Reference no: EM133553499

Case Study: A 6 year old presents to the office with symptoms of worsening cough and wheezing for the past24 hours. They are accompanied by their mother, who is a good historian. She reports that herchild started having symptoms of a viral upper respiratory infection 2 to 3 days ago, beginningwith a runny nose, low-grade fever of 100.5ºF orally, and loose cough. Wheezing started on theday before the visit, so she administered albuterol metered-dose inhaler (MDI) two puffs beforebed and then two puffs at around 2 a.m. The cough and wheezing appear worse today, accordingto the mother. The child had difficulty taking deep-enough breaths to inhale this morning's doseof albuterol, even using the spacer.The child has been a patient at the clinic since birth and is up to date on theirimmunizations, growth and development have been normal, and they have been generallyhealthy except for mild intermittent asthma. Their asthma is usually precipitated by a viral upperrespiratory infection. The patient has required oral prednisone an average of two or three timesper year for the past 3 years. They have an albuterol MDI at home with a spacer, which theirparents are comfortable using. The child is in first grade. This is the first asthma exacerbation ofthe school year, and their mother expresses a concern about sending him to school with aninhaler.

Assessment: The child is afebrile with a respiratory rate of 36 and a tight cough every 1 or 2 minutes, andweighs 45 pounds. The examination is all within normal limits except for breath sounds. Thechild has diffuse expiratory wheezes and mild retractions. Pulse oximeter readings indicateoxygen saturation of 93%.

Question 1. What is the initial management plan in the clinic?

Question 2. What would be the management plan at a follow-up visit?