Asthma Case Study

She denies any cough, fever, sputum production or hemoptysis. She is currently on birth control

EH is a 68-year-old male who comes into the clinic complaining of a fever with a temperature of 103 °F. He has had a cough for the last three days that is producing some thick green brown mucous. The MD feels he most likely has bacterial pneumonia. He also has a history of having rheumatoid arthritis, and being immune compromised as he is on an immunosuppressant methotrexate. He has noted that over the last year he has lost weight unintentionally and feels he is underweight.

Task analysis is the process of obtaining information about a job by determining the duties, tasks, and activities involved and the knowledge, skills, and abilities required in performing each task. There can be broken down into six

R.J. is a 15-year-old boy with a history of asthma diagnosed at age 8. His asthma episodes are triggered by exposure to cats and various plant pollens. He has been using his albuterol inhaler 10 to 12 times per day over the last 3 days and is continuing to wheeze. He normally needs his inhaler only occasionally (2 or 3 times per week). He takes no other medications and has no other known medical conditions. Physical examination reveals moderate respiratory distress with a respiratory rate of 32, oximetry 90%, peak expiratory flow rate (PEFR) 60% of predicted, and expiratory wheezing.

I did talk with him about my concern regarding the lesions that are close to the eye and I felt it was very important that he be seen by ophthalmology and this was arranged for him today. He will keep that appointment this afternoon over at Eyesight. I talked about antiviral therapy as he is within a couple days of the onset. He was written for Valtrex 1000 mg three times daily for seven days. In addition, prednisone 10 mg tablets, 40 mg for two days, then 20 mg for two days, then 10 mg for two days. I reviewed the case with Brett Rankin, MD, as I was concerned with the lesions in the ear and my concerns regarding the possibility of this leading to a Ramsay Hunt syndrome. Currently as his hearing is unchanged and there is no facial paralysis issues, I am hoping that will not be worry with the steroids and the antiviral therapy starting. Dr. Rankin talked about doing a hearing evaluation to ensure there is no asymmetry between his two ears, even though the patient perceived that his hearing was okay and that will be arranged for him. He knows he will be contacted by Dr. Rankin's office for that. He knows to contact me if his symptoms worsen in any way. We did talk about the potential complications and he is aware of what to be looking for. A viral culture was performed to confirm the diagnoses, but he understands that may take time to return the results to us. He will monitor symptoms in the

Acute tonsillitis is inflammation of the tonsils secondary to an infectious process causing painful swallowing and is more commonly attributed to a viral cause rather than bacterial (Shepherd, 2013). A physical assessment of the tonsils may reveal an increase in size with edema and erythema. This is often associated with upper respiratory symptoms like, headache and cough (Shepherd, 2013). Another diagnosis is pharyngitis. Pharyngitis is also a sore throat which is secondary to inflammation noted at the back of the throat and associated with complaints of pain when swallowing (Shepherd, 2013). Viral pharyngitis is the most common and can be contributed to the rhino or coronavirus which lasts between 5-7 days and presents with associated symptoms like cough, headache, fatigue and mild fever (Ruppert & Fay, 2015). Finally, GABHS or more commonly noted as strep throat is a potential diagnosis. This bacterial infection is most common in children and adolescents. Often individuals present with symptoms including throat pain, fever, chills, headache, cervical lymphadenopathy and exudate noted to tonsils or in the pharyngeal (Ruppert & Fay, 2015). This infectious process in younger children may also present with gastrointestinal symptoms like nausea, vomiting and abdominal pain but is not accompanied by cough or nasal

Our patient has a total of 3 per the modified Centor criteria, providing a positive predictive value of roughly 33% for having strep throat. Treating empirically with antibiotics is not universally recommended unless the (modified) Centor Criteria score is 4 or more. Thus, obtaining a rapid strep test, also known as a rapid antigen detection test (RADT), is strongly recommended, along with a throat culture should the RADT be negative. Infectious mononucleosis, although potentially a diagnosis given the patient’s age, is not likely as fatigue is generally a common complaint and the onset if more insidious. Referring the patient to an Ear, Nose and Throat (ENT) physician is premature given there is no urgent need and does not assist the

a bacterial infection has occurred(Carson-DeWitt). Fever and discomfort can be helped by taking acetaminophen (Carson-DeWitt). A cool mist vaporizer may help with the cough (Carson-DeWitt). Fever leads to dehydration, therefore patients must be given lots of fluids and liquids to stay hydrated(Carson-DeWitt).

