Pediatric – Week 4 Discussion 2nd REPLY

Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.

KN Discussion:

Do you recommend a limited or an involved use of antibiotics in treatment of these disease(s) and other unconfirmed bacterial illnesses and why? What are the standards regarding the use of antibiotics in pediatric population, and what assessment findings would warrant prescribing an antibiotic for asthma symptoms?

Antibiotics are the most commonly prescribed medications to the pediatric population. Despite the fact that antimicrobial therapy is a huge advancement in medicine and has saved myriad of lives, improper use can cause significant harm (Gerber et al., 2021).  For instance, antibiotic overuse is linked to antibiotic resistance, which may be viewed as a threat to public health (Gerber et al., 2021). According to the Centers for Disease Control and Prevention CDC (2017), antibiotic-resistant pathogens are responsible for about 3 million infections and 35 000 deaths annually in the United States alone. Therefore, the CDC Core Elements and TJC Antimicrobial Stewardship Standard emphasize the importance of careful monitoring of antimicrobial use and antibiotic resistance (Gerber et al., 2021). Current guidelines for antibiotic use among children are created by the CDC and The American Academy of Pediatrics (AAP); they provide clear directions on when and for how long should antibiotics be prescribed (CDC, 2017). The management of the following conditions is reviewed in detail, including medication management: urinary tract infection, upper respiratory infection, acute otitis media, acute sinusitis, pharyngitis, and bronchiolitis (CDC, 2017).

The patient from the case study presents to the office with a chronic cough and is being diagnosed with asthma. Asthma is a condition characterized by the inflammation of the airways that causes reversible airflow obstruction (Serebrisky & Wiznia, 2019).  Airflow obstruction is a complex process that may involve airway hyperresponsiveness or inflammation, bronchoconstriction, chronic mucus plugs formation, chronic airway remodeling, and airway wall edema (Serebrisky & Wiznia, 2019). Thus, it is not recommended to routinely treat asthma with antibiotics, unless the exacerbation caused by an underlying bacterial infection is present.  The patient from the case study is not in acute distress and there is no evidence supportive of the current bacterial infection.

Using national guidelines and evidence-based literature, develop an Asthma Action Plan for this patient.

Asthma management is focused on the treatment of inflammation, prevention of exacerbation, and preserving the regular activity level (UpToDate, 2019). According to Patel &Teach (2019), asthma is classified into intermittent, mild persistent, moderate persistent, and severe persistent. The patient from the case study has a plethora of symptoms suggesting moderate persistent asthma. In this age group, it is recommended to start inhaled corticosteroids (ICS) daily for inflammation management (UpToDate, 2019). Depending on the dose of daily ICS, leukotriene receptor antagonists (LTRAs) and long-acting beta-agonists (LABAs) may be added to the treatment plan for symptom prevention (UpToDate, 2019). ICS, LABAs, and LTRAs should be used regularly as prescribed by healthcare providers, despite the attack occurrence (UpToDate, 2019). Short-acting β-agonist (SABA) are the drugs of choice for immediate relief during an asthma attack (UpToDate, 2019). SABA should be used as needed. If the child develops severe shortness of breath, quick-relief medicines do not help, or is unable to perform usual activities, a caregiver should seek immediate medical attention (Patel &Teach, 2019).

Patient and caregiver education should be reinforced. Asthma attacks are often triggered by environmental influences (Patel &Teach, 2019). It is suggested to avoid cold weather, tobacco smoke, strong odors and sprays, pollen, and animal dander (UpToDate, 2019). Recommendations include maintaining good hygiene, eliminating of dust mites, cockroaches, and indoor mold. It is crucial to maintain good hydration, identify trigger agents, stay up to date with vaccinations, promote a well-balanced diet, and reiterate proper hand hygiene (UpToDate, 2019).

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, in particular and pediatric population, in general?

Wheezing is a common respiratory symptom in kids (Patel &Teach, 2019). One-third of children have at least one wheezing episode before they turn 3(Fakhoury, 2018). The prevalence of wheezing tends to decline as children grow (Fakhoury, 2018). For example, by 11 years of age, it decreases to about 13 percent (Fakhoury, 2018). Wheezing is a respiratory symptom that may be benign and self-limited or an indicator of serious illness that requires intervention (Fakhoury, 2018). Therefore, complete assessment and history collection are vital in treating wheezing pediatric patients (Fakhoury, 2018). A healthcare provider should consider the patient’s age, personal and family medical history, allergies, positional changes, recurrency, onset, and other symptoms associated with wheezing (Fakhoury, 2018). Children over 2 years with a history of cough, airflow obstruction confirmed by spirometry, and response to bronchodilators are concerning for asthma (Serebrisky & Wiznia, 2019). Pediatric airways are narrower than that of an adult; in addition, kids are nose breathers and have a larger tongue (Serebrisky & Wiznia, 2019).  Since their airway is generally smaller, obstruction and inflammation are typically causing major discomfort (Serebrisky & Wiznia, 2019). On physical assessment, common findings are audible wheezing, dyspnea, nasal flaring, cough, restlessness, anxiety, red ears, dark red or cyanotic lips, sweating, use of accessory muscles, retractions, and decreased oxygen saturation (Fakhoury, 2018). A chest x-ray should be reserved for the children with unexplainable wheezing and no relief with bronchodilators; this would require further investigation and immediate evaluation in the emergency department (UpToDate, 2019).

References

Centers for Disease Control and Prevention. (2017). Pediatric Outpatient Treatment Recommendations. /orders/www.cdc.gov/antibiotic-use/clinicians/pediatric-treatment-rec.html

Fakhoury, K. (2018). Evaluation of wheezing in infants and children. UpToDate. Waltham, MA: UpToDate. /orders/www.uptodate.com/contents/evaluation-of-wheezing-in-infants-and-children?search=wheezing&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2

Gerber, J. S., Jackson, M. A., Tamma, P. D., Zaoutis, T. E., & COMMITTEE ON INFECTIOUS DISEASES. (2021). Antibiotic stewardship in pediatrics. Pediatrics, 147(1). /orders/pediatrics.aappublications.org/content/147/1/e2020040295

Patel, S. & Teach, S. (2019). Asthma. Pediatrics in Review. /orders/pedsinreview.aappublications.org/content/40/11/549/tab-figures-data

Serebrisky, D., & Wiznia, A. (2019). Pediatric asthma: a global epidemic. Annals of global Health, 85(1).

UpToDate. (2019). An Overview of Asthma Management. /orders/www.uptodate.com/contents/an-overview-of-asthma-management