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Respiratory/Cardiac/Peripheral Vascular Systems Response

Respiratory/Cardiac/Peripheral Vascular Systems Response

Respiratory/Cardiac/Peripheral Vascular Systems Response

QUESTION
reply to SARAH’s POST…Review the documented subjective and objective history. Provide scholarly support to identify a differential diagnosis based on the reported findings. Include additional subjective or objective data that would support this diagnosis.

8-year-old Rhiannon Regis is brought to the clinic by her mother, Rachel Regis, for a cough

HPI: Rhiannon’s mom states that the cough began 2 weeks ago but “won’t go away.” Rhiannon’s mom states there is phlegm with Rhiannon’s cough. Rhiannon reports her cough is worse at night which makes it difficult for her to sleep.

PE: BP: 100/60, HR: 110 RR: 18 Temp: 100.5. Rhiannon is awake, alert, and oriented with appropriate answers and behaviors. Dullness noted with percussion. Crackles were noted in the RLL when listening to lung sounds. Rhiannon’s 02SAT is 94% on room air. Her cough is productive with green/yellow sputum noted.

Based upon the patient’s health history and physical exam, a diagnosis of bacterial pneumonia can be made. Cough is one of the most common symptoms for which patients seek medical care (Dains, Ciofu Baumann, & Scheibel, 2016). Cough can be characterized by being acute (less than 3 weeks), subacute (3-8weeks), and chronic (lasting more than 8 weeks). A cough that is acute, is most likely caused by a viral or bacterial infection. Rhiannon has had a cough for 2 weeks and can be classified as acute. On percussion, dullness replaces resonance when fluid or solid tissue replaces air containing lung (Bickley, 2017). Auscultation of the lungs is an important part of the exam when a cough is present. Crackles can arise from abnormalities of the lung parenchyma (as seen in pneumonia), as well as other pulmonary or airway issues (Bickley, 2017).

Pneumonia is an infection that infects one or both lungs, and is caused by bacteria, virus or fungus (National Heart, Lung, and Blood Institute, n.d.). Additional common symptoms are chest pain upon breathing or coughing, chills, cough with or without mucus, fever, low oxygen levels, and shortness of breath. Possible diagnostic tests that can assist the provider in making an accurate diagnosis are: chest x-ray, sputum cultures, and lab testing. Chest radiography suggesting a lung infiltrate is required for diagnosis of community acquired pneumonia (CAP) (Watkins et al., 2011) Chest X-ray is recommended for patients who present with acute respiratory illness and the following:
1. Temperature > 100° F (37.8° C)
2. Heart rate > 100 beats per minute
3. Respiratory rate > 20 breaths per minute
And any patient with at least two of the following clinical findings:
1. Decreased breath sounds
2. Crackles
3. Absence of asthma
(Watkins, Lemonovich, &, 2011)

Chest radiography suggesting a lung infiltrate is required for diagnosis of community acquired pneumonia (CAP) (Watkins et al., 2011)

References

Bickley, L. S. (2017). Bates’ guide to physical examination and history taking (12th ed.). Philadelphia, PA: Wolters Kluwer.

Dains, J. E., Ciofu Baumann, L., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MI: Elsevier.

National Heart, Lung, and Blood Institute. (n.d.). https://www.nhlbi.nih.gov/

Watkins, R. R., & Lemonovich, T. L. (2011, June 1,). Diagnosis and management of community acquired pneumonia in adults. American Family Physician, 83(11), 1299-1306. Retrieved from https://www.aafp.org/
Respiratory/Cardiac/Peripheral Vascular Systems Response

ANSWER
Respiratory/Cardiac/Peripheral Vascular Systems Response

Student’s Name:
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Dear Sarah,
I like how you have made an inferred break down of the case study. I do concur with you that the diagnosis made on the child is of bacterial pneumonia. As you had noted, pneumonia can be caused by bacteria, viruses, or fungi, but regardless of the causes, the clinical manifestation of pneumonia remains the same (Rambaud-Althaus et al., 2015). In a healthy person, adult or child, pneumonia occurs as a secondary illness because the bacteria or viral illness was already on the client; only the symptoms begin to manifest with reduced immunity.
I agree that the typical manifestation of any form of pneumonia is cough, and it determines how the illness can be characterized based on the length and form of cough. The illness begins like a cold with multiple symptoms manifesting after 2 to 3 days. The incubation period for pneumonia varies depending on the cause. Bacterial pneumonia has more sudden and severe symptoms than viral pneumonia, whose symptoms gradually occur but remain similar to the flu. For example, suppose a child is infected with a respiratory syncytial virus, thus developing pneumonia. In that case, the symptoms may take 4-6 days before manifesting, but from bacterial infection, symptoms may begin 18 to 72 hours and last for 1 to 2 weeks (Griffiths, Drews & Marchant, 2017). The best way to confirm the cause of pneumonia is to take a lab test of the mucus sample or sputum.
The symptoms that manifest on the patient indeed confirm the presence of bacterial pneumonia. The exciting fact is that you have provided a detailed analysis of objective and subjective diagnosing and testing, such as Auscultation, sputum testing, and chest X-ray, which are crucial in assessing acute respiratory illness. The tests are significant since there are multiple differential diagnoses from respiratory illnesses such as asthma, atelectasis, bronchiectasis, bronchiolitis, bronchitis, COPD, fungal pneumonia, lung abscess, and viral pneumonia (Sattar & Sharma, 2020). The article is informative, and I support the importance of conducting a thorough diagnosis of bacterial pneumonia to provide the patient with the right care plan.

References
Griffiths, C., Drews, S. J., & Marchant, D. J. (2017). Respiratory syncytial virus: infection, detection, and new options for prevention and treatment. Clinical microbiology reviews, 30(1), 277-319.
Rambaud-Althaus, C., Althaus, F., Genton, B., & D’Acremont, V. (2015). Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis. The Lancet infectious diseases, 15(4), 439-450.
Sattar, S. B. A., & Sharma, S. (2020). Bacterial pneumonia. StatPearls [Internet].

Respiratory/Cardiac/Peripheral Vascular Systems Response

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