This week was similar to previous weeks. I saw many patients with a history of asthma that are sick and actually having an intermittent episode unbeknown to them or the parents. Some patients will complain of a slight cough, or runny nose. After listening to them, we observed reduced airway entry all over, sometimes wheezing, adventitious lung sounds, and prolonged expirations which are all signs of a mild intermittent asthma episode.

Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.

           There was telemedicine visit that was scheduled same day because the mother was concerned her 2-year-old daughter was not getting better after multiple rounds of albuterol treatment at home. The 2-year-old have history of asthma. The physician asked the mother to lift up her shirt to visualize her breathing pattern and noted retractable chest and abdominal movement. In addition, she had increase respiration rate, we can hear her breathing and wheezing, and coughing.  The physician prescribed prednisone once a day to help decrease the mucosa edema. She explained that the albuterol treatment is not working because of the constriction and edema, therefore its not getting through. Once the edema decreases with the help of the prednisone, then the breathing treatment with albuterol will start working. Possible differential diagnoses are upper respiratory tract infection (URTI) that can cause symptoms including coughing, wheezing, and shortness of breath that are comparable to moderate intermittent asthma. They are typically caused by viral infections such rhinovirus or respiratory syncytial virus (RSV) (Khan et al., 2020). Also, symptoms of allergic rhinitis, also referred to as hay fever, include nasal congestion, sneezing, itching, and rhinorrhea. The condition is caused by inflammation of the nasal mucosa as a result of contact to allergens. Additionally, allergic rhinitis should be considered a differential diagnosis, especially if the patient’s symptoms are primarily upper respiratory tract with little to no lower respiratory symptoms. This is because allergic rhinitis can exacerbate asthma symptoms through the nasal-bronchial reflex (Tenero et al., 2023).

Mention the health promotion intervention for this patient.

           When a kid with mild intermittent asthma receives health promotion interventions, the goal is to enable them and their caregivers to manage the illness well and lessen the frequency and intensity of asthma episodes. Education is essential to ensuring that the kid and family are aware of asthma triggers, how to use an inhaler correctly, and how important it is to take prescribed medications exactly as directed. By putting an asthma action plan into practice, the family and child can better identify early warning indicators of worsening symptoms and when to seek medical assistance. Lung function and general fitness can be enhanced by encouraging the child to continue with regular physical activity and making sure that the right warm-up and cool-down routines are followed. It is imperative to make environmental changes to lessen exposure to recognized triggers such pollen, dust mites, tobacco smoke, and pet dander. Furthermore, encouraging open communication among the child, family, and medical professionals makes it easier to monitor the condition of the kid’s asthma and modify treatment regimens as necessary to improve quality of life and asthma control (Di Cicco et al., 2021).

What did you learn from this week’s clinical experience that can be beneficial for you as an advanced practice nurse?

           I learned no matter how much education you give to the parent and/or child it is still important to remind them of the signs and symptoms acute asthma exacerbations especially when other family members are sick in the presence of the patient, and if the patient has not had any vaccines such as the flu to prevent illness. Also, the importance of continuing medication regimen in the absence of illness for prevention measures.


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