Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-04-26 Encounter: Spruce text message CC: Stuffy nose and cough requiring nightly albuterol nebulizer treatments to sleep. HPI: Malcolm (age not specified) is experiencing nasal congestion and cough. Parents have needed to use albuterol nebulizer treatments several nights to help him sleep, and also on some daytime occasions as needed. No fever reported. DayQuil was tried on Thursday with unclear benefit. Mother returned from London on Friday night, suggesting a possible recent viral exposure in the household. Assessment: Likely viral upper respiratory illness with reactive airway/bronchospastic component given response to albuterol and spastic cough pattern. No labored breathing reported. Timing consistent with typical viral illness course. Plan: Recommended Delsym for cough as preferred over DayQuil. Encouraged trial of nebulizer treatment for all children to assess response and improve sleep and school functioning. Continue albuterol nebulizer as needed. Medications: - Delsym Not specified (new) - Albuterol Nebulizer, used nightly and daytime as needed (continue) Key clinical quotes: "sounds spastic for sure, no jags of coughing. I'm assuming no labored breathing? using albuterol in the daytime?" "I'm curious what it would look like if you gave them all a neb" "I'm guessing it would help sleep and school" Source: Spruce conversation t_27C02FVS44O00