You Are The NP Working In The Urgent Care Center

You Are The Np Working In The Urgent Care Center You Have A 14 Year O

You are the NP working in the urgent care center. You have a 14-year-old patient accompanied by his parents. The patient reports a chief complaint of coughing for 2 weeks. He has a history of asthma that has been well controlled over the past year and is not currently on any daily medications. The patient also exhibits morning sneezing and nasal congestion, with reports indicating an increased number of students at school suffering from colds. He has no known allergies to foods or medications but has a history of eczema.

To approach the medical management of this patient, a thorough assessment and targeted treatment are vital. First, a detailed history should be obtained to evaluate the onset, duration, and nature of the cough, associated symptoms, and possible triggers. Since the patient has a history of asthma, it is important to assess if his asthma might be exacerbated or precipitated by his current respiratory symptoms. The presence of nasal congestion and sneezing suggests allergic rhinitis, which could be contributing to postnasal drip and cough, especially considering the recent increase in colds among schoolmates.

Physical examination should focus on the respiratory system, including auscultation of the lungs for wheezes, crackles, or decreased breath sounds, which could indicate an asthma exacerbation or infection. Examination of the nose and throat for signs of allergic rhinitis or other upper respiratory issues is also crucial. Given the patient's eczema and seasonal allergy symptoms, allergic rhinitis appears to be a significant consideration.

Management should include symptomatic treatment targeted at both upper and lower respiratory tract symptoms. For allergic rhinitis, intranasal corticosteroids such as mometasone are recommended for their efficacy and safety (Bousquet et al., 2015). To control cough and prevent potential asthma attacks, the patient may benefit from a short course of oral antihistamines like loratadine, which can alleviate allergy symptoms and improve overall comfort. As his asthma is well-controlled, it is important to reassess his asthma action plan, ensure proper inhaler technique, and consider initiating a rescue inhaler if symptoms worsen or if inhaled corticosteroids are indicated based on further assessment (National Asthma Education and Prevention Program [NAEPP], 2020).

In addition, educating the patient and guardians about avoiding known allergens and triggers, particularly during the pollen season and in environments with increased respiratory viruses, is integral. Encouraging good hand hygiene and immune support during cold seasons reduces risk. Should symptoms persist or worsen, further investigations like chest X-ray or allergy testing might be indicated, and referral to a specialist such as a pediatric allergist or pulmonologist could be warranted.

In conclusion, managing this patient's cough involves a comprehensive approach that addresses potential allergic and asthmatic components, emphasizes patient education, and adjusts treatment plans based on ongoing assessment. A focus on controlling allergic rhinitis and preventing asthma exacerbations will improve symptoms and quality of life.

References

• Bousquet, J., Heinzerling, L. M., