HPI: A 14-month-old Native American boy brought in by his mom due to cough, low grade fever and runny nose for the past 2 days. This morning, the mother noted that her son was breathing quickly and “it sounds like he has rice cereal popping in his throat.” Mom is worried because her son seems to have a lot of “bouts of colds”. Per mom, his oral intake is decreased. He didn’t want to eat this morning.
Physical Exam: Smiling, alert Native American boy.
Vital Signs: Temp of 99.9, pulse 112, respiratory rate is 58, Pulse ox 96%
HEENT: There is moderate, thick, clear rhinorrhea and postnasal drip.
Cardiovascular: His capillary refill is less than 3 seconds
Pulmonary: lung sounds are diminished in the bases, he has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields.
Analyze the patient information.
Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.
Post an analysis of your assigned case by using the following:
- What additional questions will you ask?
- Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds, and so forth that might be pertinent in arriving to your differential diagnoses)
- What additional examinations or diagnostic tests, if any will you conduct?
- What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials.
- What is your most likely diagnosis and why?
- How will you treat this child?
- Provide medication treatment and symptomatic care.
- Provide correct medication dosage. Use the knowledge you learned from this week's and previous weeks' readings as well as what you have learned from pharmacology to help you with this area.
- Patient Education, Health Promotion & Anticipatory guidance:
- Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
- Include any socio-cultural barriers that might impact the treatment and management plans.
- Health Promotion:
- What immunizations should this child have had?
- Based on the child’s age, when is the next well visit?
- At the next well visit, what are the next set of immunizations?
- What additional anticipatory guidance should be provided today?
Explanation & Answer
Running Head: DIAGNOSIS AND MANAGEMENT OF HEENT DISORDER
Diagnosis and Management of HEENT Disorder – Case Study
DIAGNOSIS AND MANAGEMENT OF HEENT DISORDER
The 14-month old Native American boy is showing signs of diagnosis and history of
asthma disorder which has led to the low-grade fever, cough, and running nose for the past 2
days. The exacerbate condition of quick breathing that produces a sound of a cereal popping in
his throat is causing bouts of cold that have reduced eating capabilities. From the physical
examination, the boy is alert and smiling with a temperature of 99.9, a pulse of 112, Pulse ox of
96%, and a respiratory rate of 58.
The HEENT symptoms include thick, moderate, clear rhinorrhea accompanied with a
postnasal drip. The cardiovascular symptoms include a capillary refill of fewer than 3 seconds.
The pulmonary symptoms show diminished lung sounds in the bases and he is showing signs of
pronounces subcostal and intercostal reactions. All lung fields produce are expiratory wheezes.
Since the case has not fully addressed the LOCATES mnemonic, the additional questions to ask
include the duration which the conditions presented by the child has lasted, the treatment
previously had, and any form of aggravates that the child has had before
Based on the patient information provided above, the most probable primary diagnosis is foreign
body aspiration. Therefore, the differential diagnosis will be done to rule out other conditions
that bear close similarity in the signs as a symptom of asthma as follows:
Exposure to Toxic Substance
According to Burns, Dunn, Brady, et al.,( 2017), the boy may have been exposed to
common toxic substances which have led to the asthma symptoms. Toxic substances such as
smoke may cause rapid changes in the child's temperature gradients and barometric pressure
while the exposure to paint fumes and air pollutants may cause asthma exacerbation. The child
DIAGNOSIS AND MANAGEMENT OF HEENT DISORDER
showed signs of thick, moderate, clear rhinorrhea accompanied with a postnasal drip which may
be attributed to the exposure to irritants and toxic substances, making it a primary diagnosis.
However, since the patient showed pulmonary symptoms of diminished lung sounds in
the bases, pronounced subcostal, and intercostal reactions, and decreased bre...