Case Scenario: Keisha has come in for her annual well-child visit. Keisha enjoys preschool, she has been a healthy child, and she is at the 50% for height and weight. On exam, you note a Grade III/VI, mid-systolic murmur, heard best in the left sternal border.
- What additional information should the APRN know about Keisha?
- What tests should the APRN order?
- What should the APRN specifically include in the cardiac physical examination?
- How should the APRN approach referrals?
Additional Information that the APRN has to know about Keisha
The APRN should inquire about Keisha's past medical history and ask whether she has had any signs and symptoms of the heart like fatigue, breathing difficulties, cyanosis, low weight gain or syncope. Additionally, a complete evaluation of family history on heart disease, cardiac-related death information and genetic disorders must be established before diagnosis. A full patient medical history including recurring respiratory infections, feeding troubles or reduced exercise tolerance must be recorded because it reveals the significance of the heart murmur.
Tests to Order
The APRN should request for an electrocardiogram (ECG) to check for any conduction disturbances or signs of the ventricular hypertrophy that implies structural heart disease. Chest X-ray should also be used to assess the size of the heart and pulmonary vasculature for the markers of increased cardiac demand. If the murmur is suspected to be pathological, then an echo should be arranged to give further views of the cardiac structures and their performance (Riley, 2024). If there is still doubt, the child may be referred to a pediatric cardiologist for further diagnostic studies.
Cardiac Physical Examination
The APRN should examine the location and intensity of the murmur, its pitch and the nature of radiation, if it is position related or activity related. In performing an inspection of the precordium, examination for thrills, heaves, or abnormal impulses should be done. There should be equal strength and number on the right and left sides, and femoral should be checked to eliminate coarctation of aorta (Malik & Goyal, 2023). Other examination findings that should be assessed include capillary refill time, blood pressure in the four limbs, and signs of cyanosis or clubbing (Malik & Goyal, 2023). More assessment should be done to check for an S3 or S4 gallop, click or changes in the murmur with the Valsalva maneuver.
Approach to Referrals
If the murmur is considered innocent, no referral may be required but subsequent examination should be done to check on any changes. If there is a suspicious feature like loud murmur, diastolic component, abnormal heart sounds or any other associated symptoms then the patient should be referred to a pediatric cardiologist for further examination through echocardiogram and cardiology follow up as recommended by Ford et al., 2022. Parents can get worried about the child's condition hence the need to explain why the child needs to be referred to a specialist, what might be expected, and that there is nothing wrong with the process.
Glyka
Case Scenario 6: Luis is a 12-year-old male who lives in a dilapidated, older apartment complex. He has had a chronic cough since moving into that apartment building 8 weeks ago. His asthma has worsened despite using his albuterol inhaler more than usual (3 times a day or more) and steroid inhaler, complains of shortness of breath, wheezing, and chest tightness, and a dry cough at night and early morning hours (waking him up 2-3 times a week). Luis has had to miss school and is too tired to play with his friends.
- What diagnostic tests might you perform and why?
- What is the gold standard for diagnosing asthma?
- How would you manage his asthma symptoms?
- What type of education should you give parents and Luis?
- What is the proper way to use a metered dose inhaler?
Question 1: Diagnostic Tests.
- The test measures lung function precisely to both diagnose and verify asthma cases.
- Other potential lung causes of persistent cough will be ruled out through the diagnostic procedure of chest X-ray testing.
- The testing determines the presence of any environmental causes that might trigger allergies.
- PEF monitoring provides assessments about asthma control and variability as described by Al-Moamary et al. (2021).
Question 2: Gold Standard for Diagnosing Asthma.
- The diagnosis of asthma uses spirometry testing with bronchodilator response as its standard method. Need Assignment Help?
Question 3: Management of Asthma Symptoms.
- Controller medications: Increase inhaled corticosteroid dosages or including long-acting beta-agonist (LABA) medications in the care plan (Cloutier et al., 2021).
- Rescue medications: When symptoms rapidly appear, you should maintain your use of an albuterol inhaler at regular intervals.
- Environmental control: Discover and minimize asthma triggers, including mold as well as dust mites in the environment.
- Action plan: Develop a written asthma action plan for Luis and his parents.
Question 4: Education
- Luis requires the following education together with his parents about his condition.
- Teach the correct technique for using a metered-dose inhaler (MDI) with a spacer.
- Help Luis and his parent's understand effective methods to minimize contact with asthma precipitating factors.
- The patient and parents need training to detect asthma attack warning signs in their early stages.
- The healthcare professional should schedule periodic appointments to track asthma management results (Martin et al., 2022).
Question 5: The correct methodology to administer a Metered-Dose Inhaler (MDI)
Shake the inhaler well, attach the spacer if available, and exhale fully. Then, insert the mouthpiece into the mouth before pressing lips tightly around it. To get the medicine from the inhaler, press the button while inhaling long and deep breaths. The breath-holding period begins once complete exhalation happens, and it extends for 10 seconds before the slow exhale. Lastly, wait 30-60 seconds after each puff before using additional medication.