Diagnosis and management of respiratory disorders

Write 2 pages on
1) An explanation of these three differential diagnosis for the patient in the case study.
(Asthma exacerbation, bronchiolitis, and laryngeal foreign body aspiration).
2) Explain which is the most likely diagnosis for the patient and why. (asthma
exacerbation) Include an explanation of unique characteristics of this disorder you
identified as the primary diagnosis.
3) Then, explain a treatment and management plan for the patient with asthmatic
exacerbation including appropriate dosages for any recommended treatments.
4) Finally, explain strategies for educating patients and families on the treatment and
management for asthma exacerbation.

Diagnosis and management of respiratory disorders

Asthma is the commonest respiratory disorder for kids. For Brian, the 14-year-old
patient in the case study, three differential diagnoses for him are asthma exacerbation,
bronchiolitis, and laryngeal foreign body aspiration. Asthma exacerbation: the major
symptoms of this condition include coughing, a tight chest, shortness of breath, and wheezing
(Keeney et al., 2014). Bronchiolitis: this is a common disease of the respiratory tract and is
brought about by an infection which affects bronchioles – minuscule airways – which lead to

DIAGNOSIS AND MANAGEMENT OF RESPIRATORY DISORDERS 2
the lungs. Bronchiolitis usually happens in the initial two years of life. Symptoms include
being irritable, short pauses in breathing, persistent dry cough and rasping, wheezing, and
vomiting after feeding (Burns et al., 2013). Laryngeal foreign body aspiration: kids who
aspirate a foreign body at first usually present chocking and afterwards exhibit symptoms of
respiratory syndrome. This condition is regarded as a differential diagnosis for asthma.
Symptoms include gasping, coughing, chocking, and respiratory distress (Burns et al., 2013).
Of the three, asthma exacerbation is the most likely diagnosis for this patient. This is
because the symptoms exhibited by the patient match with those of asthma exacerbations. In
the case study, Brian has a 2-day history of worsening cough as well as shortness of breath.
He woke up today with a persistent cough and he also has wheezes. All these symptoms –
breathing faster, wheezing, persistent coughing, shortness of breath – are clear indications of
asthma exacerbations (Mold et al., 2014). For the patient with asthmatic exacerbation, a
treatment and management plan includes the following:

Management of children aged above 12 years and adults
Medication Dosage Description

Pharmacological
intervention Short-acting
beta 2 agonists

 An inhaled, short-acting beta-2
agonist
 Use 2 or more canisters of beta 2
agonists every months or 10-12
puffs daily

Short-acting beta 2 agonists
usually work very fast and offer
symptomatic relief (Keeney et
al., 2014)

Inhaled
corticosteroids

 Optimal dosages are 80 mg or
less daily of
methylprednisolone or 400 mg
or less daily of hydrocortisone

Inhaled corticosteroids should be
taken regularly where: symptoms
disturb sleep every week, Beta 2
agonists are being utilized over 2
times every week, and a kid has
an asthma attack in the past 2
years necessitating systemic
corticosteroids (Mold et al.,
2014)

Intravenous
Salbutamol
MDI with
spacer

 5 mg in 2 ml of normal saline
every 20 minutes in the first
hour

Patients who receive intravenous
salbutamol have to be in a setting
in which there is continuous
cardiac monitoring (Burns et al.,
2013)

Non-  Avoid exposure to cigarette/tobacco smoke

DIAGNOSIS AND MANAGEMENT OF RESPIRATORY DISORDERS 3

pharmacological
intervention

 Allergen immunotherapy should be considered for patients whose asthma symptoms
are clearly connected to exposure to allergens (National Heart, Lung, and Blood
Institute, 2007).
It is worth mentioning that managing and treating asthma in children entails an
appreciation of the existing treatment practice and a readiness to support and educate the
asthmatic children and their close relatives in the longer-term. The strategies for educating
patients and families on the treatment and management of asthma exacerbation entail
providing smoking cessation advice to the child and caregivers/family members. This is
important since passive or direct smoking decreases lung function and raises the need for
rescue medication as well as long-term preventer treatment (Burns et al., 2013). Allergen
avoidance should be included in the education: the patient may be allergic to pets and/or
house dust mite. There could be pet allergy and it is sensible not to have a dog or a cat in the
house since domestic pets may trigger an asthma attack. Physical and chemical techniques of
house dust mite avoidance may trigger asthma exacerbations and should be avoided (Mold et
al., 2014). Other trigger avoidance suggestions for the family include removal of soft toys
from the bed, removal of carpets, washing of bed linen using high-temperature, improve
ventilation, and using total bed-covering barrier systems. Education also includes
encouraging adherence to asthma action plan to control asthma daily.

DIAGNOSIS AND MANAGEMENT OF RESPIRATORY DISORDERS 4

References

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Chapter 31,
“Respiratory Disorders”. Pediatric primary care (5th ed.). Philadelphia, PA:
Elsevier.
Keeney, G.E., Gray, M.P., Morrison, A.K., Levas, M.N., Kessler, E.A., Hill, G.D., Gorelick,
M.H., & Jackson J.L. (2014). Dexamethasone for Acute Asthma Exacerbations in
Children: A Meta-analysis. Pediatrics, 133(3): 493–499.
Mold, J.W., Fox, C., Wisniewski, A., Lipman, P.D., Krauss, M.R., Harris, D.R., Aspy, C.,
Cohen, R.A., Elward, K., Frame, P., Yawn, B.P., Solberg, L.I., & Gonin, R. (2014).

DIAGNOSIS AND MANAGEMENT OF RESPIRATORY DISORDERS 5
Implementing asthma guidelines using practice facilitation and local learning
collaboratives: a randomized controlled trial. Annals of family Medicine, 12(3), 233-
240
National Heart, Lung, and Blood Institute. (2007). Expert panel report 3 (EPR3): Guidelines
for the diagnosis and management of asthma.

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