Diagnosis And Management Of Respiratory, Cardiovascular, And Genetic Disorders

Case Study 2:
Brian is a 14-year-old known asthmatic with a 2-day history of worsening cough and shortness of breath. He reports using a short-acting beta agonist every 3 hours over the previous 24 hours. He has a long-acting inhaled corticosteroid, but the prescription ran out, and he forgot to refill it. He says he came today because he woke up at 2 a.m. coughing and couldn’t stop, thus preventing him from going back to sleep. Over-the-counter cough suppressants don’t help. He denies cigarette smoking, but his clothing smells like smoke. His respiratory rate is 18 and he has prolonged expiration and expiratory wheezes in all lung fields. There are no signs of dyspnea. All other exam findings are normal.

 

 

 

Diagnosis and Management of Respiratory, Cardiovascular, and Genetic Disorders

 

 

 

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Diagnosis and Management of Respiratory, Cardiovascular, and Genetic Disorders

Respiratory, cardiovascular, and genetic infirmities extensively affect death and disability globally. Diagnosis and management of respiratory, cardiovascular, and genetic maladies are crucial aspects of healthcare, requiring diligent attention and skills. These infirmities can profoundly influence an individual’s quality of life and overall well-being. Appropriate diagnosis is the foundation for successful management, as it permits healthcare professionals to modify treatment plans and interventions to the particular needs of each individual. Through accurate diagnosis, healthcare providers can recognize the underlying cause of these infirmities, assisting them in executing targeted therapies and interventions to lessen symptoms and enhance overall health. Managing respiratory, cardiovascular, and genetic maladies frequently involves a multidisciplinary perspective, including g medical professionals from distinct specialties working collaboratively to equip inclusive care (Birnkrant et al., 2018). With the development in medical technology and research, the diagnosis and management of these infirmities progress, offering new opportunities for enhanced outcomes and improved quality of life for individuals. This essay will explore a case scenario of Brian, a 14-year-old known asthmatic with a 2-day history of worsening cough and shortness of breath, eventually explaining the differential diagnosis for Brian, the most likely diagnosis for Brian and the unique features of the disorder identified in Brian, the treatment and management plan and suitable dosage for the recommended treatments, and strategies for educating Brian and his families on the treatment and management of the respiratory, cardiovascular, and genetic disorders.

The Differential Diagnosis for Brian

Based on the provided case study, several potential differential diagnoses exist for Brian’s symptoms. The primary concern is his known history of asthma, which makes exacerbating his condition the most likely cause. The aggravating cough, shortness of breath, and wheezing demonstrate an acute asthma exacerbation, and it could be due to insufficient control of his symptoms with the expired prescription of the long-acting inhaled corticosteroid, resulting in elevated inflammation and bronchoconstriction (Normansell et al., 2018). Another possibility is an upper respiratory tract infection, like viral bronchitis. URI can cause cough and wheezing, particularly in individuals with underlying asthma. The history of a worsening cough over the past two days, especially accompanied by symptoms like nasal congestion, sore throat, or fever, could support this diagnosis. It is also essential to consider environmental factors contributing to Brian’s symptoms. The smell of smoke on his clothing suggests exposure to secondhand smoke, which can trigger or worsen asthma symptoms (Bekie, 2018). This exposure may have played a role in his current exacerbation. The possibility of an alternative respiratory condition, such as pneumonia or allergic bronchopulmonary aspergillus, is less likely but still worth considering. These conditions may present with similar symptoms, but additional findings, such as fever, productive cough, or chest pain, would be more indicative of these diagnoses. To establish a definitive diagnosis, further evaluation is necessary. This may include spirometry to assess lung function, chest X-ray to evaluate for signs of infection, and potentially sputum culture or blood tests to rule out infectious causes. Additionally, obtaining a thorough history of Brian’s asthma management and adherence to medication is crucial for determining the underlying cause of his exacerbation

The Most Likely Diagnosis for Brian and the Unique Characteristics for Asthma Exacerbation

Based on the provided information, the presumable diagnosis for the patient, Brian, is an acute asthma exacerbation. Asthma is a chronic inflammatory infirmity of the airways featured by recurrent occurrences of wheezing, breathlessness, chest tightness, and coughing. Brian’s history of asthma, aggregating cough and shortness of breath, and the prolonged expiration and expiratory wheezes heard during the examination, point toward an asthma exacerbation. Several factors contribute to this diagnosis. Firstly, Brian’s age of 14 is within the standard age range for asthma onset, often during childhood or adolescence. Secondly, his regular use of a short-acting beta agonist suggests that he relies on quick-relief medications for asthma symptoms. Additionally, the fact that his long-acting inhaled corticosteroid prescription ran out and he forgot to refill it suggests insufficient maintenance therapy, which can subscribe to asthma exacerbations. Brian’s nocturnal coughing and difficulty sleeping are typical features of asthma exacerbations. The lack of enhancement with over-the-counter cough suppressants further supports the diagnosis, as these medications do not address the underlying inflammation and bronchoconstriction associated with asthma. A smoke smell on Brian’s clothing suggests exposure to environmental triggers, such as secondhand smoke, which can worsen asthma symptoms (Hartmann-Boyce et al., 2021).  However, Brian denies cigarette smoking himself. The timely diagnosis for Brian is an acute asthma exacerbation because of his clinical presentation, history of asthma, insufficient maintenance therapy, nocturnal manifestations, and exposure to potential triggers. Asthma exacerbations require suitable treatment with bronchodilators and anti-inflammatory medications to relieve symptoms and prevent further deterioration.

