Question

A nurse on a pediatric unit is caring for a school-age child. The child's vital signs at 0830 are as follows: Temperature 37.1°C (98.8° F), Heart rate 100/min, Respiratory rate 22/min, Blood pressure 90/60 mm Hg, Pulse oximetry 97. The nurse's notes indicate that the child is alert and responsive to stimuli, with warm and dry skin. Capillary refill is less than 3 seconds. The child has regular and shallow respirations, mild intercostal retractions, and expiratory wheezes auscultated in the anterior and posterior lung bases. The abdomen is soft, flat, and non-distended. At 1100, the child appears restless with moderate intercostal retractions. Scattered rhonchi are heard in the anterior bases, along with wheezing on inhalation and exhalation. The point of maximum intensity (PMI) is in the left mid-clavicular line at the 4th intercostal space. The heart rate is regular without murmurs, gallops, or rubs. Radial and pedal pulses are 2+ bilaterally. Based on this information, what is the most likely diagnosis for the child? 1) Asthma 2) Pneumonia 3) Bronchiolitis 4) Congestive heart failure

Answer 1

The child's clinical signs, including restlessness, increased intercostal retractions, and wheezing on both inhalation and exhalation, suggest the most likely diagnosis is asthma.

Step-by-step explanation:

Based on the clinical presentation of the school-age child, the most likely diagnosis is asthma. The child's vital signs show a slightly elevated heart rate and respiratory rate, which is consistent with asthma.

Additionally, the child's restlessness and increased intercostal retractions, along with the expiratory wheezes initially and then wheezing on both inhalation and exhalation, are common signs of an asthma exacerbation. The absence of fever, which is often present in pneumonia, also points towards asthma.

The pulse oximetry reading is within a normal range, which decreases the likelihood of a severe respiratory condition such as congestive heart failure, especially given the regular heart rate without murmurs, gallops, or rubs and normal blood pressure.

While bronchiolitis is a possibility due to wheezing, it more commonly affects infants and toddlers rather than school-aged children.

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