Diagnosis and MAnagement of Respiratory Disorders

Case Study

HPI: A 14-month-old Native American boy brought in by his mom due to cough, low grade fever and runny nose for the past 2 days. This morning, the mother noted that her son was breathing quickly and “it sounds like he has rice cereal popping in his throat.” Mom is worried because her son seems to have a lot of “bouts of colds”. Per mom, his oral intake is decreased. He didn’t want to eat this morning.

Physical Exam: Smiling, alert Native American boy.
Vital Signs: Temp of 99.9, pulse 112, respiratory rate is 58, Pulse ox 96%
HEENT: There is moderate, thick, clear rhinorrhea and postnasal drip.
Cardiovascular: His capillary refill is less than 3 seconds
Pulmonary: lung sounds are diminished in the bases, he has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields.

To prepare:

Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.

Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.

Post an analysis of your assigned case by using the following:

  • What additional questions will you ask?
    • Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds, and so forth that might be pertinent in arriving to your differential diagnoses)
  • What additional examinations or diagnostic tests, if any will you conduct?
  • What are your differential diagnoses? What historical and physical exam
  • features support your rationales? Provide at least 3 differentials.

  • What is your most likely diagnosis and why?
  • How will you treat this child?
    • Provide medication treatment and symptomatic care.
    • Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.
  • Patient Education, Health Promotion & Anticipatory guidance:
    • Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
    • Include any socio-cultural barriers that might impact the treatment and management plans.
    • Health Promotion:
      • What immunizations should this child have had?
      • Based on the child’s age, when is the next well visit?
      • At the next well visit, what are the next set of immunizations?
      • What additional anticipatory guidance should be provided today?

 

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