Week 2 Discussion-2nd reply Jessica Alper Chief complaint The chief complaint that this fifteen-year-old patient is complaining of is shortness of breath and nonproductive nocturnal cough.  Primary and differential diagnoses The patient states that she typically only feels the stated symptoms after working out, but lately she has consistently felt that way. She denies symptoms related to upper respiratory system, gastrointestinal, or urinary. The objective findings reveal vital signs that are within normal limits and the patient is in no signs of respiratory distress. Assessment of head, eyes, ears, nose, and throat are not impressive, and the inspection of the anterior and posterior chest show no abnormalities. While auscultating the patient’s chest, decreased air movement and high-pitched whistling on expiration was observed. The lungs were also noted to be resonant upon percussion.  The primary diagnosis for this patient is severe persistent asthma. Asthma is defined as complex and it typically involves airway inflammation, intermittent airflow obstruction, as well as bronchial hyperresponsiveness. Symptoms usually involve wheezing, coughing, shortness of breath, as well as chest tightness and pain (Morris, 2022). The patient is feeling these same symptoms daily, multiple times a day, and throughout the night, with a nocturnal nonproductive cough, therefore this is the final diagnosis for this patient.  The first differential diagnosis is viral bronchiolitis, which is defined as “an acute inflammatory injury of the bronchioles that is usually caused by a viral infection” (Maraqa, 2021). Congestive heart failure is another differential diagnosis as well as chronic sinusitis. Congestive heart failure is a condition that causes pulmonary vessels and interstitial pulmonary edema, reducing the compliance of the lungs, therefore leading to a feeling of dyspnea and wheezing (Morris, 2022). Acute sinusitis is an “inflammatory process involving the paranasal sinus” (Brook, 2022), and it may be associated with allergies. It can lead to unproductive cough as well as exacerbation of asthma.  Treatment plan The goal of asthma is to control it as best as possible. An ideal goal for a 15-year-old child is to have less than 2 days per week in which the patient will have an attack, along with less than twice per month of nightly awakenings. According to the symptoms, this patient should follow step 4 or step 5 of the guidelines. Step 4 would include a medium-dose inhaled corticosteroids, as well as long-acting beta agonist. If the patient did not respond to this treatment, an alternative plan including a medium-dose inhaled corticosteroid and a leukotriene receptor antagonist or Theophylline may be used. If both these treatments fail, then the patient should be moved to step 5 of treatment, which includes a high-dose inhaled corticosteroid and a long-acting beta agonist would be prescribed (Managing Asthma, 2022). It is also important to orde ...

1. Week 2 Discussion-2nd reply
Jessica Alper
Chief complaint
The chief complaint that this fifteen-year-old patient is
complaining of is shortness of breath and nonproductive
nocturnal cough.
Primary and differential diagnoses
The patient states that she typically only feels the stated
symptoms after working out, but lately she has consistently felt
that way. She denies symptoms related to upper respiratory
system, gastrointestinal, or urinary. The objective findings
reveal vital signs that are within normal limits and the patient is
in no signs of respiratory distress. Assessment of head, eyes,
ears, nose, and throat are not impressive, and the inspection of
the anterior and posterior chest show no abnormalities. While
auscultating the patient’s chest, decreased air movement and
high-pitched whistling on expiration was observed. The lungs
were also noted to be resonant upon percussion.
The primary diagnosis for this patient is severe persistent
asthma. Asthma is defined as complex and it typically involves
airway inflammation, intermittent airflow obstruction, as well
as bronchial hyperresponsiveness. Symptoms usually involve
wheezing, coughing, shortness of breath, as well as chest
tightness and pain (Morris, 2022). The patient is feeling these
same symptoms daily, multiple times a day, and throughout the
night, with a nocturnal nonproductive cough, therefore this is
the final diagnosis for this patient.
The first differential diagnosis is viral bronchiolitis, which is
defined as “an acute inflammatory injury of the bronchioles that
is usually caused by a viral infection” (Maraqa, 2021).
Congestive heart failure is another differential diagnosis as well
as chronic sinusitis. Congestive heart failure is a condition that
causes pulmonary vessels and interstitial pulmonary edema,

