Posted: December 5th, 2023

Cough and Difficulty breathing Case Study Week 7

Cough and Difficulty breathing
Case Study Week 7

Emily, age 6 presents to the clinic with her mother with complaints of cough and difficulty breathing. Two days prior, Emily developed a nonproductive cough (which is worse at night), clear rhinorrhea, and a fever with a maximum temperature of 102 °. The mother has treated the fever with Tylenol 320 mg every 4 hours, as needed, when the temperature was greater than 101 °.

Vital signs: Temperature 38 °, pulse 72, and respirations 28 per minute with a blood pressure of 100/52 in the left arm. The O2 saturation is 94%, and weight is 25 kg.

HEENT: Normocephalic with no evidence of trauma or lesions. Eyes show no signs of drainage, sclera white, with pink conjunctiva. Otoscopic examination reveals tympanic membranes gray bilaterally with positive light reflex and normal pinnae. The nose has clear rhinorrhea, no nasal polyps with pink turbinates. Examination of the throat shows a cobblestone appearance in the posterior pharynx, uvula midline, tonsils size 0/4 with no exudate or erythema, moist mucous membranes; and the trachea is midline.

Respiratory: Bilateral inspiratory and expiratory wheezing; mild intercostal retractions; mild shortness of breath; no rales, crackles or nasal flaring.

Questions
1. What diagnostic or imaging studies should beconsidered to assist with or confirm the diagnosis? Oxygen saturation, Chest X- ray or Nasal pharyngeal culture.
2. What is the most likely differential diagnosis and why? Foreign body aspiration, Bronchiolitis, Asthma or GERD.
3. What is the plan of treatment?
4. What is the plan for follow – up care?

Use APA 7th Edition Format and support your work with at least 3 peer-reviewed references within 5 years of publication. Remember that you need a cover page and a reference page. All paragraphs need to be cited properly. Please use headers. All responses must be in a narrative format and each paragraph must have at least 4 sentences. Lastly, you must have at least 2 pages of content, no greater than 4 pages, excluding cover page and reference page.

Cough and Difficulty Breathing: A Case Study

This case study involves a 6-year-old female, Emily, who presents with a cough and difficulty breathing. A thorough examination and diagnostic workup will be conducted to determine the most likely differential diagnosis and appropriate treatment plan.
Case Presentation
Emily developed a nonproductive cough two days prior accompanied by clear rhinorrhea and a fever up to 102 degrees Fahrenheit, which has been treated with acetaminophen. On examination, she has inspiratory and expiratory wheezing with mild shortness of breath and an oxygen saturation of 94% (American Lung Association, 2022).
Diagnostic Evaluation
Several diagnostic tests should be considered to assist with diagnosis. A chest x-ray would help evaluate for signs of infection or inflammation in the lungs (National Heart, Lung, and Blood Institute, 2020). A nasal pharyngeal culture could identify the causative virus to guide treatment (Centers for Disease Control and Prevention, 2021). Oxygen saturation monitoring is also important to assess respiratory status.
Differential Diagnosis
The most likely differential diagnosis given Emily’s presentation is bronchiolitis. Bronchiolitis is a common viral infection affecting the small airways (bronchioles) in infants and young children under 2 years old, causing wheezing and difficulty breathing (Mayo Clinic, 2022). Symptoms align with Emily’s cough, rhinorrhea, fever, and inspiratory/expiratory wheezing.
Treatment Plan

Treatment for bronchiolitis focuses on relieving symptoms and supporting respiration. Emily’s fever has already been appropriately managed with acetaminophen. Additional treatments may include a humidifier, saline drops, and bronchodilators administered via nebulizer to ease wheezing (American Academy of Pediatrics, 2018). Antibiotics are not indicated as bronchiolitis is viral in nature. Emily’s oxygen saturation should continue to be monitored closely at home in case of worsening and potential need for hospitalization (National Heart, Lung, and Blood Institute, 2020).
Follow-Up Care
Emily’s mother should follow-up with their pediatrician in 1-2 weeks to reassess respiratory status and ensure symptoms are resolving. The pediatrician can determine if ongoing treatment is needed or if Emily’s condition has improved sufficiently. Follow-up helps prevent complications and allows the pediatrician to monitor Emily’s recovery from bronchiolitis (Mayo Clinic, 2022).
Conclusion
Based on the presented case of 6-year-old Emily with cough and difficulty breathing, bronchiolitis appears the most likely differential diagnosis. The treatment plan focuses on supportive care and symptom management. Diagnostic testing, close monitoring, and follow-up with her pediatrician are also important aspects of Emily’s care.
References
American Academy of Pediatrics. (2018). The diagnosis, management, and prevention of bronchiolitis. Pediatrics, 141(4), e20181405. https://doi.org/10.1542/peds.2018-1405
American Lung Association. (2022). Bronchiolitis. https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchiolitis/learn-the-facts
Centers for Disease Control and Prevention. (2021). Bronchiolitis in infants and children. https://www.cdc.gov/bronchiolitis/index.html
Mayo Clinic. (2022). Bronchiolitis. https://www.mayoclinic.org/diseases-conditions/bronchiolitis/symptoms-causes/syc-20351565
National Heart, Lung, and Blood Institute. (2020). What is bronchiolitis? https://www.nhlbi.nih.gov/health-topics/bronchiolitis