Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.

Understanding Health Insurance: A Guide to Billing and Reimbursement
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Author:GREEN
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Chapter9: Cms Reimbursement Methodologies
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You are working in a large urban pediatric clinic after-hours.

A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions.

  • The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA).
  • Born at 36 weeks gestation.
  • Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
  • T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96%
  • A swab for respiratory syncytial virus (RSV) is positive.

 

Doctor orders - Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated.

After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed.

Client is discharged with these orders:

  • methylprednisolone 0.4 mg/kg oral BID for 3
  • Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed.
  • Call if needed prior to the Q4 dose.
  • Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake.
  • Return for re-evaluation in 3 days
  1. Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.
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