Allergic Rhinitis Case Study

Lungs: Demonstrate good air entry. Faint end-expiratory wheeze throughout all lung fields. No rales or rhonchi. Symmetric chest expansion. Breathing nonlabored.

A 40-year-old woman comes to the clinic with a history of worsening nasal congestion and recurrent sinus infections. She had been healthy until about 1 year ago when she first noticed persistent rhinorrhea, sneezing, and stuffiness. She noted that when she went on a 2-week vacation to Mexico, her rhinorrhea disappeared, only to return when she came home again. She has lived in the same house for the past 5 years along with her husband and one child. They have had a dog for 4 years and a cat for 1 year. On physical examination, she has boggy, swollen nasal turbinates and a cobblestone appearance of her posterior pharynx.

According to the provider, the claimant's cough has been improved. His review of systems was positive for fatigue, malaise, sleep difficulty, shortness of breath, wheezes, and a cough. His blood pressure was 115/71 mmHg and his BMI was 30.35 kg/m2. The physical examination revealed wheezes. Clonazepam was prescribed for agitation. Atorvastatin, Nystatin, Citalopram, and a probiotic were prescribed. Continued use of Aspirin and a regular inhaler were suggested. Further, a follow-up visit with Endocrinology, Cardiology, and Pulmonology. As it relates to a spot in his lung, a repeat CT scan was recommended. The bronchial washes were negative for

Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored. Diminished breath sounds in all lung fields. Resonant to percussion.

Lungs: Upon auscultation, lungs are clear, no dyspnea, wheezing, or crackles. Dyspnea could be a sign of pulmonary embolism, asthma, pneumonia, and pneumothorax. Wheezing could be a sign of anaphylaxis reaction, asthma, bronchitis, emphysema, RSV, COPD, and sleep apnea. Crackles could indicate congestive heart failure, atelectasis, pulmonary fibrosis, interstitial lung disease, and pulmonary edema,

History of Present Illness: Ms. Johnson is a very pleasant 66-year-old woman who was previously evaluated in this office by Elvira Aguila, MD for the diagnosis of asthma. She was last seen in January 2015. She states that overall, she has done well. However, over the last two to three weeks, she has noticed increasing shortness of breath as well as productive cough, rhinorrhea and postnasal drip. She states that she has been using her rescue inhaler above and beyond what is normal for her up to 10 times a day yesterday and she states that she has had some improvement in her symptoms with her short acting bronchodilator. She denies any fevers or chills.

Respiratory: nNormal breath sounds present in all lung fields; no wheezing, rattles, crackles, or rhonchi

Allergic rhinitis is an annoying condition. Your nose is stuffy and runny. You may sneeze a lot and have watery eyes. Your entire nose, eyes, and throat may itch and annoy you. Your sense of smell and taste can even be affected. And worse, even though the symptoms are caused by allergies, people may avoid you thinking you harbor cold germs. Here are some treatment options you may want to try so you get relief.

Amy Parsons is a 16-year-old who states that she has periods when she experiences severe coughing described as dry, hacking, and non-productive. Amy reports shortness of breath and cough after swimming during summers and cough along with occasional wheezing during fall and winter months when she swims competitively. She has no known allergies, no history of surgeries or hospitalizations, and no chronic illnesses. Amy’s physical exam is unremarkable but she reports four to five colds per year. The test results for Amy’s the peak expiratory flow rates (PEF) are as follow: 290/310/320 with her predicted at 453. The following paragraphs will identify and explain the pathophysiology involved in Amy’s case.

Allergic rhinitis (AR) is an inflammatory condition which affects the membrane lining of the nose; causing it to become sensitive to allergens such as pollen, dust and animal dander. During AR, antigens bind with immunoglobulin E (IgE) to form an antigen-antibody complex which then attach themselves to the surface of nasal mast cells; inducing a cascade of cellular events leading to mast cell degranulation and the release of histamine via exocytosis. The release of histamine and other inflammatory mediators on blood vessel and nerve endings results in the symptoms of AR such as sneezing, itching and nasal discharge (rhinorrhoea). AR which occurs the same time every year is known as seasonal AR or more commonly known as “hay fever”. Avoiding causative allergens is essential in the management of the symptoms of AR; however, drug treatment is used to alleviate and control its symptoms. This evaluation will focus on the use of H1 anti-histamines, corticosteroids and IgE therapy in the treatment and management of seasonal AR. (ARIA, 2008)

The patient presents for routine follow up. States overall he has done not okay. He has been seen and evaluated for his chronic hoarseness telling that he needed to rest his vocal chords. States that it may be getting a little better if he has quit singing for several weeks. The patient states that he still continues to be quite short of breath. States that he feel he does have COPD from his tobacco use. States that he does have a lot of drainage and coughing early morning with sputum production. He has denied any dizziness, syncope, chest pain, or other difficulties. Appetite is well. Bowel and bladder function is without difficulties. He has also continued on his verapamil, lisinopril, aspirin, and daily

Hi would like to add to your discussion. JR’s medical management can be improved by referring him to allergy specialist. “The goals of asthma are 2-fold: reduce impairment from asthma symptoms and reduce risk of asthma exacerbations.” (Caverly & Taussig, 2011, p. 24).

Social History: Child is active and involves with his peers on the playground for sports and other activities without difficulty, denies having any chest pain, dizziness or shortness of breath during activities. Denies having any history of poor feeding or failure to thrive.

His main concern was his Tinea Pedis and Onychomycosis that has not been resolved and has required changes on treatment (refer to section 7). Ricardo had an episode of RT olecranon bursitis that was treated with steroids and analgesic gel, problems resolved w/o complications. Flu vaccine administered on 9/21/16. Hearing evaluation exam indicating mild hearing loss. No changes in mobility or daily activities; he remains on 1:1 level of supervision to prevent injuries.

Respiratory: Lung sounds are clear on auscultation without rales, rhonchi, or wheezes. Respiration unlabored with