Professional Documents
Culture Documents
Case Study
ASTHMA
group V
This case presents a patient with hardly controlled asthma
that remains refractory to treatment despite use of
standard-of-care therapeutic options. For patients such as
this, one needs to embark on an extensive work-up to
confirm the diagnosis, assess for comorbidities, and finally,
to consider different therapeutic options. The discussion also
tackle how asthma occurs on children.
CASE STUDY ASTHMA
DESCRIPTION:
PATIENT NAME: MICHAEL TARNEY
ADDRESS: 1636 AIRFLOW LANE
AGE: 10 YEARS OLD
SEX: MALE
HEIGHT: 4'8
WEIGHT: 40Kg
RACE: AFRICAN AMERICAN
ALLERGIES: NO UNKNOWN DRUG ALLERGIES
CHIEF COMPLAINT
01 02 03
The patient had a O2
The patient is a 10 y-o He experienced asthma saturation of 89% during the
child, 40 kg in weight, attack(asthma emergency, can barely talk
142.24 cm (4'8) in height. exacerbation) at night and breathe. Since it was
Therefore, he is having a causing to run him in ED. It nighttime, oxygen levels in
BMI of about is known that asthma gets blood are lower during
19.8kg/m2(87% at risk of worse at night. sleep due to a mildly
overweight). reduced level of breathing.
Below 88% is a cause of
concern.
HISTORY OF PRESENT ILLNESS
Michael self-treated his breathing difficulty with an albuterol inhaler
that carries in his pocket wherever he goes. His mother reports that he
is using his inhaler at least three to four times every week for the past
few months. She states she had to obtain refills every 2 weeks. This is
Michael’s second reported ED visit this past month due to difficulty
breathing, Michael’s last visit symptoms included watery eyes and
stuffy nose. These symptoms are not present at this visit, however, his
mother became concerned when he was disinterested in dinner and
experienced trouble speaking.
This section show the previous situation/s of the patients before his current visit on
the Emergency Department. This may help more on the observation of the
pathophysiology of the patient’s disease.
1. The patient’s mother states that his son always carries Albuterol inhaler in his
pocket and he is puffing 3 to 4 times every week. But according to her, she is refilling
his son’s inhaler every two weeks, means he consumes a lot, it is possible that the
patient is puffing 4-8 times a day.
2. In his last visit, it was observed that he has symptoms of watery eyes and stuffy
nose, possible occurrence of allergic rhinitis. However, it is not observed in his
current visit.
3. The patient was also disinterested during dinner and experienced trouble
speaking. Possible that the patient appears anxious and had moderate
respiratory distress.
PAST MEDICAL HISTORY
1 2 3
It was stated Otitis media was
Michael
that all his visits observed in his age
developed his of 1-3 years, a
have occurred in
asthma when reason for the
the early fall.
he was 5. patient on taking
Thus, the weather antibiotics during
Albuterol was had triggered his the previous time.
given. disease causing This maybe
him in that irrelevant in his
situation. current situation for
his HEENT seems
normal.
SOCIAL HISTORY
FAMILY HISTORY
This part sought to investigate whether the patient inherited his disease.
01
It is possible to develop
asthma at any age, 02
children with asthmatic 03
parents are at an High blood
increased risk of getting
pressure Allergies can
it when they’re younger.
Asthma can be inherited cannot be be inherited.
but not in a larger inherited.
probability. Environment
of the children may be
the main cause of his
disease.
REVIEW OF SYSTEM
PHYSICAL EXAMINATION
In this section, the following may show the positive or normal findings of signs
and symptoms of the patient.
2. The patient has high blood pressure (120/75 mmHg). As normal ranges
for 10 y-o children must 95-110 systolic, 60-70 diastolic. . A short-term high
blood pressure is possible in this case because his anxiety was present
during his time in ED.
3. The patient currently experiencing fever due to his signs, evident in his
temperature for about 38.5 degrees.
