i human 6 Billy Johnson CASE STUDY Case, Exams of Nursing

Download i human 6 Billy Johnson CASE STUDY Case and more Exams Nursing in PDF only on Docsity!

i human 6 Billy Johnson CASE STUDY Case

COMPREHENSIVE i-HUMAN CASE STUDY: BILLY JOHNSON PATIENT DEMOGRAPHICS

Positive Exposures: Known contact with cousin diagnosed with streptococcal pharyngitis 7 days ago, with direct contact during weekend playdate. Interventions: Mother administered children's acetaminophen (dose unspecified) with temporary fever reduction, but fever recurred this morning. Illness Impact: Patient is described as "not himself" - lethargic, fussy, lying on couch (unusual behavior), with significant decrease in normal activity level. PAST MEDICAL HISTORY (PMH)

• Prenatal/Birth: Full-term vaginal delivery, no complications
• Medical Conditions: None
• Surgeries: None
• Hospitalizations: None
• Immunizations: Up to date per age
• Allergies: NKDA
• Medications: Occasional acetaminophen as needed (last dose: this morning)
• Tonsil Status: Tonsils present, no history of tonsillitis

SOCIAL HISTORY

• Living Situation: Lives with both parents, one sibling (age 4)
• School: First grade, regular attendance
• Environmental: No tobacco smoke exposure
• Diet: Normally good appetite, currently poor due to symptoms
• Activities: Age-appropriate play, currently limited by illness FAMILY HISTORY
• Mother: 32, healthy
• Father: 34, hypertension
• Sibling: 4, healthy
• Maternal grandmother: Type 2 diabetes
• Paternal grandfather: CAD
• No family history of rheumatic fever, autoimmune disorders, or recurrent streptococcal infections REVIEW OF SYSTEMS (POSITIVE FINDINGS)
• General: Fever, fatigue, malaise

• Ears: Tympanic membranes pearly gray, landmarks visible bilaterally
• Nose: Patent nares, no discharge
• Oropharynx: Tonsils 3+ (enlarged), erythematous with patchy white exudate bilaterally. Petechiae noted on soft palate. Uvula midline, no deviation.
• Neck: Tender, enlarged anterior cervical lymph nodes (approximately 2 cm) bilaterally. No nuchal rigidity. Cardiovascular:
• Tachycardic, regular rhythm
• No murmurs, rubs, or gallops
• Capillary refill <2 seconds Respiratory:
• Clear to auscultation bilaterally
• No wheezes, crackles, or rhonchi
• Non-labored breathing Abdomen:
• Soft, non-tender, non-distended
• Active bowel sounds present
• No hepatosplenomegaly Skin:
• No rash, erythema, or lesions
• Warm and dry

Neurological:

• Alert, oriented to person/place
• Cranial nerves II-XII intact
• Normal muscle tone and strength DIAGNOSTIC RESULTS Rapid Streptococcal Antigen Test: POSITIVE for Group A Streptococcus (GAS) Additional Considerations (if ordered):
• Throat culture: Not routinely needed with positive rapid test
• Monospot/EBV testing: Not indicated given positive strep test
• CBC: May show leukocytosis with neutrophilia if obtained ASSESSMENT Primary Diagnosis: Acute Streptococcal Pharyngitis (Strep Throat)

PLAN

1. Pharmacologic Treatment: - Amoxicillin 50 mg/kg/day divided BID x 10 days o Specific: 500 mg (22.7 mg/kg/dose) PO BID x 10 days o Alternative: Penicillin VK 25-50 mg/kg/day divided BID-TID x 10 days - Symptom management: o Acetaminophen 10-15 mg/kg/dose q4-6h PRN fever/pain (max 5 doses/24h) o Ibuprofen 10 mg/kg/dose q6-8h PRN (max 4 doses/24h) o Ensure 24-hour spacing between completing antibiotic and antacid administration 2. Non-Pharmacologic Measures: - Encourage cool fluids, popsicles, soft foods - Adequate rest - Warm salt water gargles if child can cooperate 3. Infection Control: - Patient is contagious until on antibiotics for 24 hours - Exclude from school/daycare until afebrile AND on antibiotics >24 hours - Good hand hygiene instruction

