A 3-year-old male presents to the primary care clinic in the care of his mother

A 3-year-old male presents to the primary care clinic in the care of his mother for evaluation with a “high fever,” irritability, sore throat, and “funny breathing.” MOC states that he attends day care full time and has had a cold for the past few days with a cough and runny nose. The fever started last night; she gave him some acetaminophen, but he still has a fever today. He is not eating very well but will drink fluids, particularly cold ones and will eat popsicles. He has not had any vomiting or diarrhea. Covid test was negative.
PMH: Negative for chronic health problems.
Medications: None
Allergies: None
Immunizations: Up-to-Date
ROS
General: negative, no weight loss
HEENT: denies headache, eye or ear pain; has nasal congestion & sore throat
Neck: no lumps, swelling, stiffness
Chest/Cardiac/Pulmonary: cough, worse at night; sounds “barky.”
GI: decreased appetite. No vomiting, diarrhea, constipation.
Neuro: alert
MSK: denies injuries
Skin: no rashes
PE
General: Alert, ill-appearing; anxious and leaning forward while sitting on Mom’s lap
124-32-110/74-SaO2=90 in RA
Wt = 22 kg
HEENT
Head: normocephalic, atraumatic
Eyes: PERRLA, clear
Nose: moderate amount white discharge
Mouth/Throat: erythematous, tonsils 3+ bilaterally without exudate
Neck: Supple, full ROM; no lymphadenopathy. Inspiratory & expiratory stridor heard at rest
Chest: Symmetric, tachypneic; intercostal retractions noted.
Cardiac: tachycardic, normal S1 and S2
Pulmonary: Decreased air entry; no adventitious sounds
Skin: no rashes, swelling, mild circumoral cyanosis
A 3-year-old male presents to the primary care clinic in the care of his mother for evaluation with a “high fever,” irritability, sore throat, and “funny breathing.” MOC states that he attends day care full time and has had a cold for the past few days with a cough and runny nose. The fever started last night; she gave him some acetaminophen, but he still has a fever today. He is not eating very well but will drink fluids, particularly cold ones and will eat popsicles. He has not had any vomiting or diarrhea. Covid test was negative.
PMH: Negative for chronic health problems.
Medications: None
Allergies: None
Immunizations: Up-to-Date
ROS
General: negative, no weight loss
HEENT: denies headache, eye or ear pain; has nasal congestion & sore throat
Neck: no lumps, swelling, stiffness
Chest/Cardiac/Pulmonary: cough, worse at night; sounds “barky.”
GI: decreased appetite. No vomiting, diarrhea, constipation.
Neuro: alert
MSK: denies injuries
Skin: no rashes
PE
General: Alert, ill-appearing; anxious and leaning forward while sitting on Mom’s lap
124-32-110/74-SaO2=90 in RA
Wt = 22 kg
HEENT
Head: normocephalic, atraumatic
Eyes: PERRLA, clear
Nose: moderate amount white discharge
Mouth/Throat: erythematous, tonsils 3+ bilaterally without exudate
Neck: Supple, full ROM; no lymphadenopathy. Inspiratory & expiratory stridor heard at rest
Chest: Symmetric, tachypneic; intercostal retractions noted.
Cardiac: tachycardic, normal S1 and S2
Pulmonary: Decreased air entry; no adventitious sounds
Skin: no rashes, swelling, mild circumoral cyanosis