Examkin

Soru

Zorluk: OrtaPediatric Respiratory Disorders

During a busy winter shift in the pediatric emergency department, a physician evaluates an infant born at term who is now 7 months of age. The child's parents report a three-day prodrome of rhinorrhea and low-grade pyrexia, which has recently progressed to marked work of breathing and a refusal to breastfeed. Vital signs demonstrate a temperature of 37.9°C (100.2°F), respiratory rate of 74/min, heart rate of 172/min, and a pulse oximetry reading of 87% on ambient air. Physical examination reveals an irritable infant with significant nasal flaring, prominent suprasternal retractions, and diffuse bilateral polyphonic wheezes and fine crackles. The child has no history of atopy, eczema, or previous wheezing episodes. Which of the following interventions represent appropriate management for this patient? (Select exactly 2 options)

  1. Initiation of supplemental oxygen therapyCevap
  2. Administration of intravenous or enteral fluidsCevap
  3. C
    Trial of aerosolized albuterol
  4. D
    Administration of systemic dexamethasone
  5. E
    Initiation of empiric intravenous ceftriaxone

Cevap

The correct interventions are the initiation of supplemental oxygen therapy and the administration of intravenous or enteral fluids.
This infant's clinical presentation—a viral prodrome progressing to respiratory distress, wheezing, and crackles during the first year of life—is the classic presentation of viral bronchiolitis, most commonly caused by Respiratory Syncytial Virus (RSV). The cornerstone of management for bronchiolitis is strictly supportive. Because this patient is hypoxemic (SpO2 < 90%), supplemental oxygen therapy is immediately indicated. Furthermore, given the significant tachypnea (RR > 70) and history of poor oral intake, the infant is at high risk for aspiration if fed orally; therefore, intravenous or nasogastric hydration is a critical and appropriate management step.

Adım Adım Çözüm

1
Analyze the patient's presentation and vital signs.
The 7-month-old presents with hypoxemia (SpO2 87%), severe tachypnea (RR 74), wheezing, and crackles following a viral prodrome.
Establishing the clinical diagnosis of severe viral bronchiolitis is required before selecting interventions.
2
Determine the therapeutic goals for viral bronchiolitis.
Management is exclusively supportive, focusing on maintaining adequate oxygenation and hydration status.
Viral bronchiolitis is a self-limiting disease without effective targeted antiviral or anti-inflammatory therapies for general inpatient use.
3
Select interventions that address the patient's specific physiological deficits.
The patient requires supplemental oxygen to correct hypoxemia and intravenous or nasogastric fluids to maintain hydration safely.
An SpO2 < 90% necessitates oxygen therapy, and an RR > 70 combined with feeding refusal creates a high aspiration risk, contraindicating oral feeding.

Anahtar Kavram

Supportive Care in Severe Viral Bronchiolitis
Bu soruyu puanla

Konular

Pediatric Respiratory Disorders

Bu konudan daha fazla soru