• Do not share eating utensils, cups, or toothbrushes 4. Follow-up:
• Return to clinic if: o No improvement in 48-72 hours o Development of difficulty breathing, swallowing saliva o Signs of dehydration (no urine >8 hours, dry mucous membranes) o Rash develops
• Routine follow-up not required if symptoms resolve
• Consider test-of-cure only if symptoms persist or recur 5. Education:
• Complete full 10-day antibiotic course regardless of symptom improvement
• Review signs of potential complications: o Rheumatic fever (joint pain/swelling, chest pain, SOB, rash) o Post-streptococcal glomerulonephritis (dark urine, edema, hypertension) o Peritonsillar abscess (worsening throat pain, difficulty swallowing, voice changes)
• Importance of hand hygiene to prevent household spread

• Code sequencing: J02.0 should be listed first as the reason for encounter CLINICAL PEARLS

1. Antibiotic Choice: Amoxicillin remains first-line for pediatric strep pharyngitis due to taste, cost, and efficacy. 10-day course is essential for eradication and prevention of rheumatic fever.
2. Complication Prevention: The primary reason to treat strep pharyngitis is to prevent acute rheumatic fever, which peaks in incidence at ages 5-15 years.
3. Diagnostic Approach: Rapid strep test sensitivity is ~86%, specificity ~96%. In high-prevalence settings or with high clinical suspicion, a negative rapid test may still warrant culture backup.
4. Carrier State: Asymptomatic carriers generally do not require treatment and have low transmission risk. Treatment is indicated for symptomatic infection or during outbreaks.
5. Return to School: CDC guidelines recommend exclusion until afebrile AND on antibiotics for at least 24 hours.

6. Household Contacts: Consider testing symptomatic household contacts. Prophylaxis is not routinely recommended for asymptomatic contacts. i-Human Case # Billy Johnson – Full Comprehensive Case Patient Introduction

• Name: Billy Johnson
• Age: 8 years
• Sex: Male
• Race: African American
• Setting: Outpatient / Urgent Care Clinic
• Accompanied by: Mother
• Chief Complaint: “My son is coughing a lot and having trouble breathing.” History of Present Illness (HPI) Billy Johnson is an 8 - year-old male with a known history of asthma who presents with worsening cough, wheezing, and shortness of breath for the past 2 days. Symptoms began after playing outside in cold weather and worsened overnight. Mother reports:
• Increased nighttime coughing

Past Medical History

• Asthma (diagnosed age 4)
• Seasonal allergies Medications
• Albuterol inhaler PRN
• Fluticasone inhaler (inconsistent use) Allergies
• NKDA Family History
• Mother: Asthma
• Father: Allergic rhinitis Social History
• Lives with parents
• No tobacco exposure at home
• Attends school
• No pets

Vital Signs

• Temp: 98.6°F (37°C)
• HR: 110 bpm
• RR: 26/min
• BP: 102/64 mmHg
• SpO₂: 93% on room air Physical Examination General
• Alert but mildly distressed
• Sitting upright, using accessory muscles HEENT
• Nasal mucosa edematous
• Throat clear Lungs
• Diffuse bilateral wheezing
• Prolonged expiratory phase
• Decreased air movement at bases
• Mild intercostal retractions Cardiac
• Tachycardic
• Regular rhythm

1. Viral Upper Respiratory Infection – no fever, wheeze suggests asthma
2. Pneumonia – unlikely without fever/focal crackles
3. Bronchiolitis – age inconsistent
4. Foreign body aspiration – no sudden onset Treatment Plan Medications

• Albuterol nebulizer q20 min × 3, then reassess
• Oral prednisone 1 – 2 mg/kg/day × 5 days
• Resume daily inhaled corticosteroid (Fluticasone) Education
• Proper inhaler technique (use spacer)
• Importance of daily controller use
• Identify triggers (cold air, exercise)
• Asthma action plan reviewed
• When to seek emergency care Follow-Up
• Reassess in 48 – 72 hours
• Pulmonology referral if frequent exacerbations
• School asthma action form provided

SOAP NOTE (Exam-Ready) S: 8 - yo male with asthma, worsening wheeze/SOB ×2 days O: RR 26, SpO₂ 93%, diffuse wheezing A: Acute asthma exacerbation – moderate P: SABA, oral steroids, resume ICS, education, follow-up i-Human Case Study: Billy Johnson Patient: Billy Johnson Age: 6 years old Scenario: Presented to the pediatric clinic by his mother, Mrs. Johnson, for a "sore throat and fever." Part 1: Chief Complaint & History of Present Illness (HPI) Best Opening Question:

• "Hello, Mrs. Johnson. I'm Dr. [Your Name]. What brings Billy in today?" Mrs. Johnson's Response: