NURS 6512 Assignment 2: Digital Clinical Experience: Focused Exam: Cough
NURS 6512 Assignment 2: Digital Clinical Experience: Focused Exam: Cough
NURS 6512 Assignment 2: Digital Clinical Experience: Focused Exam: Cough
Patient Particulars
Name: Danny Rivera
Age: 8years
Gender: male
Subjective Data
Chief Complaint: coughing for five days
History of Present Illness (HPI): Danny Rivera is an 8 years old male who reports having a productive cough. The cough is of acute onset, work triggers the cough, and it is worse at night such that it keeps him awake. The cough is gurgly and watery associated with fatigue, pain in the right ear, running nose, and throat soreness. However, he denies fever, headache, dysphagia, nosebleed, phlegm, sputum, chest pain, trouble breathing, and abdominal pain.
Medications: over the counter drugs to relieve sore throat
Allergies: the patient is allergic to fur, cold air, dust, and smoke. He develops hives after coming into contact with fur. However, he denies food and drug allergies.
Past Medical History (PMH): the patient had an ear infection and pneumonia in the past. He denies hospital admission and blood transfusion.
Past Surgical History (PSH): he denies major and minor surgical procedures
Personal/Social History: the child is in grade two. He performs exemplary well in his classwork and extra-curricular activities. He relates well with his teachers, parents, siblings, and playmates. The child enjoys reading and playing soccer.
Immunization History: the child’s immunization schedule is up to date. His last tetanus vaccine was six months ago. He is due for the influenza vaccine in two months.
Family History: The patient is the firstborn in his family. He has a younger sister who is two years old. His parents
NURS 6512 Assignment 2 Digital Clinical Experience Focused Exam Cough
are alive. His 34 years old father has asthma and diabetes. His mother is healthy and takes care of the family. His 60years old paternal grandfather is asthmatic. His paternal grandmother has had COPD for five years due to tobacco use. His maternal grandparents are alive and healthy. There is no history of cancer, mental health illnesses, kidney disease, and heart disease.
Review of Systems
General: the child denies weight loss, night sweats, and fever
HEENT: The patient denies headache and dizziness. He reports tearing and itchiness of the eyes. However, he denies blurring of vision, hearing problems, and painful ears.
Respiratory: the patient has a productive cough. However, he denies chest pain, wheezing, fast breathing, sputum production, and hemoptysis.
Cardiovascular/Peripheral Vascular: the patient denies dyspnea, syncope, lower limb swelling, orthopnea, and paroxysmal nocturnal dyspnea.
Psychiatric: the child denies hallucinations, suicidal ideation, sadness, hopelessness, and insomnia.
Neurological: the child denies numbness, paralysis, facial droop, and tingling sensation.
Lymphatics: the patient denies swollen arms and legs, recurring infections, skin fibrosis, and lymph nodes.
Objective Data
Vital signs: temperature is at 37.8 degrees Celsius, blood pressure at 98/68mmHg, the pulse rate at 88beats per minute, pulse oximetry at 98%, and respiratory rate at 36 breaths per minute.
General: the patient has a healthy body weight and height for his age. He is well-kempt, alert, and oriented. He is sitting on the bench calmly through coughing constantly. He appears to be fatigued but stable.
HEENT: the patient has moist mucus membranes. He has swollen, dull, and watery eyes with pink conjunctiva. The patient has a clear nasal discharge with Redness and cobblestoning in the back of the throat. The Right Tympanic membrane is red inflamed. Right cervical lymph node enlarged with reported tenderness.
Respiratory: the patient has an increased respiratory rate with no acute respiratory distress. The chest expansion is symmetrical with no swelling and scar. There is a resonant percussion note with clear breath sounds are to auscultation. There is a negative bronchophony.
Cardiology: the heart is at the 5th ICS MCL. They hear sounds S1 S2 are present. There are no murmurs, gallops, or rubs.
Lymphatics: the patient does not have lower limb edema, erythema, splenomegaly, and red streaks.
Psychiatric: the patient is calm and oriented to time, place, and person. His speech is steady with a soft tone and volume. His thought process s congruent and future-oriented. His judgment and insight are intact. He has no hallucinations, paranoid behavior, and suicidal ideation.
Diagnostics tests
- Total serum IgE helps rule out allergic rhinitis
- Allergy skin test
- Total blood eosinophil count supports the diagnosis of allergic rhinitis when it is high
- A 3-view sinus series radiograph evaluates sinusitis and adenoid hypertrophy
- Coronal CT scan imaging evaluates acute and chronic sinusitis (these are complications of rhinitis).
Assessment
The patient presents with cough, running nose, fatigue, pain in the right ear, and throat soreness. He is allergic to fur, cold air, dust, and pollen. He has a positive family history of asthma. Upon examination, the patient has moist mucus membranes, clear nasal discharge, redness of the throat, dull eyes with pink conjunctiva, right cervical lymph node, and inflamed right tympanic membrane. The most probable diagnoses are allergic rhinitis, common cold, and Strep throat.
Differential diagnoses
Allergic rhinitis is the inflammation of the nasal membranes characterized by sneezing, coughing, itching ears, nose, and eyes, congestion, postnasal drip, fatigue, drowsiness, and rhinorrhea (Zhang, et al, 2021). The prevalence of allergic rhinitis is 7% in younger children less than 18years old. The patient has allergic rhinitis because the trigger is cold air at night in addition, he presents with sleep disturbance due to worsening cough at night. He has otitis media, conjunctivitis, fatigue, palatal abnormalities, and thin watery nasal secretions.
