Week 4 Discussion
Leticia
• 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?
I recommend a very limited to no treatment of antibiotics for a case presented as this case. Katherine’s physical examination and history do not make mention of signs or symptoms of infection. There is no mention of fever, discolored mucus, or exposure to bacterial infection.
The use of antibiotics has been associated with an increased risk of developing allergic disorders and asthma in children with a predisposition to atopic immune response. The study’s findings support the most recent understanding of immunological maturation of the immune system (Droste, et al., 2008).
The American Academy of Pediatrics (AAP), along with the Centers for Disease Control and Prevention provides guidance on how to treat in children respiratory infection in an effort to reduce the unnecessary use of prescribed antibiotics. The guidance focuses on the application of stringent diagnosis criteria, considering the benefits and harm of prescribing antibiotics, and better understanding instances when prescribing antibiotics is not indicated. The guidance is based on recent clinical guidelines developed through studies (CDC, 2015)
The use of antibiotics for children with upper respiratory treatment remains argumentative since more than 90% of these infections are caused by viruses. Because antibiotics are overprescribed, many times due to parental expectations and economic and socio-cultural pressure, the result is antibiotic resistance. For this reason, in the presented case an assessment finding such as severe acute otitis media or severe acute rhinosinusitis lasting over 10 days would be a reason to prescribed antibiotics (Cotton, Innes, Jaspan, Madine, & Rabie, 2008).
• Using national guidelines and evidence-based literature, develop an Asthma Action Plan for this patient.
An Asthma action plan as three zones, green, yellow and red. Patients in the green zone are well controlled and only need maintenance treatment. Patient in the yellow zone may have mild wheezing, tight chest and coughing at night. Patients in the red zone experience breathing hard and fast, trouble speaking, nose open wide and ribs show. When Katherine arrived, she was in the red zone. An action plan for Katherine includes nebulizer treatment with albuterol. She needs to be prescribed albuterol inhaler to be used at home and use it when wheezing every 4 hours. A four-day treatment of prednisone will also be prescribed (Cotton, Innes, Jaspan, Madine, & Rabie, 2008).
• 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?
About 75% of children who present wheezing are diagnosed before the age of seven with asthma. When the wheezing is accompanied by coughing, shortness of breath and history of respiratory symptoms, the diagnosis of asthma is more certain. Clinical findings in Katherine’s case that guide me towards the diagnosis of asthma include non-productive cough for 3 weeks (a typical sign of asthma), shortness of breath when walking for the past 3 days (exercise is a trigger for asthma, bilateral diffused wheezing (suggestive of asthma but does not make it a defined diagnosis), history of eczema, exposure to cigarette smoking (common triggers in patients with asthma),and pulse oximetry at 93% (indicative of poor gas exchange due to the constrictions in the respiratory system) (Cotton, Innes, Jaspan, Madine, & Rabie, 2008).
Children who have eczema with parents who suffer from allergies and asthma are at higher risk of developing asthma (Wainer, 2009). In patients with asthma, a chest x-ray is indicated if an upper respiratory infection is suspected such as pneumonia (Lynch, Fenta, Jacobson, Li & Juhn, 2012).
References
CDC Grand Rounds: Getting Smart About Antibiotics. (2015, August 21). Retrieved June 27, 2019, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6432a3.htm
Cotton, M., Innes, S., Jaspan, H., Madide, A., & Rabie, H. (2008). Management of upper respiratory tract infections in children. Retrieved June 27, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098742/
Droste, J. H., Wieringa, M. H., Weyler, J. J., Nelen, V. J., Vermeire, P. A., & Bever, H. P. (2008, September 05). Does the use of antibiotics in early childhood increase the risk of asthma and allergic disease? – Droste – 2000 – Clinical & Experimental Allergy – Wiley Online Library. Retrieved June 27, 2019, from https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2222.2000.00939.x
Lynch, B. A., Fenta, Y., Jacobson, R. M., Li, X., & Juhn, Y. J. (2012, February). Impact of delay in asthma diagnosis on chest X-ray and antibiotic utilization by clinicians. Retrieved June 27, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433831/
Wainer, A. (2009, May 26). How Eczema May Lead to Asthma. Retrieved June 27, 2019, from https://www.nhs.uk/news/medical-practice/how-eczema-might-lead-to-asthma/