What is the best approach to manage a 6-year-old patient with a history of CPAP requirement, now experiencing respiratory distress, vomiting, and low-grade fevers while on antibiotics?

SOAP Note Questions for 6-Year-Old with Respiratory Distress

For a 6-year-old female with recent PICU discharge and recurrent respiratory distress, focus assessment on identifying the cause of respiratory deterioration, evaluating treatment efficacy, and determining appropriate interventions for respiratory support.

Subjective Questions

• When did the breathing difficulty begin to worsen after PICU discharge? 1
• Has there been any change in the character, frequency, or amount of secretions requiring suctioning? 1
• What is the nature of the vomiting (frequency, timing in relation to feeds, character)? 1
• What is the GT feeding regimen (type, rate, volume)? 1
• What was the reason for CPAP requirement during previous PICU stay? 2, 3
• What antibiotics is she currently taking for the urinary tract infection? 1
• What is the duration and pattern of the low-grade fevers? 1
• Has there been any change in her level of alertness or behavior? 1

Objective Questions

Respiratory Assessment

• What are the specific areas of coarse breath sounds and are there any areas of decreased breath sounds? 1
• Is there any change in the degree of indrawing compared to discharge? 1
• What is the respiratory rate trend over the past 24 hours? 1
• Is there any stridor, grunting, or wheezing? 1
• What is the oxygen saturation trend since discharge? 1

Infection Evaluation

• What is the complete blood count with differential? 1
• What are the inflammatory markers (CRP, procalcitonin)? 1
• Has a chest radiograph been performed since the symptoms worsened? 1
• Was a sputum or tracheal aspirate culture obtained during the PICU stay? 1
• What were the results of previous urine cultures and sensitivities? 1

Feeding and Nutrition

• What is her current weight compared to her discharge weight? 1
• Is there any abdominal distension or tenderness? 1
• What is her current hydration status? 1

Assessment Questions

• Could this represent a recurrence of the original respiratory condition or a new process? 1
• Is there evidence of aspiration related to GT feeds? 1
• Could this be a hospital-acquired pneumonia or ventilator-associated pneumonia from previous PICU stay? 1
• Is the current antibiotic therapy appropriate for the suspected respiratory infection? 1
• Is there a possibility of pleural effusion or empyema? 1
• Could there be an underlying chronic lung condition contributing to recurrent respiratory distress? 1

Plan Questions

Diagnostic Plan

• Should a chest radiograph be obtained to assess for pneumonia, atelectasis, or pleural effusion? 1
• Is a chest ultrasound indicated to evaluate for pleural fluid? 1
• Should blood cultures be obtained given the recurrent fever? 1
• Is a respiratory viral panel indicated? 1

Treatment Plan

• Does the patient require escalation of respiratory support (CPAP, high-flow nasal cannula)? 4
• Is a change in antibiotic therapy warranted based on current symptoms? 1
• Should the GT feeding regimen be modified to reduce risk of aspiration? 1
• Is chest physiotherapy indicated for secretion clearance? 1
• Should the patient be transferred back to the PICU for closer monitoring? 1
• What parameters should be used to monitor response to therapy? 1

Follow-up Plan

• What vital sign parameters would indicate clinical improvement or deterioration? 1
• What is the appropriate frequency for reassessment of respiratory status? 1
• What discharge criteria should be established? 1
• What education does the family need regarding GT feeding techniques and respiratory care at home? 1