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Case Study: Michelle Tanner (6 years old)

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Case Study: Michelle Tanner (6 years old)

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Annie's dad presents her to the local prompt care office with c/o a persistent productive cough that has been ongoing "for a few months", increased fatigue, difficulty gaining weight despite her normal healthy eating habits, SOB, along with her past medical history of RSV as an infant (twice) and pneumonia at ages 4 and 5. Her father said she "looks pale". She is also complaining of stomach pain and constipation. She was diagnosed with asthma last year.

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Assessment:

-hx. of meconium ileus

-frequent respiratory infections

-dry mouth

General appearance:

-barrel chest

-clubbing of fingers/toes

-cyanosis

-lack of weight gain/ growth failure

-s/s of anemia

(pallor, fatigue, SOB, tachycardia)

Respiratory:

-wheezing

-dry, non-productive chronic cough

-dyspnea

-s/s lower airway respiratory infections/ involvement

-decreased breath sounds over areas of atelectasis

GI/GU:

-large, bulky frothy stools containing undigested food

-volume of stools increased w/ solid food

-steatorrhea (floating of stools in toilet)

-azotorrhea (foul smelling due to protein)

Skin:

-Parent may report child "taste salty"

(from elevated sodium in sweat)

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Cystic Fibrosis is...

A multisystem respiratory disease that requires extensive medical management to minimize recurrent lung infections. Alterations in oxygen can affect the child's ability to participate in typical every day activities. Children with CF are vulnerable to alterations in regular growth and development.

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Non-pharmaceutical:

-physical therapy

-exercise regimens

Pharmaceutical:

-Chest Physiotherapy (CPT)

-Albuterol Nebulized saline

-Inhaled antibiotics

-Antibiotics (azithromycin or ciprofloxacin)

-Vitamin supplementation

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-multivitamin

-albuterol inhaler

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Respirations: 24 breaths per minute

Heart Rate: 98 bpm

Blood Pressure: 105/ 70mmHg

Oxygen Saturation: 95% RA

Temperature: 98.9 F

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-CXR

-Sweat chloride test (Greater than or equal to 60 mmol/L)

-CBC (leukocytosis)

-PFTs

-Sputum Culture (growth of Pseudomonas aeruginosa)