Primary Healthcare Of Chronic Clients-Families

Primary Healthcare Of Chronic Clients-Families

The 5-year-old child’s presenting symptoms, which are coughing, wheezing, right ear pain, and dry, scaly patches behind her knees and elbows, indicate asthma, eczema, and acute otitis media. Below, the differentials, diagnosis, prescription, and my rationales are discussed in detail.

First, the cough and wheezing that is reported for two days are indicative of asthma. Asthma is a chronic disease affecting the respiratory system, leading to the inflammation and narrowing of the air passages (Hashmi et al., 2023). As a result, this inflammation leads to coughing and wheezing, which are the presenting symptoms, just like in the patient. Furthermore, asthma is associated with recurrence, which may explain the recurrent symptoms in the child. Asthma is common in children due to the hyperresponsiveness of their airways to triggering factors such as exercise, tobacco smoke, obesity, emotional factors, and others (Hashmi et al., 2023). For treatment, I would first prescribe conservative measures that involve avoiding or eliminating any triggering factors of asthma. On the other hand, I would prescribe bronchodilators like muscarinic antagonists and beta-20 agonists such as ipratropium bromide and salbutamol, respectively. Also, I would prescribe anti-inflammatories like inhaled steroids to help reduce the swelling (Hashmi et al., 2023).

Secondly, the complaint of pain in the left ear raises the query of acute otitis media. Acute otitis media is a middle ear infection, a common pediatric diagnosis after an upper respiratory infection (Kolb & Ferrer-Bruker, 2020). The best indicative symptom of otitis media is ear pain, which the child is presenting. However, children can also have other non-specific symptoms such as headache, fever, vomiting, or diarrhea. Ear pain is commonly associated with the bulging of the tympanic membrane due to the fluid buildup in the middle ear (Kolb & Ferrer-Bruker, 2020). Otitis media diagnosis is based on the clinical findings combined with the supporting symptoms and signs; hence, there is no need for imaging or laboratory testing. The otoscopic examination helps in examining and having a definitive diagnosis of otitis media (Kolb & Ferrer-Bruker, 2020). Middle ear infections can be caused by bacteria, viruses, or both; hence the causative agent has to be defined to prescribe the right medication. Bacterial infection is the common cause, and high-dose amoxicillin or cefuroxime is recommended for patients allergic to penicillin. For acute pain, I would prescribe a mild analgesic such as acetaminophen or ibuprofen (Kolb & Ferrer-Bruker, 2020).

Lastly, the dry, scaly patches on the posterior part of the knees and elbows are indicative of eczema. Also referred to as atopic dermatitis, eczema is a common type of dermatitis that is commonly found in children but can also be found in adults (Nemeth & Evans, 2020), unlike in infants where atopic dermatitis presents with plaques on the face, scalp, and extremities, children with eczema present with rashes localized at the extensor’s surfaces like elbows, knees, ankles, and wrists just like the patient. The patch patterns affect the flexural surfaces of the popliteal and antecubital fosse (Nemeth & Evans, 2020). Eczema diagnosis is based on the appearance of the rash and the history taken. I would advise the mother to use skin moisturizing regimens and avoid environmental allergens and harsh shops. Further, I would describe topical anti-inflammatory medications like topical non-steroid products such as pimecrolimus to treat skin flare-ups (Nemeth & Evans, 2020).

In conclusion, the possible differentials the child would suffer from are asthma, otitis media, and eczema, as discussed above. Further evaluations with laboratory and diagnostic tests can be used to confirm the diagnosis. Treatment entails the use of different medications together to treat respective diseases.

References

Hashmi, M. F., Tariq, M., & Cataletto, M. E. (2023). Asthma. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430901/

Kolb, L., & Ferrer-Bruker, S. J. (2020). Atopic Dermatitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448071/

Nemeth, V., & Evans, J. (2020). Eczema. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538209/

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A 5-year-old child and her mother are present at your clinic. The mother reports that the child has had a cough and sounds “wheezy” for the last 2 days. She states that the child always gets like this when she is sick.

Primary Healthcare Of Chronic Clients-Families

She also reports that the child has been complaining that her right ear hurts. In addition, you notice dry scaly patches on the child’s elbows and behind her knees.

What are your differentials and diagnosis? What would you prescribe for each condition? Remember to include your rationales.