Case Study Analysis – Chronic Illness in a Pediatric Patient

Case Study Analysis – Chronic Illness in a Pediatric Patient

The case of Timothy necessitates the development of differential diagnoses (DDx) and a comprehensive plan of care.

Differential Diagnoses

Cough

The differential diagnoses for Timothy’s cough and wheezing are asthma, allergic rhinitis, and viral upper respiratory tract infection (URI). Given the patient’s past medical history of asthma, the best explanation for the symptoms is an asthmatic attack. In allergic rhinitis, post-nasal drip may lead to cough. A viral URI can also cause an asthma attack (Thomas & Bomar, 2023).

Right Ear Pain

Possible diagnoses for right ear pain in Timothy include otitis media, otitis externa, and Eustachian tube dysfunction. Otitis media is a frequent problem affecting children and can cause earache without fever. Otitis externa is an infection of the outer ear canal, and any movement of the ear causes pain (Danishyar & Ashurst, 2023). Earache may be caused by Eustachian tube malfunction, which is associated with allergies or URIs and leads to changes in pressure or the formation of fluid in the ear.

Dry, Scaly Patches

The skin changes indicative of the dry, scaly skin are signatures of atopic dermatitis or eczema, psoriasis, or contact dermatitis. Atopic dermatitis is a type of dermatitis that causes dryness, scaling, and itching and is so common in children. However, psoriasis, although less frequently, can present in a similar manner. Irritant contact dermatitis or allergic contact dermatitis can sometimes cause localized dry skin conditions.

Final Diagnoses

The most likely final diagnoses are asthma exacerbation, otitis media, and atopic dermatitis.

Plan of Care

Asthma Exacerbation

Administer a new albuterol inhaler (Ventolin HFA) with directions regarding two puffs every 4-6 hours PRN. Inform Timothy’s mother about the importance of sticking to the asthma action plan, identifying the signs of worsening of the condition, and follow-ups. Follow up in 1-2 weeks.

Otitis Media

In adherence to the American Academy of Pediatrics guidelines for the diagnosis and management of acute otitis media, which recommend amoxicillin as the first-line treatment, prescribe amoxicillin 500 mg per PO twice daily for ten days. Inform Timothy’s mother to complete the antibiotics, observe worsening signs of the infection, and use acetaminophen or ibuprofen for pain. Make a follow-up appointment in two weeks (Johnson & Bounds, 2022).

Atopic Dermatitis

The National Eczema Association emphasizes the use of topical corticosteroids and regular moisturizing (Lax et al., 2022). Hence, administer hydrocortisone 1% cream to be applied topically, twice daily for 1-2 weeks. It is crucial to teach the patient about the necessity of daily moisturizing and identification of irritants, as well as symptoms of infection. Suggest a review in four weeks to assess the efficacy of the treatment given.

This plan addresses Timothy’s symptoms and ensures proper management and follow-up.

References

Danishyar, A., & Ashurst, J. V. (2023, April 15). Acute otitis media. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470332/

Johnson, D. B., & Bounds, C. G. (2022). Albuterol. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482272/

Lax, S. J., Harvey, J., Axon, E., Howells, L., Santer, M., Ridd, M. J., Lawton, S., Langan, S., Roberts, A., Ahmed, A., Muller, I., Ming, L. C., Panda, S., Chernyshov, P., Carter, B., Williams, H. C., Thomas, K. S., & Chalmers, J. R. (2022). Strategies for using topical corticosteroids in children and adults with eczema. Cochrane Database of Systematic Reviews, 2022(3). https://doi.org/10.1002/14651858.cd013356.pub2

Thomas, M., & Bomar, P. A. (2023). Upper respiratory tract infection. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532961/

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Discussion Prompt
A 7-year-old boy named Timothy, who has asthma, comes to your clinic with his mother. His mother tells you that Timothy has been coughing for a week and has been making a wheezing sound for the last two days. She mentions that they haven’t visited the clinic in over a year, and they have run out of Timothy’s albuterol inhaler, which he was using three times a day for the past week – his only medication. There is no fever present. Additionally, Timothy’s mother reports that he has been complaining of pain in his right ear. Furthermore, you observe dry, scaly patches on Timothy’s elbows and behind his knees.
For Timothy’s cough, right ear pain and the dry, scaly patches, please provide three potential differential diagnoses (DDx) for each condition, along with your brief reasoning for selecting each DDx. Subsequently, identify the most likely final diagnoses.
Finally, outline a comprehensive plan of care for Timothy’s final diagnoses. Include prescription details as if you were sending them to the pharmacy for fulfillment. Explain the patient teaching that should be provided and specify when Timothy should return to the clinic for follow-up. Ensure that your responses are supported by clinical practice guidelines or two high-level scholarly articles. Avoid using point-of-care references.

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