FNP-690: Cough Case Scenario Paper

Directions:Use the chart below to answer the following questions for this case scenario.

Include a minimum of three scholarly references. Peer reviewed resources should not be older than 5 years.

Scenario:

8-year-old established male patient presents to the primary care clinic with 4-week history of intermittent increased cough that is not going away. Has albuterol that he uses when he wheezes while playing soccer. Less energetic than usual. Eating a little less than usual. Mom hasn’t noted fever but has noted that cough sounds loose sometimes.

What other information would you as the provider need to support or eliminate diagnoses? Think about information you would gather for the Subjective and Objective components.
What are three differential diagnoses?
Provide your clinical rationale for each by utilizing peer-reviewed resources.
How would you manage each of these based on appropriate guidelines (include work-up, medication, monitoring needed, and follow-up?

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	Differential 1	Differential 2		Differential 3
Differentials	Acute Bronchitis	Exercise- Induced Asthma (EIA)		Acute bacterial rhinosinusitis
What information (Subjective and Objective data) do you need to support or eliminate this diagnosis?	Subjective data needed to support the diagnosis for Bronchitis include cough and production of green, yellow, or blood-tinged sputum (Nowicki & Murray, 2020). Struggling to meet your deadline ? Get assistance on FNP-690: Cough Case Scenario Paper done on time by medical experts. Don’t wait – ORDER NOW! Meet My Deadline Other symptoms that may support the diagnosis include sore throat, runny nose, headache, myalgia, and extreme fatigue. Objective data that support Bronchitis include: rhinorrhea, coarse rhonchi diffuse wheeze, inspiratory stridor, and pharyngeal erythema (Nowicki & Murray, 2020).	Subjective data needed to support EIA include the following symptoms which occur during or after physical exercise, Chest tightness or chest pain, Cough, dyspnea, wheezing, Poor performance in exercises, Fatigue, increased recovery time, and GI discomfort (Aggarwal et al., 2018). Objective data needed to support the diagnosis include wheezing, rhonchi, and a prolonged expiratory phase (Aggarwal et al., 2018).		Subjective data needed to support Acute bacterial rhinosinusitis include Persistent nasal discharge or a cough that lasts 10 days or more without improvement, and localized pain or pressure on the affected sinus (Leung et al., 2020). Objective data include a fever of 102° or more and Rhinnorhea (Leung et al., 2020).
Supporting clinical rationale	Subjective data in the patient that supports Bronchitis include a prolonged wet cough, sputum production, wheezing, and fatigue (Nowicki & Murray, 2020).	Pertinent positive symptoms of EIA include wheezing during exercise, wet cough, and reduced energy when playing soccer (Aggarwal et al., 2018).		Supporting pertinent symptoms include a persistent wet cough that does not improve (Leung et al., 2020).
Plan (Evidence-Based)
Work-up	Sputum cytology is recommended if the cough is persistent to rule out TB. Chest X-ray is indicated in patients whose physical exam suggests pneumonia (Nowicki & Murray, 2020).		Exercise Challenge Testing: To measure the severity of bronchospasm that results from exercise (Aggarwal et al., 2018). Complete blood count can be indicated to assess for infections. Sputum analysis and culture can be used to assess for infection.	CT Scan of the sinuses to confirm or rule out infection of the sinuses (Leung et al., 2020).
Medication	i. Albuterol 10 mg every 1-4hr PRN to control wheezing. Albuterol is a bronchodilator. Bronchodilators have the advantage of possible superiority to antibiotics in alleviating bronchitis symptoms (Nowicki & Murray, 2020). ii. Dextromethorphan/guaifenesin This is an expectorant used to treat minor cough caused by bronchial and throat irritation (Nowicki & Murray, 2020).		Albuterol 80 mcg (2 puffs) inhale 15-30 min before physical exercise. Albuterol is the DOC and first-line therapy in the treatment of EIA (Aggarwal et al., 2018). It is indicated to prevent exercise-induced bronchospasm	Amoxicillin/clavulanate 250mg/125mg per oral. Amoxicillin/clavulanate is indicated in acute bacterial rhinosinusitis to treat bacterial infection in children and adults (Leung et al., 2020).
Monitoring	The patient will be monitored for worsening symptoms such as high fever, shortness of breath, vomiting, or persistent cough (Nowicki & Murray, 2020).		The patient will be monitored for tolerance to exercise after using Albuterol (Aggarwal et al., 2018).	The patient will be monitored for development of sinus complications (Leung et al., 2020).
Follow-up	The patient will be followed-up after two weeks to assess for alleviation of symptoms.		The patient will be followed-up after four weeks to assess alleviation of EIA symptoms with treatment.	Follow-up after seven days to assess the patient’s response to antibiotic therapy.

References

Aggarwal, B., Mulgirigama, A., & Berend, N. (2018). Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management. NPJ primary care respiratory medicine, 28(1), 31. https://doi.org/10.1038/s41533-018-0098-2

Leung, A. K., Hon, K. L., & Chu, W. C. (2020). Acute bacterial sinusitis in children: an updated review. Drugs in context, 9, 2020-9-3. https://doi.org/10.7573/dic.2020-9-3

Nowicki, J., & Murray, M. T. (2020). Bronchitis and Pneumonia. Textbook of Natural Medicine, 1196–1201.e1. https://doi.org/10.1016/B978-0-323-43044-9.00155-2

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Use the “FNP-690 Cough Case Scenario” resource to complete this assignment. List at minimum three scholarly references at the end of the chart. Peer-reviewed resources should not be older than 5 years.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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FNP-690 Cough Case Scenario