Diagnosis and Management

Case study 1; Treatment and Management

The case is about a 14-month child with a respiratory issue. To begin with, additional information may be required for the diagnosis. For instance, the questions that could be asked are; was he unable to eat completely in the morning? And did the child drink anything? Besides, because the case did not address all of the LOCATES mnemonics, some questions that could be asked are; has he shown any reaction to perfumes, dust or anything that could trigger an allergy? More to this, additional history required would be current medications, has the child been around any sick person and any possible allergic reactions treated or noticed before (Jha et al., 2016). In regards to this, no additional examination required but a key tool needed is oxygen saturation. Key diagnostic testing required are X-ray to rule out the possibility of pneumonia, and both flu and RSV swab.

Differential Diagnosis

In regards to the examination, the boy is likely to have Bronchiolitis. It is the most common lung infection in infants and young children. It results in inflammation and congestion in small airways of the lung. It is always brought by a virus and usually start with symptoms that are similar to those of a common cold but then advances to coughing, wheezing and sometimes a breathing problem which is being displayed by the child under examination (Ralston et al. 2014). However, even with the issues raised, most children get better with adequate care from home. Normally, a small percentage of children needs hospitalization especially in severe condition.

Another possible diagnosis to consider

A reactive airway disease could be diagnosed in this case. In children, it is a common term that does not show a particular diagnosis. It can be used to describe a history of wheezing, coughing, and shortness of breath due to an infection (Frongia et al., 2015). These signs may or may not be as a result of asthma which consists of coughing, wheezing and problem in breathing. The reactive airway disease (RAD) is normally caused by a trigger, but since there is no exposure in the scenario, the overall child assessment and physical examination matches better with bronchiolitis diagnosis.

Treatment

The treatment for the child would include Albuterol nebulizer to help in opening the airways together with supportive care such as saline drops with suctioning to the nose, adequate rest and fluids to prevent dehydration (Ralston et al. 2014). The impact of Β-agonist is more effective compared to normal saline drops (Baron and El-Chaar, 2016). Since dehydration is an issue in this case because the child is always struggling to breathe, they too weak to eat (Zorc & Hall, 2010). Thus, in most cases, IV fluid is key in cases where the child does not eat or drink. However, based on the child’s oxygen saturation status, if it becomes threatening, the child will be hospitalized but, if the saturation is within the normal limits after medication in the office, the situation can be managed at home. In allows to go home, I would see the child the following day for assessment.

Education and immunization

In the prevention of RSV, it important to wash hands constantly as well as avoid contact with other people who might be sick. The objects like toys that are regularly touched should be cleaned with disinfectants. Moreover, a possible social-economic factor that can affect the child is parents’ financial inadequacy to afford medication. In regards to immunization, the child should be given two doses from Hepatitis B-series. The next visit would be in a month time.

References

Baron, J., & El-Chaar, G. (2016). Hypertonic saline for the treatment of bronchiolitis in infants and young children: a critical review of the literature. The Journal of Pediatric Pharmacology and Therapeutics, 21(1), 7-26.

Frongia, G., Ahrens, P., Capobianco, I., Kössler-Ebs, J., Stroh, T., Fritsche, R., … & Holland-Cunz, S. (2015). Long-term effects of fundoplication in children with chronic airway diseases. Journal of pediatric surgery, 50(1), 206-210.

Jha, D. A., Jarvis, H., Fraser, C., & Openshaw, P. J. (2016). Respiratory syncytial virus. European Respiratory Society.

Ralston, S. L., Lieberthal, A. S., Meissner, H. C., Alverson, B. K., Baley, J. E., Gadomski, A. M., … & Phelan, K. J. (2014). Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics, 134(5), e1474-e1502.

Ruuskanen, O., Lahti, E., Jennings, L. C., & Murdoch, D. R. (2011). Viral pneumonia. The Lancet, 377(9773), 1264-1275.

Zorc, J. J., & Hall, C. B. (2010). Bronchiolitis: recent evidence on diagnosis and management. Pediatrics, 125(2), 342-349.