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Clinical Accuracy Spoken Here
Preschoolers present special challenges in Asthma Care

Children as young as 4 may be aware of their "difference" due to asthma and their behavior may reflect this. At each visit ask parents about their children's activities and provide support to help children with things that may be difficult for them to do consistently. Help parents understand the unique personality traits and capabilities of their preschool child in encouraging the partnership for asthma care. Begin teaching about what makes the child's asthma worse and how to avoid or manage exposures. Preschool children may spend much of their time outside the home and encounter such triggers as smoke, pets, chalk dust, and upper respiratory infections. Asthma episodes may increase. The goal is to avoid or manage exposures to prevent such episodes.

Athena Forum, Asthma: Mod. D www.athenaforum.com

Young Children have “Hypoglycemic Unawareness”

While current standards for diabetes management reflect the need to maintain glucose control as near to normal as safely possible, special consideration must be given to the unique risks of hypoglycemia in young children. Glycemic goals need to take into account most children less than 7 years of age have a form of “hypoglycemic unawareness.” The counter regulatory mechanisms are immature, and they may lack the cognitive capacity to recognize and respond to hypoglycemic symptoms, placing them at greater risk for severe hypoglycemia and its sequelae.

Athena Forum, Diabetes: Mod. A
Excellence in Case Mgmnt

UM Case Study – Avoiding Multiple Hospitalizations

Leroy S. is a 67 year old male with increasing shortness of breath. His symptoms have been worsening over the last 5 days despite taking his medications. He is a poor historian. He has had 5 COPD admissions in the last two months and a recent bout of diverticulitis. He uses home oxygen at 2 liters and has refused Home Health in the past.

P.E.: decreased breath sounds bilateral with diffuse wheezing in all lung fields. VS: T 97, P 88, R 22, BP 130/82. Chest x-ray showed interstitial prominence and mild pulmonary edema. The ED physician orders include: EKG, Serial cardiac enzymes, VS q4, regular diet, labs, IV Solu-Medrol q6hrs, nebulizers q4, and oxygen at 3L.

As a HCM, how would you intervene to keep Leroy S. stabilized on an outpatient basis?

[Reference: Athena Forum, Utilization Management: Mod. A]

In the Headlines . . .

Congenital Heart Defects Associated with Obesity, Diabetes, Smoking

Congenital heart defects affect nearly 1% of newborns in the United States and are a leading cause of infant mortality. A total of 31 states have birth defects surveillance programs. CDC's National Birth Defects Prevention Study has reported finding increased risk for congenital heart defects associated with maternal obesity (4), diabetes (5), and smoking (6). Health-care providers and Case Managers should assist their patients to maintain a healthy weight, control diagnosed diabetes, and quit smoking. [www.cdc.gov]

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The look of confidence
  CM Excellence® Series: 
  » Principles of Case
  » Patient Advocacy
  » Utilization Management
  » Discharge Planning
  » Hospital Revenue Cycle

  Clinical Series: 
  » Asthma
  » Behavioral Health
  » Colorectal Cancer
  » COPD
  » CV Risk: Stroke & MI
  » Diabetes
  » EOL & Palliative
  » GI Disorders
  » Heart Failure
  » Multiple Sclerosis
  » Obesity Management
  » Pain Management
  » Rheumatoid Arthritis
  » Women’s Health



Cathy Wright Cathy Wright, BSN, RN
Clinical Editor
Athena Forum


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