Fill This Form To Receive Instant Help
Fill This Form To Receive Instant Help
Homework answers / question archive / NSG6440 Week 2 Discussion This week you learned about common conditions in the adolescent client
NSG6440 Week 2 Discussion
This week you learned about common conditions in the adolescent client. Please review the following case study and answer the following questions.
A fifteen-year-old female presents to your clinic complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately, she has felt this way continuously. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no other medications. She has had no surgeries. Her mother has allergies and eczema, and her father has high blood pressure. She is the only child. She denies smoking and illegal drug use. On examination, she is in no acute distress and her vital signs are: T 98.6, BP 120/80, pulse 80, and respirations 20. Her head, eyes, ears, nose, and throat examinations are essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On auscultation of her chest, there is decreased air movement and high-pitched whistling on expiration in all lobes. Percussion reveals resonant lungs.
The main complaint is represented by "shortness of breath and a nonproductive nocturnal cough". The medical terminology for this manifestation is dyspnea. Considering the symptomatology, three differential diagnoses can be proposed:
Relying on the patient's appearance and also the stated symptoms, I came up with the list of potential diagnosis in the list above. The patient stated that the difficulty in breathing started once she engaged into physical activity and has since developed to be short of breath all of the time. Bronchitis is a possibility as a differential diagnosis for the patient's persistent cough, difficulty breathing, and wheezing. Bronchitis can cause wheezing, but the other two symptoms are less frequent. The patient does not have the other bronchitis symptoms such as pain during inhalation, sputum formation, or upper respiratory infections symptoms.
As another differential diagnosis, the patient could have seasonal allergies. When exposed to irritants in the environment, rhinorrhea, itchy eyes, and nasal congestion are common. Dry cough, shortness of breath, and wheezing can all be symptoms of exposure to the allergen and Immunoglobulin E (IgE) production. Our hypothetical patient has a long history of allergy symptoms, which she inherited from her mother, including eczema. The patient, on the other hand, does not report any additional symptomatology relevant to this condition and is said to be allergic only to steroid nasal spray (Sinyor et al.,2018)
Because of the clinical presentation and the worsening of shortness of breath, this patient was diagnosed with mild persistent asthma. Coughing more at nighttime than during the daytime, shortness of breath, wheezing, and chest pains are all signs of persistent asthma. The manifestations of moderately chronic asthma are defined as chest pains, difficulty breathing, or wheezing that interferes with everyday activities for more than one night a week.
Spirometry and PEFR, also known as peak expiratory flow rate, are acknowledged as the gold standard for diagnosing asthma. I'd prefer to see the individual transferred to an allergist for evaluation before taking any other inhaled corticosteroids. The female and her mom both have a background of allergy symptoms, and her mom has eczema, so this exacerbation of symptoms could be caused by an undiscovered allergen. Following the determination of the PEFR and the identification of potential allergens, a comprehensive asthma management plan that includes additional LABAs (long-acting beta-adrenoreceptor agonists) and/or inhaled corticosteroids may be implemented. Because the patient is now using the corticosteroid inhaler without any other allergy medication, I would start a daily antihistamine, such as Claritin 10mg PO (per os) daily, to reduce any additional allergic reaction. Starting with a leukotriene receptor agonist, such as Montelukast, is also an option. Controlling an allergic reaction could considerably reduce asthma symptoms (Quirt et al.,2018).
References
Quirt, J., Hildebrand, K. J., Mazza, J., Noya, F., & Kim, H. (2018). Asthma. Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology, 14(Suppl 2), 50. https://doi.org/10.1186/s13223-018-0279-0
Sinyor B, Concepcion Perez L. (2021), Pathophysiology Of Asthma. [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551579/
