nstructions: Out of the presented case scenario below, prese
nstructions: Out of the presented case scenario below, present the… nstructions: Out of the presented case scenario below, present the Pathophysiology of the identified illness and corresponding drug study. ( Pathophysiology – 50 points/ Drug Study – 50 points)BRONCHIAL ASTHMAA12-year- old comes in with a complaint of coughing for 2 weeks. Coughing is present every night. He has also had a mild fever, but his temperature has not been measured at home. His parents have been using a decongestant/antihistamine syrup and albuterol syrup which were leftover from a sibling. Initially, the cough improved but it worsened over the next 2 days. He is noted to have morning sneezing and nasal congestion. There are colds going around the school. He has had similar episodes in the past, but this episode is worse. He has no known allergies to foods or medications.His past history is notable for eczema and dry skin since infancy. He is otherwise healthy and he is fully immunized. His family history is notable for a brother who has asthma. In his home environment, there are no smokers or pets.Exam: VS T 38.1, P 100, RR 24, BP 85/65, oxygen saturation 99% in room air. He is alert and cooperative in minimal distress if any. His eyes are clear, the nasal mucosa is boggy with clear discharge, and his pharynx has moderate lymphoid hypertrophy. He has multiple small lymph nodes palpable in his upper neck. His chest has an increased AP diameter and it is tympanitic (hyper resonant) to percussion. Rhonchi and occasional wheezes are heard on auscultation, but there are no retractions. The heart is in a regular rhythm and no murmurs are heard. His skin is dry, but not flaky, inflamed, or thickened.He is initially felt to have moderately persistent asthma and possible asthmatic bronchitis. He is initially treated with nebulized albuterol and nebulized corticosteroids for bronchospasm and bronchial inflammation. He is also treated with an antihistamine at night to reduce his morning allergy symptoms. In follow-up, his cough does not improve and he is still having fever (T 38.2C, 101.0F). A chest X-ray is obtained, but no radiographic evidence of pneumonia is present. His cough persists, but only with exercise and drinking cold juice.His chest now sounds clear in the office. After one week of no night cough, his nebulized albuterol+corticosteroid is reduced to 2 times a day. His exercise-induced cough gradually resolves. His nebulized corticosteroid is replaced with nebulized cromolyn twice a day and oral montelukast (a leukotriene inhibitor) is added. He enrolls in a soccer league and plays with minimal coughing. His routine nebulized albuterol+cromolyn is stopped and is used only pre-exercise to prevent exercise-induced bronchospasm. No cough is observed at night or with exercise. He is continued on nightly antihistamines, pre-exercise albuterol+cromolyn nebs, and once-daily montelukast. He is given an asthma treatment plan which gives his parents clear instructions on which medications to start based on his symptoms and severity. Health Science Science Nursing
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