The Treatment and Management Plan for Brian

Based on the case scenario, Brian, a 14-year-old asthmatic, is encountering aggravating cough and shortness of breath. Firstly, addressing his acute symptoms and equip immediate relief is essential. His prolonged expiration, expiratory wheezes, and the fact that he has been using a short-acting beta agonist every three hours without enhancement indicate that his asthma is not well managed. The fact that his long-acting, inhaled corticosteroid prescription ran out further supports this. Therefore, the preliminary treatment plan should address his acute exacerbation and optimize his long-term asthma control. To manipulate his acute symptoms, a short-acting beta agonist, like albuterol, can be administered through a nebulizer or metered-dose inhaler with a spacer, equipping bronchodilation and relieving his cough and shortness of breath (Kling & White, 2021). If his manifestations persist or exacerbate, systemic corticosteroids may be appropriate to lessen airway inflammation. These can be given orally or intravenously, depending on the severity of the exacerbation. In terms of long-term management, it is vital to ensure that Brian consistently provides his long-acting inhaled corticosteroid to uphold control over his asthma. Therefore, a new prescription should be issued, and education should be equipped to Brian and his caregivers on the significance of adhering to his medication regimen. In addition, since Brian’s clothing smells like smoke, it indicates exposure to second-hand smoke, which can exacerbate his asthma symptoms. It is essential to address this matter by advising Brian and his family to avoid smoking or exposure to smoke, as it can stimulate and worsen his asthma. Regular follow-up visits should be scheduled to observe Brian’s asthma control, evaluate the effectiveness of the treatment plan, and make any necessary adjustments to optimize his long-term management.

Education for Patients and Families on the Treatment and Management of the Respiratory, Cardiovascular, and Genetic Disorder

When educating patients and families on treating and managing respiratory disorders like asthma, it is essential to provide inclusive information and guidance to ensure effective management and prevention of exacerbations. For Brian, a 14-year-old known asthmatic, the focus should be optimizing his asthma control and addressing his acute symptoms. Firstly, it is crucial to emphasize the importance of regular use of long-acting inhaled corticosteroids as a preventive measure to reduce the frequency and severity of asthma attacks (Bleecker et al., 2022). Stress the significance of refilling prescriptions on time and establishing a system to prevent forgetting. Additionally, educate the family on using inhalers and spacers to ensure proper drug delivery and maximum benefit. This can be through explaining the role of short-acting beta-agonists as rescue medications during acute exacerbations and emphasizing the significance of using them as prescribed. Encouraging the family to monitor Brian’s symptoms and peak flow readings regularly is also appropriate to assess his asthma control and make appropriate adjustments to the treatment plan. Moreover, it is crucial to discuss environmental triggers, such as exposure to smoke, and advise on avoiding them to minimize the risk of exacerbations (Murray et al., 2021). Educating the family about the early signs of worsening asthma and when to seek medical attention promptly would also be recommendable. Lastly, providing information on lifestyle modifications, such as regular exercise and a healthy diet, would be suitable to support overall respiratory health. Providing comprehensive education and involving the family in the management process aims to empower them with the knowledge and skills to control and prevent future asthma symptoms effectively.

Conclusion

Brian, a 14-year-old known asthmatic, presents with a deteriorating cough and shortness of breath. His symptoms, along with his history of asthma and exposure to smoke, point towards an asthma exacerbation as the timely diagnosis. Asthma exacerbations are characterized by prolonged expiration and expiratory wheezes in all lung fields, and Brian’s respiratory rate and absence of dyspnea align with this diagnosis. Brian’s treatment and management plan should involve immediate administration of a long-acting inhaled corticosteroid, which he ran out of, along with educating him on the importance of medication adherence and avoiding triggers such as cigarette smoke. It is essential to emphasize to patients and their families the significance of following prescribed treatment regimens and seeking timely medical attention to better control and manage respiratory, cardiovascular, and genetic disorders.

 

References

Bekie, C. A. (2018). Head Start Parent Perspectives on Child Exposure to Secondhand Smoke at Home (Doctoral dissertation, Walden University).

Birnkrant, D. J., Bushby, K., Bann, C. M., Alman, B. A., Apkon, S. D., Blackwell, A., … & Ward, L. M. (2018). Diagnosis and management of Duchenne muscular dystrophy, part 2: respiratory, cardiac, bone health, and orthopedic management. The Lancet Neurology, 17(4), 347-361. https://doi.org/10.1016/S1474-4422(18)30025-5

Bleecker, E. R., Al-Ahmad, M., Bjermer, L., Caminati, M., Canonica, G. W., Kaplan, A., … & Price, D. (2022). Systemic corticosteroids in asthma: A call to action from World Allergy Organization and Respiratory Effectiveness Group. World Allergy Organization Journal, 15(12), 100726. https://doi.org/10.1016/j.waojou.2022.100726

Hartmann-Boyce, J., Gunnell, J., Drake, J., Otunla, A., Suklan, J., Schofield, E., … & Dennison, P. (2021). Asthma and COVID-19: a review of evidence on risks and management considerations. BMJ Evidence-Based Medicine, 26(4), 195-195. http://dx.doi.org/10.1136/bmjebm-2020-111506

Kling, S., & White, D. A. (2021). Management of asthma exacerbations in children. South African Medical Journal, 111(8), 710-713. https://doi.org/10.7196/SAMJ.2021.v111i5.15853open_in_new

Murray, C. S., Jackson, D. J., & Teague, W. G. (2021). Prevention and outpatient treatment of asthma exacerbations in children. The Journal of Allergy and Clinical Immunology: In Practice, 9(7), 2567-2576.

Normansell, R., Sayer, B., Waterson, S., Dennett, E. J., Del Forno, M., & Dunleavy, A. (2018). Antibiotics for exacerbations of asthma. Cochrane Database of Systematic Reviews, (6). https://doi.org/10.1002/14651858.CD002741.pub2

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