2. reducing the compliance of the lungs, therefore leading to a
feeling of dyspnea and wheezing (Morris, 2022). Acute sinusitis
is an “inflammatory process involving the paranasal sinus”
(Brook, 2022), and it may be associated with allergies. It can
lead to unproductive cough as well as exacerbation of asthma.
Treatment plan
The goal of asthma is to control it as best as possible. An ideal
goal for a 15-year-old child is to have less than 2 days per week
in which the patient will have an attack, along with less than
twice per month of nightly awakenings. According to the
symptoms, this patient should follow step 4 or step 5 of the
guidelines. Step 4 would include a medium-dose inhaled
corticosteroids, as well as long-acting beta agonist. If the
patient did not respond to this treatment, an alternative plan
including a medium-dose inhaled corticosteroid and a
leukotriene receptor antagonist or Theophylline may be used. If
both these treatments fail, then the patient should be moved to
step 5 of treatment, which includes a high-dose inhaled
corticosteroid and a long-acting beta agonist would be
prescribed (Managing Asthma, 2022). It is also important to
order a short-acting beta agonist to be used for emergencies.
This SABA, such as Albuterol, should be only used up to 3
times in 20-minute intervals.
It is important to educate the patient about environmental
control, and to know how to manage the symptoms.
Additionally, it is crucial to educate the patient about having an
Asthma Action Plan readily available. This plan is a tool that
provides information and instructions on how to manage the
patient’s symptoms. It includes medications and it helps the
patient recognize worsening symptoms and when to seek
emergency. It contains different colors that can help determine
the severity of the asthma. The green color is the “Go Zone”,
which tells the patient to use preventive medicine. The yellow
one is the “Caution Zone”, which tells the patient to add a
quick-relief medication. Lastly, the red zone is the “Danger
Zone”, which is dangerous and requires the help of a physician

3. (Asthma Action, 2021).
References
Asthma action plan. (2021). Asthma and Allergy Foundation of
America.
https://www.aafa.org/asthma-treatment-action-plan/
Brook, I. (2022). Acute sinusitis. Medscape.
https://emedicine.medscape.com/article/232791-
overview
Managing asthma in children 12 years of age and adults. (2022).
Asthma Initiative of Michigan for Healthy Lungs.
https://getasthmahelp.org/asthma-management-
adults.aspx
Maraqa, N. F. (2021). Bronchiolitis. Medscape.
https://emedicine.medscape.com/article/961963-
overview
Morris, M. J. (2022). Asthma differential diagnoses. Medscape.
https://emedicine.medscape.com/article/296301-
differential
Week 2 discussion – 1st Reply
Edgar Gonzalez
The chief complaint is “shortness of breath and a nonproductive
nocturnal cough.” The 15-year-old female patient reports that
her symptoms are persistent and have progressed from only
have them with extreme exercise. She denies associated
symptoms such as upper respiratory symptoms, chest pain,
gastrointestinal symptoms, or urinary tract symptoms. She does
not report alleviating or aggravating factors. She has a history
of seasonal allergies and a family history of allergies, eczema,
and hypertension. She does not use tobacco or recreational
drugs.
Based on the presenting symptoms, the top three diagnoses
include moderate persistent asthma, acute bronchitis, and
sinusitis (Dunphy et al., 2017). Moderate persistent asthma
presents with wheezing, shortness of breath, nocturnal

4. symptoms, and exacerbations that affect activity two times or
more per week and may last for several days (Burns et al.,
2019). A family history of asthma and eczema is commonly
seen, along with recurrent bronchitis episodes and seasonal
exacerbations. Acute bronchitis most often presents with a
cough for several weeks. It can also present with fever, malaise,
chest discomfort, and wheezes (Goolsby & Grubbs, 2018).
Sinusitis is common among patients with allergies and asthma.
Sinusitis can present with difficulty breathing, fever, headache,
severe sinus congestion, and can be triggered by allergens
(Goolsby & Grubbs, 2018).
A stepwise approach is recommended for the management of
asthma. The treatment of choice for moderate persistent asthma
is a low-dose inhaled corticosteroid, such as Pulmicort, a long-
acting beta2-agonist, such as Symbicort, and a short-acting
beta-agonists, such as albuterol as needed (Pollart & Elward,
2009). A custom Asthma Action Plan tailored to the patients
should also be considered. These action plans give patients and
their families instructions on managing asthma with
medications, recognizing warning signs of it getting worse, and
what to do in an emergency (CDC, 2022). The action plan
should be given using a traffic light style of green, yellow, or
red to manage symptoms, that the patient and their caretaker
should know what to do if the patient goes into the yellow or
red zones (Burns et al., 2019). This action plan should also be
provided to the patient’s school to implement appropriate
interventions as needed.
References
Burns, C., Dunn, A., Brady, M., Starr, N., & Blosser, C.
(2019).
Burns' pediatric primary care (7th ed.). Elsevier.
Centers for Disease Control and Prevention. (2022).

5. Asthma action plans. U.S. Department of Health &
Human Services. https://www.cdc.gov/asthma/actionplan.html
Dunphy, L., Winland-Brown, J., Porter, B., & Thomas,
D. (2017
). Primary Care: the art and science of advanced
practice nursing (5th ed.). F. A. Davis.
Goolsby, M. J. & Grubbs, L. (2018).
Advanced assessment: Interpreting findings and
formulating differential diagnoses (4th ed). F. A. Davis.
Pollart, S. M., & Elward, K. S. (2009). Overview of changes to
asthma guidelines: diagnosis and screening.
American family physician,
79(9), 761–767.