SOLVED863

8 Year old – Andy Andy is an 8 year old who with past medical history of cystic fibrosis diagnosed at 2 months of age. They present to the ED with their parent with a 2 day history of fever, increased work of breathing, and increased productive cough with green sputum. History: Andy was born at 37w3d via NSVD with a NICU stay for meconium ileus and poor feeding. He was discharged home after 1 week. At 2 months of age his newborn screen returned + for cystic fibrosis. He is followed by a pediatric pulmonologist but has not been seen in clinic for the last year. Physical exam: Andy appears small and malnourished for their age. You notice tachypnea, increased work of breathing with subcostal and and suprasternal retractions. Looking at Andy from the front and side you note a slight barrel chest. You note clubbing of their nailbeds. Auscultation of the chest reveals normal cardiac sounds without murmur, and lung sounds with diffuse crackles and rhonchi. A strong, productive cough is appreciated and Andy spits out yellow phlegm into a tissue. Andy’s abdomen is flat, soft and non-tender with present bowel tones. Their skin is flushed, warm and
SCIENCE
HEALTH SCIENCE
NURSING

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