Respiratory viral panel nasal swab case study

Chief Complaint

“My daughter has had a bad fever, and now she is having trouble breathing, and albuterol doesn’t help.”

HPI

Terri Collins is an 8-year-old African-American girl who presents to the ED with a 2-day history of fevers, malaise, and nonproductive cough. The mother gave acetaminophen and ibuprofen to help control the fever. Mother stated that “a lot of other kids in her class have been sick this fall, too.” Terri started having trouble breathing the morning of admission, and the mother gave her albuterol, 2.5 mg via nebulization twice within an hour. Terri still sounded wheezy to the mother after the albuterol, and Terri stated it was “hard to breathe.” Terri was previously well controlled regarding asthma symptoms. Previous clinic notes reported symptoms during the day only with active play at school or at home and rare nighttime symptoms. She uses PRN albuterol to help with symptoms after playing. Her assessment in the emergency department revealed Terri to have labored breathing, such that she could only complete four- to five-word sentences. She had subcostal retractions, tracheal tugging with tachypnea at 54 breaths/min. Her other vital signs were a heart rate of 160 bpm, blood pressure of 115/59, temperature of 38.8°C, and a weight of 22.7 kg. The initial oxygen saturation was 88%, and she was started on oxygen at 1 L/min via nasal cannula. Bilateral expiratory and inspiratory wheezes were noted on examination. A chest x-ray revealed a right lower lobe consolidation consistent with pneumonia and possible effusion. After receiving three albuterol/ipratropium nebulizations, her breath sounds and oxygenation did not improve, so she was started on albuterol via continuous nebulization at 10 mg/hr and her oxygen was titrated to 3 L/min. She was also given a dose of 25 mg IV methylprednisolone and a dose of 600 mg IV magnesium sulfate. Terri was then transferred to the PICU for further treatment and monitoring.

PMH

Asthma; last hospitalization 4 years ago, and has had two courses of oral corticosteroids in the past year

FH

Asthma on father’s side of the family

SH

Lives with mother, father, and two siblings, both of whom have asthma. There are two cats and a dog in the home. Father is a smoker but states that he tries to smoke outside and not around the kids. She is in the second grade and is very active on the playground.

Meds

Albuterol 2.5 mg nebulized Q 4–6 H PRN wheezing

Fluticasone propionate 44 mcg MDI two puffs BID

Acetaminophen 160 mg/5 mL—10 mL Q 4 H PRN fever

Ibuprofen 100 mg/5 mL—10 mL Q 6 H PRN fever

All

NKA

ROS

(+) Fever, cough, increased work of breathing

Physical Examination

Gen

Alert and oriented but in mild distress with difficulty breathing

VS

BP 125/69, P 120, T 37.9°C, RR 40, O₂ sat 94% on 3 L/min nasal cannula

Skin

No rashes, no bruises

HEENT

NC/AT, PERRLA

Neck/LN

Soft, supple, no cervical lymphadenopathy

Chest

Wheezes throughout all lung fields, still with subcostal retractions

CV

RRR, no m/r/g

Abd

Soft, NT/ND

Ext

No clubbing or cyanosis

Neuro

A&O, no focal deficits

Labs

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Na 141 mEq/L	WBC 34.2 × 103/mm3
K 3.1 mEq/L	Neut 91%
Cl 104 mEq/L	Lymph 5%
CO2 29 mEq/L	Mono 4%
BUN 16 mg/dL	RBC 5.07 × 106/mm3
SCr 0.52 mg/dL	Hgb 13 g/dL
Glu 154 mg/dL	Hct 41%
	Plt 310 × 103/mm3

Respiratory viral panel nasal swab: positive for influenza A

Chest X-Ray

RLL consolidation

Assessment

Asthma exacerbation with viral pneumonia

Questions

1. What additional information is needed to fully assess this patient?
2. What nondrug therapies might be useful for this patient?
3. Develop a plan for follow-up that includes appropriate time frames to assess progress toward achievement of the goals of therapy.

Education

As educators, it is important to remember that parents/guardians may not have prior knowledge about learning disabilities, their risk factors, or early intervention strategies for exceptionalities in children of various ages. Additionally, parents/guardians may not understand how specific learning disabilities affect students in educational settings as well as everyday life. As educators, we can communicate and collaborate with parents/guardians to provide information and resources that help them understand learning disabilities, define the roles of the state, school, and the parents/guardians in accessing and providing intervention services, and navigate the acquisition of information and support agencies and services provided to students with disabilities.

Consider students in the grade level that is the focus of your field of study. Select a specific disability category (intellectual disability, specific learning disability, emotional behavior disorders, autism spectrum disorder, traumatic brain injury, or orthopedic impairment). Create a 250-500 word digital brochure that could be given to families and provide information about services and supports for individuals with disabilities.

The brochure should include the following:

• Short rationale explaining how you will use the brochure to communicate with parents/guardians and establish mutual expectations to help you work collaboratively to support child development and achievement.
• Short definition and explanation of the disability category including the developmental and individual differences typically associated with the disability category.
• Three developmentally appropriate, specially designed instructional strategies that can be used to address the educational needs of students with this disability.
• Three intervention strategies families can implement at home to promote communication skills, social skills, and literacy skills in their children affected by the chosen disability.
• Three communication/collaboration strategies that can be employed by the state, school, service providers, and parents/guardians to implement intervention services to support student achievement and development.
• Recommend local organizations families could use to learn more about the disability and community services that might be available to them. Provide contact information for the organizations and services.

Support the assignment with a minimum of three scholarly resources.

• While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
• This assignment uses a rubric. Review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Analyzing Group Techniques

Group therapy can alleviate feelings of isolation and foster a supportive and collaborative environment for sharing difficult feelings in order to facilitate healing. For many people, being part of a group that has a shared understanding of a struggle provides a unique opportunity to gain understanding of their own experiences.

As you examine one of the group therapy demonstrations from this week’s Learning Resources, consider the role and efficacy of the leader and the reasons that specific therapeutic techniques were selected.

To prepare:

• Select one of the group therapy video demonstrations from this week’s required media Learning Resources.

The Assignment

In a 4-page paper, identify the video you selected and address the following:

• What group therapy techniques were demonstrated? How well do you believe these techniques were demonstrated?
• What evidence from the literature supports the techniques demonstrated?
• What did you notice that the therapist did well?
• Explain something that you would have handled differently.
• What is an insight that you gained from watching the therapist handle the group therapy?
• Now imagine you are leading your own group session. How would you go about handling a difficult situation with a disruptive group member? How would you elicit participation in your group? What would you anticipate finding in the different phases of group therapy? What do you see as the benefits and challenges of group therapy?
• Support your reasoning with at least three peer-reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Video links

 

https://youtu.be/05Elmr65RDg

Innovation

Whose fault is it then? – Swedish High Court

a.   Content:

On a balmy Sunday morning in August 1628, almost the entire populace of Stockholm, Sweden turned out for the festivities surrounding the launch of the Vasa, the most powerful and ornamented vessel ever commissioned by his Excellency King Gustavus II Adolphus for the Royal Navy. No expense had been spared in the construction of this sophisticated modern warship, which cost more than 5% of the Swedish GNP to build. The finest shipbuilders and artisans had spent months constructing a vessel designed to strike fear in the heart of Sweden’s enemies. While still in the harbor, the crew set the sails of the Vasa. She immediately keeled over, with seawater pouring through the gun ports and over the decks. The Vasa sank to the bottom of Stockholm harbor, carrying fifty sailors to their grave.

Complete MBA-level research and study the design, construction, and ultimate demise of the Vasa. Identify each group of “customers” in the Vasa project, what their competing needs were, and how you identified those needs. Thoroughly spell out the lessons regarding the management of technology innovation that might be gained from the Vasa, and how those lessons should be applied to modern-day corporations.

b.   Format:

Your audience for this is practicing managers in your industry.  should use the style (e.g., APA) appropriate for a relevant, popular press publication and be approximately 2,000 words in length.