Cases in Pediatric Acute Care

Strengthening Clinical Decision Making

Andrea Kline-Tilford, Catherine Haut, Andrea Kline-Tilford, Catherine Haut

• Publisher: Wiley-Blackwell
• Year: 2020
• Print ISBN: 9781119568223
• eBook ISBN: 9781119568216
• Edition: 1
• Topic: Medicine
• Subtopic: Pedriatic Nursing

Cases in Pediatric Acute Care presents over 100 real-world pediatric acute care cases, each including a brief patient history, a detailed history of present illness, presenting signs and symptoms, vital signs, and physical examination findings. Ideal for developing a systematic approach to diagnosis, evaluation, and treatment, this resource provides students and advanced practitioners with the tools required to deliver comprehensive care to acute, chronic and critically ill children. The cases encompass a wide range of body systems, medical scenarios, professional issues and general pediatric concerns, and feature laboratory data, radiographic images and information on case study progression and resolution.

• Develops the essential skills necessary to provide the best possible pediatric acute care
• Discusses the most appropriate differential diagnoses, diagnostic evaluation, and management plans for each case
• Presents cases related to pulmonary, cardiac, neurologic, endocrine, metabolic, musculoskeletal, and other body systems
• Highlights key points in each case to quickly identify critical information

Cases in Pediatric Acute Care is an excellent resource for advanced practice provider students and pediatric healthcare providers managing acutely ill children.

1
Complication of Pneumonia

Ji‐Yeon Kim

Children’s Hospital of Michigan, Detroit, MI, USA

A 2‐year‐old previously healthy female is admitted to the pediatric intensive care unit (PICU) with tachypnea, grunting, and nasal flaring. She is hypoxic despite receiving supplemental oxygen with a high‐flow nasal cannula (HFNC) at 12 L/min and FiO₂ 0.7.

History of Present Illness

This is a 2‐year‐old female with no significant past medical history who presented with 2 days of fever, cough, and difficulty breathing. Her mother reports that for the past 2 weeks the patient has had intermittent low‐grade fever with cough. Difficulty breathing started 2 days ago with fever of 40°C (104°F). She has been eating and drinking less and having decreased wet diapers. She has been in close contact with her older brother who has also had symptoms of cough, rhinorrhea, and congestion. Her parents decided to bring her to the emergency department (ED) when her fever did not defervesce with acetaminophen and she continued to have difficulty breathing.

Past Medical History

The patient was born at 39 weeks gestational age. Family denies history of hospitalizations or outpatient visits for illness. Immunizations are up‐to‐date for age, but she has not received the influenza vaccine this year.

Past Surgical History

Family denies any previous surgical procedures.

Family History

Parents are healthy. There is a 6‐year‐old sibling who had a cold and fever about a week ago. Grandparents are alive and well. Paternal grandmother has a history of breast cancer. Denies family history of asthma or allergies.

Current Status

On arrival in the ED, the patient is noted to have difficulty breathing, with grunting and nasal flaring. She is tachycardic, with heart rate of 160 bpm, and tachypneic, with respiratory rate of 56 breaths per minute. On examination the patient has diminished breath sounds over the left lung field. The patient is placed on 50% oxygen using HFNC at 8 L/min but remains hypoxic with pulse oximeter reading of 90% saturation. A basic metabolic panel and complete blood count are obtained with values as noted in Tables 1.1 and 1.2. The chest X‐ray is shown in Figure 1.1.

Questions

Answer the following questions using the details provided.

1. What are the pathologic findings on the X‐ray?
2. What are the most common pathogens causing pneumonia in infants and children?
3. What are the recommended anti...

