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The most common initial clinical presentation of bacterial community acquired pneumonia includes:

A 2 year old with a history of extreme prematurity, severe bronchopulmonary dysplasia (BPD), and tracheostomy with chronic ventilator support presents with acute hypoxemia and increased work of breathing. Parents report thick secretions over the past 24 hours. On exam, the child is tachycardic and has decreased breath sounds. Despite suctioning, oxygen saturations remain low. Which of the following should be highest on your differential diagnosis?

You are admitting a 3-month-old female who weighs 3.5 kg who is a former 29 week gestation infant. She is being admitted for respiratory distress with likely bronchiolitis. She is tachypneic with RR of 80 and is having frequent brief apneic episodes that respond quickly to tactile stimulation. Currently on 2 L oxygen via simple nasal cannula. Which is the best next step in management?

A 15-year-old female admitted for treatment of new-onset acute lymphoblastic leukemia (ALL) is transferred to the PICU with acute hypoxemia, pleuritic chest pain, and tachycardia. She has a peripherally inserted central catheter (PICC) in place for chemotherapy. CT angiography confirms a pulmonary embolism (PE). Which of the following best represents the factors from Virchow’s triad that likely contributed to her PE?

A 10 year old boy with Duchenne muscular dystrophy, which is associated with weakened respiratory muscles, is admitted with pneumonia and worsening hypercapnic respiratory failure. His ABG while on 2L nasal cannula is: pH 7.28 PaCO2 62mmHg PaO2 70mmHg He is alert and cooperative with mild to moderate work of breathing. Which of the following is the MOST appropriate initial choice of respiratory support?

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Pronounce the following word.  Say the word slowly enough that it can be understood.   Hemophilia    

Pronounce the following word.  Say the word slowly enough that it can be understood.   Coagulopathy  

During the change of shift report, the oncoming nurse is told that the patient has clubbing in the upper extremities. What should the nurse expect when assessing this area?