John is a 13 year old male

John is a 13 year old male who presents to your clinic accompanied by his mother with complaint of productive cough, chest and nasal congestion and intermittent chills x 7 days. He reports symptoms initially started with mild nasal congestion, clear runny nose and sore throat, but got worse the past few days. He now has chest congestion, productive cough with greenish-yellow sputum, chills, and mild headache x 2 days. OTC meds for cold have not helped. He denies any known sick contact. Mother further reports she noticed John has been wheezing more the past 2 months. Previously, he was very physically active and participates in sports. Mom has noticed a change in his activity over the past 2 months. He used to use his albuterol inhaler about once a month but now uses it 3-4 times a week. Both John and his mom reported that he is awakened at nighttime with a dry cough and wheezing which occurs about 1-2 times a week Past Medical History: Asthma, Allergic rhinitis, Atopic dermatitis Medication History: Albuterol HFA prn for wheezing, Zyrtec 10mg QD for allergies, Tyleno! 500mg -1tab prn for headache and chills. Drug Allergy: NKDA Family Medical History: Father: HTN. Mom: healthy (denied past medical history). 3 siblings-all healthy. Maternal grandparents: alive, healthy. Paternal grandmother: alive, HTN; Paternal grandfather: unknown Surgical History: Denies any surgeries or hospitalizations Social History: Denies alcohol or cigarette use. Denies illicit drug use. Occupation: Student. Vaccinations: Up to date Physical Exam: Gen: Slightly lethargic, otherwise in no acute distress V/S: BP: 124/72, HR: 110, T: 101.3(oral), RR: 24, Wt.: 132lbs, Ht.: 66 inches HEENT: Nasal mucosa erythematous, mild nasal congestion, tonsils and pharynx normal, slight postnasal drainage, light green nasal discharge. CV: Normal S1& S2, rhythm regular Resp: regular. Mild expiratory wheezing bilaterally to auscultation. No use of accessory muscles. 02 saturation: 95% Abd: Soft, non-distended, non-tender, bowel sounds + and normal × 4 quadrants, no masses palpated. Neuro/Psych: alert and oriented X 3. CN II-XII grossly intact. Good eye contact, speech clear and goal oriented. Affect normal. Skin: Normal, no lesions. Diagnostic Tests: In-house: CBC with diff and CXR Labs/X-ray Patient results WBCs 14,700 Neutrophil 10,290 Lymphocytes 1,500 platelets 190, 000 hemoglobin 14 HCT 38% CXR Results : Consolidation in left upper lobe Case Questions: 1. What is/are the diagnoses? Support with literature evidence and interpretation of data presented in the case study. 2. Discuss the pathophysiology of the selected diagnosis. 3. Present and briefly discuss(rationale) 3 differential diagnoses for this patient. 4. Discuss plan of care for this patient-pharmacological, education, referral, and need for further diagnostic testing if any. What are your thoughts about his asthma? Support your plan of care/ interventions with literature evidence.

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