Table of contents

• Cover
• Table of Contents
• Preface
• List of Contributors
• 1 Complication of Pneumonia
• 2 Infant with Diaphoresis during Feedings
• 3 Hypotension in the Operating Room
• 4 Toddler with Vomiting and Diarrhea
• 5 Infant with Fever and Cold Symptoms
• 6 Toddler with Pineoblastoma and Bone Marrow Transplant
• 7 A 5‐Year‐Old with Altered Mental Status
• 8 An 8‐Year‐Old with Abdominal Trauma
• 9 Child with Left Eye Swelling
• 10 Billing and Coding
• 11 Language Delay
• 12 A 6‐Month‐Old Infant with RSV and Respiratory Failure
• 13 Adolescent Abdominal Pain after Cardiac Surgery
• 14 Young Infant with Vomiting
• 15 School‐age Child with Bruising
• 16 Infant with Shunted Hydrocephalus
• 17 Newborn with Poor Oral Intake and Irritability
• 18 An 8‐Week‐Old Infant with a Cough
• 19 Desaturation in Postoperative Cardiac Surgery Infant
• 20 Pre‐school Child with Seizures
• 21 Child with Blood in Stool
• 22 Osteomyelitis Case Study
• 23 A 2‐Year‐Old with Liver Transplant and Fever
• 24 Respiratory Decompensation in Trached Infant
• 25 Neonatal Hypoglycemia
• 26 Chronic Otitis Media
• 27 Complex Patient with Recurrent Lower Respiratory Tract Infection
• 28 Child with Racing Heart
• 29 Teen with Headache and Seizure
• 30 A 4‐Year‐Old with Bloody Diarrhea
• 31 Child with Persistent Fever
• 32 Quality Improvement Case Study
• 33 Newborn Immediately Post Delivery
• 34 A 5‐Year‐Old with Poor Weight Gain and Dehydration
• 35 Toddler with Complex Chronic Condition
• 36 Pre‐adolescent with Knee Pain
• 37 Infant with Increased Fussiness and Decreased Oral Intake
• 38 Infant with Prolonged Jaundice
• 39 Child with Rash and Drooling
• 40 Child with Fever and Sore Throat
• 41 Teenager with Sickle Cell Disease and Fever
• 42 Ethical Case Study
• 43 Infant with Neurologic Changes and Respiratory Failure
• 44 Acute Hyperglycemia
• 45 Infant with Progressive Lethargy and Poor Feeding
• 46 Neonatal Tachypnea
• 47 Diplopia and Esotropia
• 48 Acetaminophen Ingestion
• 49 A 3-Year-Old with Sudden Onset of Breathing Difficulty
• 50 A 2-Month-Old with Acute Abdomen
• 51 Henoch–Schönlein Purpura Nephritis
• 52 Toddler with Tachypnea and Cool Extremities
• 53 Teen with Intractable Headache
• 54 Seizures in School‐age Child
• 55 An 18-Year-Old with Upper Respiratory Symptoms, Headache and Fever
• 56 Testicular Torsion
• 57 Teen with Fever and Rash
• 58 Preterm Infant Unable to Wean from Mechanical Ventilation
• 59 Toddler with Acute Respiratory Failure
• 60 Adolescent with Head Injury
• 61 Newborn with Ambiguous Genitalia
• 62 Anemia in a Toddler
• 63 A 2-Year-Old with Fever and Cough
• 64 Research Review
• 65 Toddler with Fever and Redness Behind Ear
• 66 A 5-Year-Old with Right‐Sided Weakness
• 67 Postoperative Heart Block
• 68 Recognizing Human Trafficking
• 69 A Toddler With Stridor
• 70 Delirium in a 9‐Year‐Old Boy
• 71 Feeding Challenge in a Child with Spinal Muscular Atrophy
• 72 A 5-Year-Old with Osteomyelitis, Electrolyte Disturbance and Headaches
• 73 Child with Scald Burn Injury
• 74 Parvovirus Requiring Blood Transfusion
• 75 A Teen With High Fever, Rash and Lethargy
• 76 A 9-Year-Old With Scoliosis
• 77 An Unresponsive Infant
• 78 A Toddler With Abdominal Pain, Diarrhea and Lethargy
• 79 Sore Throat and Shortness of Breath
• 80 Oral Presentation and Communication
• 81 A 7-Year-Old with Migratory Joint Pain
• 82 Adolescent with Murmur and Chest Flutter
• 83 Outpatient Management of Asthma
• 84 A Newborn with Abnormal Movements
• 85 Postoperative Infant with Tachycardia
• 86 Brain Death
• 87 Postoperative Spinal Fusion with Complications
• 88 Orthopnea in a 10-Year-Old
• 89 Complication of Traumatic Brain Injury
• 90 Newborn with Hypothermia
• 91 Back Pain in an Active Teenager
• 92 Teen with Fever and Abdominal Pain
• 93 Complication in a 6-Year-Old with a Kidney Transplant
• 94 Acute Hypertension and Seizures in a 17‐Year‐Old Male
• 95 Jittery 2‐Week‐Old Infant
• 96 Child with Leg and Back Pain
• 97 Fussy, Tired Infant
• 98 Tics and Something More
• 99 Lightheaded Adolescent
• 100 Infant with Hyponatremia
• 101 Bone Marrow Transplant in Sickle Cell Disease
• 102 Child with Respiratory Failure and Transaminitis
• 103 A Serious Football Injury
• 104 Infant with Generalized Weakness
• 105 A 3-Day-Old with Irritability
• 106 Child with Fever and Rash
• 107 A Teen With Vomiting and Diarrhea
• 108 Acute Jaundice in a 7‐Year‐Old Child
• 109 Idiopathic Nephrotic Syndrome
• 110 School‐age Child with Hives and Lip Swelling
• 111 A 10-Year-Old with Asthma in the PICU
• 112 Skin Wound in Postoperative Neonate
• 113 Provider Burnout and Resiliency
• 114 Kidney Transplant Complication
• 115 Infant with Influenza A and New Fever
• 116 A 3‐Year‐Old with Fever and Painful Urination
• Index
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