[Answered]: PEDIATRIC CARDIAC CASE STUDY Mom & Dad bring…

PEDIATRIC CARDIAC CASE STUDY Mom & Dad bring their 5-week-old male child to your urgent care. They report him to be eating poorly, having trouble breathing and seems very tired & sleepy. They report he had been fine until a couple weeks ago when he developed a fever, cough, runny nose, and vomiting. They report his breathing continues to get worse and a much faster rate and his sleepiness is increasing as well. They also report he sweats on his forehead when feeding. Medical history: He was a full term, uncomplicated pregnancy. G3P2. Delivery was unremarkable except for meconium-stained fluid. He did well at delivery and in the nursery. His pediatric follow-up has been poor. Medications: none Allergies: NKA Physical Examination T: 98.2 F, Resp: 74, Heart Rate: 160, BP: 92/68, O2 Sat: 99% (room air). Appearance: Mildly cachectic, acyanotic infant who is pale, lethargic, and tachypneic, mild to moderate subcostal and intercostal retractions. HEENT exam is unremarkable. Neck is supple without lymphadenopathy. His skin is clear with no rashes or other significant skin lesions. Lungs: Scattered crackles with slightly decreased aeration in the left lower lobe. Heart: Regular rate and rhythm, with a Grade II/VI holosystolic murmur at the mid lower left sternal border with radiation to the cardiac apex. The S1 is normal and the S2 is prominent. An S4 gallop is noted at the cardiac apex. There are no rubs or valve clicks. Abdomen: Soft, non-distended, and non-tender. The liver edge is palpable 3 to 4 cm below the right costal margin. There are no palpable masses or splenomegaly. Bowel sounds are hypoactive. Extremities: Symmetric and cool, with peripheral pulses 1+/4+ in all extremities with no radial-femoral delay. The capillary refill is 4 to 5 seconds (delayed). A chest x-ray was done showing moderate cardiomegaly with a moderate degree of pulmonary edema. There are no pleural effusions. Please answer the following questions: What are your top four (4) differential diagnoses? Identify your primary diagnosis & explain your rationale – findings that lead you to this diagnosis. What labs and diagnostic tests would you want to order – give rationale for each. What is your treatment plan? Identify pharmacologic and non-pharmacological treatments. Be specific with medications & dosages. What is your plan of follow-up care? Explain the significance of the age of the patient in this case – how it relates to your treatment plan.