Asthma Case Study Essay Paper

Asthma Case Study Essay Paper

 Introduction

Respiratory tract infections are common in the pediatric population owing to their weak immune systems. The incidence of these infections, like pneumonia, increases greatly in children with an ongoing health condition such as asthma. This is because asthma damages the lung tissue and weakens the immune system, making it easier for infections like pneumonia to set in. In this paper, the author discusses the diagnosis of a patient’s case study and gives appropriate plan of care by answering the case questions provided Asthma Case Study Essay Paper.

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 Diagnosis and Pathophysiology

From the case study, the patient is a 13-year-old boy with a history of productive cough, chest and nasal congestion, and intermittent chills for seven days. The symptoms first started as mild nasal congestion, runny nose, and sore throat, which got worse with time. He now presents with greenish-yellow sputum, mild headache, and chills. Over-the-counter medications have not relieved his symptoms. He is also a known asthmatic, and the mother reports that his asthma has worsened the past two months, which requires him to use his inhaler more often.

Diagnosis-Bacterial pneumonia: Pneumonia clinically presents with fever, chills, chest pains, tachycardia, and tachypnea. It also presents with a productive cough with a green or yellow sputum. The patient presented with the listed symptoms and his examination revealed a respiratory rate of 22 (increased) and a heart rate of 110, which is also increased and a high temperature at 101.3 F. These could indicate an infectious process. Pneumonia infection causes an increase in white blood cell count, including neutrophils and lymphocytes. The patient’s laboratory results for complete blood count with differentials revealed elevated total white blood cell count and neutrophils at 12000 and 8500 respectively. These are typical with pneumonia. A chest radiograph also revealed left upper lobe lung consolidation. Lobar consolidation is common in infections like pneumonia. Although streptococcal pneumonia affects all age groups, it is more common in extremes of age or those with underlying medical conditions like asthma and COPD, as was the case for this patient Asthma Case Study Essay Paper.

Pneumonia pathophysiology- the infections begins with inhalation of the causative organism such as streptococcus pneumonia via the respiratory system. Once the bacteria invade the host oropharynx and nasopharynx, both immune and non-immune mechanisms are activated to clear the infectious microorganism (Jain et al., 2021). The pathogenicity of Streptococcus pneumonia includes a capsule, which helps in evading phagocytosis and its ability to adhere to the respiratory epithelium for invasion.

The non-immune includes anatomical features such as airway structures and reflexes, muco-ciliary clearance, and secretion of substances like lysozymes. These substances are the first defense mechanism that enables opsonization of the microbes by macrophages. When these fail, the immune defenses, which include macrophages, neutrophils, lymphocytes, and eosinophils, are activated.

The resultant effect is inflammation of the alveoli and terminal airspaces from immune activation. This inflammatory cascade begins with release of inflammatory cytokines and subsequent migration of phagocytes to the site of infection. This triggers the leakage of plasma and loss of surfactant resulting in air loss and consolidation (Jain et al., 2021)Asthma Case Study Essay Paper. This inflammatory cascade can directly injure the lung tissues and alter the endothelial integrity, vasomotor tone, and intravascular hemostasis. This results in an increase in mucus secretion and airway smooth muscle tone. This causes airway obstruction and symptoms of respiratory distress ensue.

In bacterial infection, it occurs in four stages: (Jain et al., 2021).

1. Congestion phase- This is characterized by protein filled exudates, which fill the alveoli.
2. Red hepatization phase- Associated with the presence of erythrocytes in the cellular exudate. It is also characterized by neutrophil influx and presence of bacteria in the specimen. This leads to symptoms such as productive cough, headache, fever, and chills.

• Gray hepatization- During this stage, the red blood cells are lysed and are degraded. This gives the lung a grayish color. Neutrophils remain and fibrin deposition takes place.

1. Resolution- the macrophages reappear and the debris including the polymorph nuclear cells, bacteria, and fibrin are cleared. The inflammatory response is cleared Asthma Case Study Essay Paper

Differential Diagnoses

1. Acute Bronchitis – Bronchitis refers to the inflammation of lung bronchi. It is often caused by a viral infection but may also be a bacterial infection or triggers like allergens. It typically presents after a cold or throat infection. Children with conditions such as asthma and allergies are at a higher risk for acute bronchitis (Hedayat et al., 2020). Symptoms may include a runny nose before cough starts, chest congestion, chills, wheezing or sore throat like this patient had.
   

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Thorough history taking and physical examination helps make a diagnosis. Other studies like chest radiograph are done to rule out other issues like pneumonia.

2. Status asthmaticus– The patient has asthma and has been using inhaler to control the symptoms. Status asthmaticus is a bad form of an acute asthma attack that does not respond to regular treatment. It may present with wheezing, trouble sleeping due to shortness of breath and coughing (Chakraborty & Basnet, 2021)Asthma Case Study Essay Paper. The cough and wheezes can be worsened by infections such as a cold. The patient’s mother reports that he has been wheezing more in the past two months and that he requires his inhaler more than usual. He has also been having nighttime cough and wheezing about two times a week. Prior to the onset of these symptoms, the patient had a sore throat, which could indicate an upper respiratory tract infection, leading to status asthmaticus.
3. Allergic reaction- From the medical history, the patient has a past medical history of allergic rhinitis and contact dermatitis. One other possible explanation for his acute presentation could be an allergic reaction. Allergic reactions could present with nasal stuffiness, difficulty breathing, throat tightness, and wheezing or cough (Dougherty et al., 2021).

