Diagnosis and Management of Respiratory Disorders

Week 5 Discussion Diagnosis and Management of Respiratory, Cardiovascular, and Genetic Disorders

Discussion board posting assignments are assigned alphabetically by FIRST NAME to ensure all cases are covered and discussed. Case Study 1: A-F Case Study 2: G-M Case Study 3: N-T Case Study 4: U-Z Case Study 1: HPI: A 14-month-old brought Native American boy by his mom due to cough, low grade fever and runny nose for the past 2 days. This morning, the mother noted that her son was breathing quickly and “it sounds like she has rice cereal popping in her throat.” Mom is worried because her son seems to have a lot of ‘bouts of colds”. Per mom, his oral intake is decreased. He didn’t want to eat this morning. PE: Smiling, alert Caucasian boy. VS: Temp of 99.9, pulse 112, resp. 42 reveals the following: respiratory rate is 58 HEENT: There is moderate, thick, clear rhinorrhea and postnasal drip. CV: Her capillary refill is less than 3 seconds PULM: lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields. Case Study 2: HPI: Brian is a 14-year-old known asthmatic with a 2-day history of worsening cough and shortness of breath. He reports using every 3-4 hours over the previous 24 hours. He has a long-acting inhaled corticosteroid. He can’t recall which one. He said he ran out a few weeks ago and has not had time to obtain a refill. He denies cigarette smoking, but his clothing smells like smoke. PE: Patient is sitting by himself. His parents are in the room during the visit. No purse lip breathing noted. Occasional nonproductive coughing during the interview. PULM: You note prolonged expiration and expiratory wheezes in all lung fields. There are no signs of dyspnea. Case Study 3: HPI: A father brought his 7-year-old with a 3-day history of cough.

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Diagnosis and Management of Respiratory Disorders

Dad states that his son is coughing up yellow mucus. The boy is afebrile and is sleeping through the night, but the father’s sleep is disturbed listening to his son coughing. Dad says he thinks his son has bronchitis and is requesting treatment. PE: VS: respiratory rate 18, HEENT: there is no cervical adenopathy, nasal turbinates are slightly enlarged, and there is moderate clear rhinorrhea. PULM: lungs are clear to auscultation, patient is able to take deep breaths without coughing. Case Study 4 HPI: Miguel is a Latino 15-year-old male who presents for a sports physical. He is a healthy adolescent with no complaints. He plays basketball. PE: He is 6 feet 5 inches tall and weighs 198 pounds. MS: You note long arms and long thin fingers. He has joint laxity in his wrists, shoulders, and elbows. Case Study 5: HPI: Trina’s mother is concern that her daughter is a picky eater and refuses to eat fruits and vegetables. Her physical activity includes soccer practice for 1 hour a week with one game each weekend from September through November. FMH: negative for myocardial infarction, but both parents take medication for dyslipidemia. PE: Trina is a Native American 10-year-old female very engaging when answering questions. Vital signs are as follows: BP 122/79, P 98, R 20. Wt. 110, Ht. 4’11 Case Study 6: HPI: You see a 2-month-old for a well-child visit. She is breastfed and nurses every 2 to 3 hours during the day, but her mother reports she is not nursing as vigorously as before. She sleeps one 4-hour block at night. PMH: Birth weight was 7 pounds 5 ounces. Weight gain over the last 2 weeks reveals gain of 5 ounces per week. PE: Fussy two-month-old Chinese infant. PULM: lung sounds are clear CV: a new III/VI systolic ejection murmur is noted along the left lower sternal border, cap refill is brisk, skin is pink and moist. ABD: bowel sounds noted in all Week 5 Discussion

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