Posted: May 1st, 2025

Cardiac, Atopic, Rheumatic, Immunodeficiency, and Respiratory System Disorders

This week, you are discussing pediatric conditions affecting cardiac, atopic, rheumatic, immunodeficiency, and respiratory system disorders. An important question for NPs is when should you refer? The answer is more about clinical judgment than what the practice guidelines say, although always follow practice guidelines on when to refer as with all else. Remember, even cardiologists have difficulty with things such as distinguishing certain murmurs. You need to be very careful about interpreting tests such as EKGs, echocardiograms, chest films, MRIs, CT scans, etc. Unless you have received formal education in these areas, it is best to refer. Always keep in mind “scope of practice.” Exceptions would be previously diagnosed conditions that are now stable with current treatment.

You are expected to present your initial topic, including, but not limited to, the following items:

Pathophysiology

Physical exam findings

Differential diagnoses and rationale

Management plan to focus on pharmacotherapy agents based upon evidence-based practice guidelines

• Topics:
• Murmurs (innocent and pathologic)
• Asthma
• Infective endocarditis, pericarditis

Myocarditis

Cardiomyopathy

1. Cardiac dysrhythmias
2. Upper respiratory disorders (common cold, rhinosinusitis)
3. Pharyngitis, tonsillitis
4. Diphtheria, pertussis
5. Croup, epiglottitis
6. Nonbacterial and bacterial pneumonia
7. Cystic fibrosis
8. Pectus deformity
9. Rashes
10. Rheumatic fever
11. Systemic erythematosus lupus (SLE)
12. Any thoughts? Should the NP order any tests or labs before or while waiting for the referral? If so, what are some of these?