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

Cardiac dysrhythmias
Upper respiratory disorders (common cold, rhinosinusitis)
Pharyngitis, tonsillitis

Diphtheria, pertussis
Croup, epiglottitis
Nonbacterial and bacterial pneumonia
Cystic fibrosis
Pectus deformity
Rashes
Rheumatic fever
Systemic erythematosus lupus (SLE)
Any thoughts? Should the NP order any tests or labs before or while waiting for the referral? If so, what are some of these?