28 Sep Please reply to the following discussion with one or more references. Participate in the discussion by asking a question, providing a statement of clarification, providing a point

Week 2 discussion – 1st Reply

Edgar Gonzalez

The chief complaint is “shortness of breath and a nonproductive nocturnal cough.” The 15-year-old female patient reports that her symptoms are persistent and have progressed from only have them with extreme exercise. She denies associated symptoms such as upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. She does not report alleviating or aggravating factors. She has a history of seasonal allergies and a family history of allergies, eczema, and hypertension. She does not use tobacco or recreational drugs. 

Based on the presenting symptoms, the top three diagnoses include moderate persistent asthma, acute bronchitis, and sinusitis (Dunphy et al., 2017). Moderate persistent asthma presents with wheezing, shortness of breath, nocturnal symptoms, and exacerbations that affect activity two times or more per week and may last for several days (Burns et al., 2019). A family history of asthma and eczema is commonly seen, along with recurrent bronchitis episodes and seasonal exacerbations. Acute bronchitis most often presents with a cough for several weeks. It can also present with fever, malaise, chest discomfort, and wheezes (Goolsby & Grubbs, 2018). Sinusitis is common among patients with allergies and asthma. Sinusitis can present with difficulty breathing, fever, headache, severe sinus congestion, and can be triggered by allergens (Goolsby & Grubbs, 2018).

A stepwise approach is recommended for the management of asthma. The treatment of choice for moderate persistent asthma is a low-dose inhaled corticosteroid, such as Pulmicort, a long-acting beta2-agonist, such as Symbicort, and a short-acting beta-agonists, such as albuterol as needed (Pollart & Elward, 2009). A custom Asthma Action Plan tailored to the patients should also be considered. These action plans give patients and their families instructions on managing asthma with medications, recognizing warning signs of it getting worse, and what to do in an emergency (CDC, 2022). The action plan should be given using a traffic light style of green, yellow, or red to manage symptoms, that the patient and their caretaker should know what to do if the patient goes into the yellow or red zones (Burns et al., 2019). This action plan should also be provided to the patient’s school to implement appropriate interventions as needed. 

References

Burns, C., Dunn, A., Brady, M., Starr, N., & Blosser, C. (2019).  Burns' pediatric primary care (7th ed.). Elsevier.

Centers for Disease Control and Prevention. (2022).  Asthma action plans. U.S. Department of Health & Human Services. https://www.cdc.gov/asthma/actionplan.html

Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D.  (2017 ). Primary Care: the art and science of advanced practice nursing (5th ed.). F. A. Davis.

Goolsby, M. J. & Grubbs, L. (2018).  Advanced assessment: Interpreting findings and formulating differential diagnoses (4th ed). F. A. Davis.

Pollart, S. M., & Elward, K. S. (2009). Overview of changes to asthma guidelines: diagnosis and screening.  American family physician,  79(9), 761–767.