Though Mario is complaining of a sore throat, cough, and congestion, it may not warrant an antibiotic nor be strep throat as previously thought by the health care provider who ordered the strep test. Due to the eyes, ears, nose, and throat being somewhat connected, Mario may be suffering from allergies. When a patient has allergy issues, the nasal passages may drain into the throat area causing a sore throat and congestion in the chest and possibly the nasal area when lying down. When antibiotics are prescribed, it is to treat a bacterial infection not a viral infection. Even though Mario is showing the classic symptoms where an antibiotic may be needed, this might not be the case. Antibiotics are for bacterial infections. If a bacterial

Shaun was seen today as ongoing management of his asthma with fixed airflow obstruction. Whilst he originally did very well coming off the Alvesco and continuing with the Seretide 250/25 two puffs twice a day, in the colder months, his asthma control has worsened and he is using Ventolin every other day multiple times throughout the day. He is also noticing some exercise limitation. Pleasingly, though, he is not having any nocturnal symptoms of asthma. There seems to be no other cause for his deterioration, in particular, he has no nasal or sinus symptoms and he has had no return of his GORD on his current Somac therapy. He has had issues before with his asthma and it is perhaps the cold air that is exacerbating his underlying airways

Based on the information and symptoms initially given, a wide range of diagnoses are possible. The first that comes to my mind is Strep throat. Streptococcal Pharyngitis will present with low grade fever and sore throat with exudates. Treatment will depend on whether it is viral or bacterial. Mononucleosis was another potential diagnosis. Infectious Mononucleosis will also present with a low grade fever and pharyngitis, and is usually transmitted through saliva. Given Caitlyn’s mom’s suspicions of her sexual promiscuity this could very likely be the problem. Due to that fact of concern, I also considered various sexually

Asthma is described as a chronic lung disease that makes it difficult to breathe due to the inflammation and narrowing of the airways. This is the most common chronic respiratory disease among children in the United States and is the leading cause of childhood hospitalization due to disease, as well as causing high rates of school absences. Many have wondered what could potentially create a greater risk factor in regards to children obtaining this disease.

1. Father is violating the Court Order from 03/16/2015: “Father shall administer any medication prescribed for Adrianna. Failure to do so shall result in cancellation of his parenting time.”

I suspect he has pertussis and the first-line treatment for pertussis is azithromycin (Kline, Lewis, Smith, Tracy, & Moerschel, 2013). Patient tend to be more adherent to azithromycin due to course of treatment being 3-5 days and daily dosing (Jordan, Turner, & Woo, 2016; Kline, Lewis, Smith, Tracy, & Moerschel, 2013).

SL, a 4-month-old Caucasian male, accompanied by his 24-year-old mother presented to the ER nurse at the local emergency department. SL’s mother reported he has had a fever, runny nose, coughing, and often wheezing during the past 4 days. With a colicky infant, she noticed a blue color to the skin, and relatively high fever developed during the night prompted her to bring him to the emergency department. SL’s mother stated when he breathes, he sounds funny, which is also accompanied by a barking cough. She has not even given any other thought but that he had developed a simple cold, because he has been exposed to other sick children at his daycare. Once the ER nurse evaluated SL, he had received a referral to a pediatric nurse at Children’s Hospital a few blocks away for further and immediate evaluation in Newborn Intensive Care Unit (NICU).