Week 2 Discussion-2nd reply
Jessica Alper
Chief complaint
The chief complaint that this fifteen-year-old patient is complaining of is shortness of breath and nonproductive nocturnal cough.
Primary and differential diagnoses
The patient states that she typically only feels the stated symptoms after working out, but lately she has consistently felt that way. She denies symptoms related to upper respiratory system, gastrointestinal, or urinary. The objective findings reveal vital signs that are within normal limits and the patient is in no signs of respiratory distress. Assessment of head, eyes, ears, nose, and throat are not impressive, and the inspection of the anterior and posterior chest show no abnormalities. While auscultating the patient’s chest, decreased air movement and high-pitched whistling on expiration was observed. The lungs were also noted to be resonant upon percussion.
The primary diagnosis for this patient is severe persistent asthma. Asthma is defined as complex and it typically involves airway inflammation, intermittent airflow obstruction, as well as bronchial hyperresponsiveness. Symptoms usually involve wheezing, coughing, shortness of breath, as well as chest tightness and pain (Morris, 2022). The patient is feeling these same symptoms daily, multiple times a day, and throughout the night, with a nocturnal nonproductive cough, therefore this is the final diagnosis for this patient.
The first differential diagnosis is viral bronchiolitis, which is defined as “an acute inflammatory injury of the bronchioles that is usually caused by a viral infection” (Maraqa, 2021). Congestive heart failure is another differential diagnosis as well as chronic sinusitis. Congestive heart failure is a condition that causes pulmonary vessels and interstitial pulmonary edema, reducing the compliance of the lungs, therefore leading to a feeling of dyspnea and wheezing (Morris, 2022). Acute sinusitis is an “inflammatory process involving the paranasal sinus” (Brook, 2022), and it may be associated with allergies. It can lead to unproductive cough as well as exacerbation of asthma.
Treatment plan
The goal of asthma is to control it as best as possible. An ideal goal for a 15-year-old child is to have less than 2 days per week in which the patient will have an attack, along with less than twice per month of nightly awakenings. According to the symptoms, this patient should follow step 4 or step 5 of the guidelines. Step 4 would include a medium-dose inhaled corticosteroids, as well as long-acting beta agonist. If the patient did not respond to this treatment, an alternative plan including a medium-dose inhaled corticosteroid and a leukotriene receptor antagonist or Theophylline may be used. If both these treatments fail, then the patient should be moved to step 5 of treatment, which includes a high-dose inhaled corticosteroid and a long-acting beta agonist would be prescribed (Managing Asthma, 2022). It is also important to order a short-acting beta agonist to be used for emergencies. This SABA, such as Albuterol, should be only used up to 3 times in 20-minute intervals.
It is important to educate the patient about environmental control, and to know how to manage the symptoms. Additionally, it is crucial to educate the patient about having an Asthma Action Plan readily available. This plan is a tool that provides information and instructions on how to manage the patient’s symptoms. It includes medications and it helps the patient recognize worsening symptoms and when to seek emergency. It contains different colors that can help determine the severity of the asthma. The green color is the “Go Zone”, which tells the patient to use preventive medicine. The yellow one is the “Caution Zone”, which tells the patient to add a quick-relief medication. Lastly, the red zone is the “Danger Zone”, which is dangerous and requires the help of a physician (Asthma Action, 2021).
References
Asthma action plan. (2021). Asthma and Allergy Foundation of America. https://www.aafa.org/asthma-treatment-action-plan/
Brook, I. (2022). Acute sinusitis. Medscape. https://emedicine.medscape.com/article/232791-overview
Managing asthma in children 12 years of age and adults. (2022). Asthma Initiative of Michigan for Healthy Lungs. https://getasthmahelp.org/asthma-management-adults.aspx
Maraqa, N. F. (2021). Bronchiolitis. Medscape. https://emedicine.medscape.com/article/961963-overview
Morris, M. J. (2022). Asthma differential diagnoses. Medscape. https://emedicine.medscape.com/article/296301-differential
