mild

intermittent

Less than 2

days in a week

Bronchodilators

which are short

– 2 puffs of

Albuterol after

every 4-6 hours

PRN.

Provide

information on

how to take the

medication,

proper inhaler

techniques,

and

In case the

symptoms

persist for

more than

twice in a week

or the patient

has used shortThis study source was downloaded by 100000824466386 from forbes.com on 04-24-2021 15:27:36 GMT -05:00

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IHUMAN CASE STUDY 3

environmental

triggers to

avoid.

acting beta

antagonists

(SABA)for

more than 2 to

3 weeks.

Mild persistent More than 2

days in a week

and use of

SABA for more

than 2 to 3

weeks.

Low dose

corticosteroid

inhaler – 80-

240 mcg/day

beclomethasone

or 180-600

mcg/day

Pulmicort.

SABA PRN for

exacerbations.

Provide

information on

how to take the

medication,

proper inhaler

techniques,

and

environmental

triggers to

avoid.

If daily use of

SABA is

required

Moderate

persistent

Symptoms

occur daily or

for more one

night in a week

but not every

night.

Low dose

steroid inhaler,

plus LABA,

LTRB, or

theophylline or

medium dose

steroid inhaler.

SABA PRN for

exacerbations.

Provide

information

adherence to

daily

prescription,

proper inhaler

techniques,

and

environmental

triggers to

avoid.

When

symptoms

persist.

Severe

persistent

Symptoms

occur all

through the

day and 7

High dose

corticosteroid

inhaler plus,

LABA and oral

corticosteroid if

Provide

information

adherence to

daily

prescription,

When

symptoms

persist.

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IHUMAN CASE STUDY 4

nights in a

week.

needed - 2

mg/kg/day but

should not

exceed 60 mg/

day. SABA PRN

for

exacerbations.

proper inhaler

techniques,

and

environmental

triggers to

avoid.

3. 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?

Wheezing is associated with breathing difficulties as a result of narrowing of the airways

and is characterized by a high pitch whistling sound that is heard during respiration. As

such, any complication or infection of the airways might have a significant impact that

might lead to a total restriction of the airways in such a patient. Nasal flashing,

murmurs and retractions, are signals indicating distress in respiration. The earliest

symptom is a nonproductive cough, followed by expiratory wheezing, tachypnea,

shortness of breath, tachycardia, prolonged expiratory phase, and hyper-resonance

(Hudgins et al., 2019). The use of accessory muscles is a sign of severe asthmatic attach

that is accompanied by decreased exercise tolerance and sudden nocturnal dyspnea.

Through auscultation, the physician can identify the location and presence of crackles,

stridor, and wheezing. however, it might be hard for these physical findings to be

realized in pediatric patients who are unable to take deep breaths. Most research has

revealed that localized wheezing might not be an indication of asthma, and hence

recommend further investigations. It is also recommended that pediatric patients who

present with localized wheezing be given bronchodilators such as albuterol as trial

treatment (Horak et al., 2016). In case, the drug does not help to stop the wheezing,

then the patient is not suffering from asthma, but other underlying pathological

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IHUMAN CASE STUDY 5

conditions of the large central airway. a chest x-ray is indicated for children who present

with symptoms of unexplained wheezing, which is not responsive to bronchodilators or

is recurrent.

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IHUMAN CASE STUDY 6

References

Baan, E.J. (Esmé J), Janssens, H.M. (Hettie), Kerckaert, T. (Tine), Bindels, P.J.E.

(Patrick), Jongste, J.C. (Johan) de, Sturkenboom, M.C.J.M. (Miriam), &

Verhamme, K.M.C. (Katia). (2018). Antibiotic use in children with asthma:

cohort study in UK and Dutch primary care databases. (BMJ Open vol. 8 no.

11.)

Sheldon, G., Heaton, P. A., Palmer, S., & Paul, S. P. (January 01, 2018). Nursing

management of pediatric asthma in emergency departments. Emergency Nurse:

the Journal of the RCN Accident and Emergency Nursing Association, 26, 4, 32-

42.

Hudgins, J. D., Neuman, M. I., Monuteaux, M. C., Porter, J., & Nelson, K. A. (January

07, 2019). Provision of Guideline-Based Pediatric Asthma Care in US Emergency

Departments. Pediatric Emergency Care.

Horak, F., Doberer, D., Eber, E., Horak, E., Pohl, W., Riedler, J., Szepfalusi, Z., ...

Studnicka, M. (August 01, 2016). Diagnosis and management of asthma -

Statement on the 2015 GINA Guidelines. Wiener Klinische Wochenschrift, 128,

541-554.

Tesse, R., Borrelli, G., Mongelli, G., Mastrorilli, V., & Cardinale, F. (January 01, 2018).

Treating pediatric asthma according to guidelines. Frontiers in Pediatrics, 6.

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