The common cold is an upper respiratory tract infection caused by rhinoviruses. It presents with a sore throat, nasal discharge, congestion, coughing, low-grade fever, hoarseness of the voice, and running nose (Czubak, et al, 2021). Its transmission occurs when there is close exposure to infected respiratory secretions, through the nose, mouth, eyes, and skin. It is more prevalent in school-going children. However, this is not the actual diagnosis because the patient has moist mucus membranes, clear nasal discharge, redness of the throat, dull eyes with pink conjunctiva, right cervical lymph node, and inflamed right tympanic membrane. In common cold, the patient presents with non-tender cervical lymph nodes and rhonchi upon auscultation. There is no obvious erythema edema of the airway.
Strep throat is the inflammation of the throat and the tonsil caused by group A streptococcus. Clinical presentations of strep throat are fever, red swollen tonsils, throat pain, cervical lymph nodes, headache, abdominal pain, malaise, and headache (Alkahlout, et al, 2021). A viral throat infection presents with coughing, running nose, hoarse voice, and conjunctivitis. This is not the actual diagnosis because the patient denies fever, white patches on the throat, and abdominal pain.
References
Alkahlout, M. A., Abujamie, T. N., & Abu-Naser, S. S. (2021). Throat Problems Expert System Using SL5. International Journal of Academic Information Systems Research (IJAISR), 5(5).
Czubak, J., Stolarczyk, K., Orzeł, A., Frączek, M., & Zatoński, T. (2021). Comparison of the clinical differences between COVID-19, SARS, influenza, and the common cold: A systematic literature review. Advances in Clinical and Experimental Medicine, 30(1), 109-114.
Zhang, Y., Lan, F., & Zhang, L. (2021). Advances and highlights in allergic rhinitis. Allergy, 76(11), 3383-3389.
Danny’s priority diagnosis is common cold. Common cold is a term used to refer to mild upper respiratory illness. The disease has viral origin. It is self-limiting disease that mainly affects the upper respiratory tract. In severe cases, patients may develop spread of the viral infection to other organs and complications such as those caused by the bacteria. Patients affected by common cold present the hospital with complaints that include sneezing, nasal discharge and stuffiness, sore throat, cough, and fatigue. The additional symptoms that patients may exhibit include hoarseness, headache, lethargy, and myalgia. The symptoms often last between 1 and 7 days with them peaking within 2-3 days of the infection (Ibrahim et al., 2021; Montesinos-Guevara et al., 2022; Wilson & Wilson, 2021). Danny has present with symptoms that align with those of common cold. For example, he complains of cough, sore throat, and running nose for the last three days, hence, common cold being his primary diagnosis.
Danny’s secondary diagnosis is rhinosinusitis. Rhinosinusitis is a disorder characterized by the inflammation of the nasal cavities and passages. Patients develop this condition following their exposure to potential causes such as smoke, lowered immunity, and asthma. Patients often report symptoms such as nasal congestion, toothache, loss of smell, halitosis, postnasal drip, and runny nose (Chandy et al., 2019; Utkurovna et al., 2022). Danny is frequently exposed to tobacco smoke, which may have led to the development of rhinosinusitis. However, the absence of additional symptoms such as postnasal drip, toothache, loss of smell, and sinus pain or pressure, makes rhinosinusitis the least likely cause of his problem.
The last differential diagnosis that should be considered for the patient is whooping cough or pertussis. Pertussis is a disorder of the upper respiratory system that is characterized by severe hacking cough accompanied by whooping breath sounds. The disease is highly contagious and requires immediate patient isolation to prevent its spread in the population. The symptoms associated with whooping cough include cough, fever, red, watery eyes, nasal congestion, and runny nose. The affected populations are increasingly predisposed to complications such as pneumonia, seizures, brain damage, and dehydration (Zhang et al., 2020). However, pertussis is Danny’s least likely diagnosis because of the lack of hacking, whooping cough and red, watery eyes.
References
Chandy, Z., Ference, E., & Lee, J. T. (2019). Clinical Guidelines on Chronic Rhinosinusitis in Children. Current Allergy and Asthma Reports, 19(2), 14. https://doi.org/10.1007/s11882-019-0845-7
Ibrahim, A. E., Elmaaty, A. A., & El-Sayed, H. M. (2021). Determination of six drugs used for treatment of common cold by micellar liquid chromatography. Analytical and Bioanalytical Chemistry, 413(20), 5051–5065. https://doi.org/10.1007/s00216-021-03469-3
Montesinos-Guevara, C., Buitrago-Garcia, D., Felix, M. L., Guerra, C. V., Hidalgo, R., Martinez-Zapata, M. J., & Simancas-Racines, D. (2022). Vaccines for the common cold. Cochrane Database of Systematic Reviews, 12. https://doi.org/10.1002/14651858.CD002190.pub6
Utkurovna, S. G., Farkhodovna, S. Z., &Furkatjonovna, B. P. (2022). OPTIMIZATION OF THE TREATMENT OF ACUTE RHINOSINUSITIS IN CHILDREN. Web of Scientist: International Scientific Research Journal, 3(3), Article 3. https://doi.org/10.17605/OSF.IO/GYBM7
Wilson, M., & Wilson, P. J. K. (2021). The Common Cold. In M. Wilson & P. J. K. Wilson (Eds.), Close Encounters of the Microbial Kind: Everything You Need to Know About Common Infections (pp. 159–173). Springer International Publishing. https://doi.org/10.1007/978-3-030-56978-5_10
Zhang, J.-S., Wang, H.-M., Yao, K.-H., Liu, Y., Lei, Y.-L., Deng, J.-K., & Yang, Y.-H. (2020). Clinical characteristics, molecular epidemiology and antimicrobial susceptibility of pertussis among children in southern China. World Journal of Pediatrics, 16(2), 185–192. https://doi.org/10.1007/s12519-019-00308-5