Healthcare Case Study: History Of Nasal Congestion And Cough (Case Study Sample)

Healthcare Case Study 2
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Case
Kaitlyn is a 4-year-old with a 2-day history of nasal congestion and cough in the early morning. Her mother reports thick, green nasal discharge. She is afebrile, and appetite and sleep are normal. Physical examination reveals: lungs clear to auscultation, tympanic membranes pearly gray without fluid in a neutral position, no cervical adenopathy, nasal turbinates are red, and clear rhinorrhea and postnasal drip.
Diagnosis: Allergic Rhinitis
According to Perkin et al. (2015), the history of patients suffering from allergic rhinitis is usually straightforward. However, sometimes the history of such a patient might involve a number of other complex symptoms. Among children, Scadding (2015) indicates that symptoms such as nasal congestion and discharge indicate allergic rhinitis. From the case study, the basal congestion and discharge are clearer signs of rhinitis. Among children, periodic coughs such as coughs in the morning as indicated in the case study may be elicited among children with allergic rhinitis. In most cases, the nasal discharge may be pale or green as indicated in the case. Moreover, findings from the case study reveal that the patient has reddened nasal turbinate with clear rhinorrhoea. In this sense, the definitive diagnosis for Kaitlyn reveals that she suffers from allergic rhinitis.
Although there are other diagnostic tests that are relevant in confirmation of the diagnosis, Scadding (2015) admits that patients’ history helps in determining the possible condition that the patient suffers from. For instance, other necessary tests such as imaging studies, allergic skin tests as well as general examination tests can help in determining other possible conditions affecting the patient. However, the presentation of the condition in this case reveals that the child suffers from allergic rhinitis. In order to confirm the diagnosis, the differential diagnoses must be ruled out.
Differential Diagnosis
Perkin et al. (2015) indicate that allergic rhinitis is often confused with acute sinusitis. Ideally, the symptoms of acute sinusitis are also similar to the symptoms of allergic rhinitis. In acute sinusitis, the lining of the nasal sinuses are often red. Perkin et al. (2015) say that most cases of sinusitis occur with allergic rhinitis as an accompanying condition. This is the reason why acute sinusitis is sometimes referred to as Rhinosinusitis. In acute sinusitis, the symptoms and signs include redness of the nose, eyelids and cheeks, postnatal discharge, congested nose, persistent coughing with pharyngeal irritation. However, in most cases of sinusitis, patients must experience fever. From the case study, the patient presents with some of these symptoms. However, this does not indicate that the patient suffers from acute sinusitis. Rather, absence of other symptoms such as the pain, fever, hyposmia, the referred pain to cheeks and face is an indicator that the child suffers from acute rhinitis. Additionally, the fact that the symptoms are only visible in the morning is an adequate indicator that the patient suffers from acute rhinitis.
Treatment
In order to treat allergic rhinitis, treatment must be divided into three main categories including elimination of the allergen, medication and using an allergen-specific immunotherapy. According to Perkin et al. (2015), allergic rhinitis is caused by allergens that children are exposed to. From the case study, it is evident that the child could be allergic to cold. In this manner, it is important to prevent the child from the cold temperatures in the morning. This will help in reducing possible allergic reactions to cold. When it comes to the use of allergen-specific medication, the child could be given corticosteroid injections.
Medication
Medications used in allergic rhinitis include antihistamines, saline, decongestants, sodium cromolyns as well as antileukotrienes (Warman, Granot & Halperin, 2015). These medications can be used as intranasal medication or as injectable. For instance, saline can be used in order to help in decongesting Kaitlyn’s congested nose. However, the healthcare provider should consider the use of oral therapy as it will make it easier to administer as compared to the other forms of medication. For instance, Kaitlyn should be given allergy-specific immunotherapy (Cetrizine) to help her from the allergic responses in the morning. Ideally, she can benefit from 5mg per oral. Four times a day. This can help reduce the cough as well as nasal congestion and irritation. On the other hand, she can be given 5mg of Loratidine four times a day. These medications will help in reducing the allergic reactions in the patient thu...