4. HEENT are normal.
1. Hemoglobin 15 g/dL – NORMAL (The healthy range for hemoglobin for men is 13.2 to 16.6 grams
per deciliter)
2. Hematocrit 45% - NORMAL (Normal hematocrit level vary based on age and race. Normal
levels for men ranges from 41% - 50%)
3. Platelets 260,000/mm2 – NORMAL (The mean normal platelet count is between 250, 000 and
20,000 cells/mm3)
4. WBC 8000/mm3 - NORMAL (A normal white blood cell count is between 4,500 and 11, 000 cells
per cubic millimeter)
8.pH 7.4 – NORMAL (Human blood has a normal pH range of 7.35 to 7.45)
9.PaO260 – LOW (Partial pressure for oxygen must range to 75 to 100 mmHg), if the
PaO2 level is lower it means that the person is not getting enough oxygen.
10.PaCO245 – HIGH (Partial pressure for carbon dioxide must range to 38 to 42 mmHg).
An elevated PaCO2 reflects alveolar hyperventilation meaning there is an absolute
decrease in ventilation.
11.Cardiac monitor: Sinus tachycardia – the patient’s heart beats faster than normal.
Sinus tachycardia is an ADR of albuterol.
PRIMARY: OTHERS:
The following are the on pharmaceutical recommendation prior to the patient aged
10 year-old suffering from asthma and some based on his diagnosis.
ALBUTEROL
The usual 2 puffs every six hours as needed may change into "one puff every six
hours as needed.". It was noticed that sinus tachycardia was developed due to the
. excessive intake of patient with Albuterol, therefore, to lessen some side effects of
albuterol, the patient may change the method in which he take the drug or to lessen
the amount he takes.
We noticed that is hard for the patient to tolerate the side effects of albuterol, we
may reduce the recommended dose. Using one puff of albuterol rather than two
puffs will provide good relief of symptoms with fewer side effects.
CEFTIN
· Cefuroxime was effective for our patient since it is used to treat
infection on the lungs. We would also like the patient to continue this
medication since he is suffering from temporary fever. Dispense a quantity
of 100mL. Same direction as: take one teaspoon twice a day.
CAPTOPRIL
· Our patient was said to have a high blood pressure. For persistent
hypertension in children should generally begin with an ACE inhibitor. For
pediatric use, Captopril is used to treat high blood pressure. But in the case of
Michael, he suffered from anxiety which possibly cause a shorth-term high blood
.
pressure. Therefore, we would like to check his BP for the second time, if the
sign did not change then we can dispense him with this medication.
CETIRIZINE
· This medication is safe to treat allergic rhinitis in children; indicated
for seasonal allergies. Our patient may take 10 mg daily.
.
SUMMARY
Michael is a 10 y-o African American male who was seen in the ED, during an
asthma exacerbation, the symptoms observed are as follows: trouble breathing,
occasional wheezing, fever, anxiety and respiratory distress. On the arrival at the
ED, Michael was only able to answer questions with single words and had an
oxygen saturation of 89%. He is having a BMI of about 19.8 kg/m2 (87% at risk of
overweight). The patient's mother states that his son always carries Albuterol
inhaler in his pocket and he is puffing 3 to 4 times every week. In his last visit, it was
observed that he has symptoms of watery eyes and stuffy nose, possible
occurrence of allergic rhinitis.
Otitis media was observed in his age of 1-3 years, a reason for the patient on
taking antibiotics during the previous time. This maybe irrelevant in the current
situation for his HEENT seems normal.
The weather had triggered his disease causing him in
that situation, by that Albuterol was given. The patient did
not deny his consume on caffeine and everyday
consuming of coke which leads to some complications.
Father has multiple allergies and high blood pressure
that may inherited to Michael. Most common cause of
recurrent wheezing are asthma and COPD, which both
cause narrowing and spasms in the small airways of his
lungs. The patient has high blood pressure (120/75 mmHg).
His neuro is normal which means that he is conscious
during his visit to the ED.
All lab and diagnostic test at normal except for
PaO260 which is LOW it means that the person is not
getting enough oxygen and PaCO245 which is HIGH. An
elevated PaCO2 reflects alveolar hyperventilation
meaning there is an absolute decrease in ventilation. The
patient also develop sinus tachycardia which is the ADR
of albuterol. Primary diagnosis are Asthma exacerbation
and Seasonal allergic rhinitis. It was also evident that the
patient have sinus tachycardia , Temporary fever, High
blood pressure. The non pharmaceutical and
pharmaceutical recommendation for our patient to have
a faster rocovery is indicated through the previous slides.