Plan of Care

1. Pharmacological Care

The pharmacological therapy for bacterial pneumonia and the dosages depend on the etiologic agents, patient’s age, history of exposure, history of drug resistance and the clinical presentations. Oral antibiotic agents are used empirically to target the most likely organism. The first line of treatment is high-dose amoxicillin for suspected community acquired pneumonia. Second or third generation cephalosporins or macrolides like azithromycin can also be used (Pahal et al., 2021). Blood culture is then retrieved to narrow down the therapeutic agents to the causative organism.

Acetaminophen can be given to manage fever and cough medications as well. The efficacy of treatment is determined by the clinical improvement, respiratory support requirement, and radiographic results. Hospitalization is only done in cases of severe pneumonia. Inhaled beta 2 agonists are used in management of acute asthma exacerbation. Oxygen therapy is indicated for respiratory distress. Asthma Case Study Essay Paper

1. Education

Preventive strategies involved educating the parents on pneumonia preventive measures. The patient is already up to date on all his vaccinations. Other measures to prevent pneumonia include adequate nutrition to boost immunity, addressing the environmental factors such as avoiding indoor pollution by cessation of smoking and avoiding known allergens (WHO, 2019). Proper hand hygiene should be encouraged to prevent bacterial infections causing pneumonia.

Patient with other underlying conditions such as asthma and COPD should attain proper control of the disease to have a more stable immune system that can fight off infections. Patients should drink plenty of fluids to keep hydrated and help thin the mucus in their lungs for clearance.

1. Referral and other diagnostic tests

In children who have an underlying condition such as asthma, specialists should be consulted in their management. Other diagnostic tests to do could include blood cultures to confirm the specific causative organism (Pahal et al., 2021). Pulse oximetry should be done to assess oxygenation levels to evaluate need for oxygen therapy.  Refer the patient to an allergist for skin testing to offer guidance of allergen control (WHO, 2019)Asthma Case Study Essay Paper.

Since the patient’s mother reports that his asthma was previously well controlled using his albuterol inhaler, we can say that his asthma exacerbation and lack of response to his usual mediation was because of the respiratory tract infection. Treatment of the infection should offer relief and enable him to manage his asthma. He should consult his specialist physician

References

Chakraborty, R. K., & Basnet S. (2021). Status Asthmaticus. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK526070/

Dougherty, J. M., Alsayouri K., & Sadowski A. (2021). Allergy. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK545237/

Hedayat, K. M., Lapraz, J., & Schuff, B. (2020). Acute bronchitis, wet cough. The Theory of Endobiogeny, 145-149. https://doi.org/10.1016/b978-0-12-816965-0.00019-6

Jain V., Vashisht R., Yilmaz G., & Bhardwaj A. (2021). Pneumonia Pathology. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK526116/

Pahal P., Rajasurya V., & Sharma S. (2021). Typical Bacterial Pneumonia. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK534295/

Pneumonia. (2019, August 2). WHO | World Health Organization. https://www.who.int/news-room/fact-sheets/detail/pneumonia Asthma Case Study Essay Paper

John is a 13 yr old male who presents to your clinic accompanied by his mother with complaint of productive cough, chest and nasal congestion and intermittent chills x 7 days. He reports symptoms initially started with mild nasal congestion, clear runny nose and sorethroat, but got worse the past few days. He now has chest congestion, productive cough with greenish-yellow sputum, chills, and mild headache x 2 days. OTC meds for cold have not helped. He denies any known sick contact.
Mother further reports she noticed John has been wheezing more the past 2 months. He used to use his albuterol inhaler about once a month but now uses it 3-4 times a week. Both John and his mom reported nighttime dry cough and wheezing which occurs about 1-2 times a week
Past Medical History: Asthma, Allergic rhinitis, Atopic dermatitis
Medication History: Albuterol HFA prn, Zyrtec 10mg QD, Tylenol 500mg -1tab prn for headache and chills.
Family Medical History: Father: HTN; Mom: healthy. 3 siblings-all healthy
Drug Allergy: NKDA
Social History: Denies alcohol or cigarette use. Denies illicit drug use. Occupation: Student. Asthma Case Study Essay Paper
Vaccination: Up to date

Physical Exam
Gen: Slightly lethargic, otherwise in no acute distress
V/S: BP: 124/72, HR: 110, T: 101.3(oral), RR: 22, wt: 132lbs, Ht: 66inches
HEENT: Nasal mucosa erythematous, mild nasal congestion, tonsils and pharynx normal, slight postnasal drainage, light green nasal discharge.
CV: Normal S1& S2, rhythm regular
Resp: regular. Mild expiratory wheezing bilaterally to auscultation. No use of accessory muscles. 02 saturation: 95%
Abd: Soft, non-distended, non-tender, bowel sounds + and normal x 4 quadrants, no masses palpated.
Neuro/Psych: alert and oriented X 3. CN II-XII grossly intact. Good eye contact, speech clear and goal oriented. Affect normal.
Skin: Normal, no lesions.
Diagnostic Tests: In-house: CBC with diff and CXR
Labs/X-ray
L.C’s values
WBCs
12,000
Neutrophil
8,500
Lymphocyte
4,500
Platelet
190, 000
Hemoglobin
14
HCT
38%
CXR Result
Consolidation in left upper lobe

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Case Questions:
1. What is/are the diagnoses: Support with literature evidence and interpretation of data presented in the case study. Discuss the pathophysiology of the selected diagnosis.
2. Present and briefly discuss(rationale) 3 differential diagnoses for this patient.
3. Discuss plan of care for this patient-pharmacological, education, referral, and need for further diagnostic testing if any. Your thoughts about his asthma?.
4. Support plan of care/intervention with literature evidence. Asthma Case Study Essay Paper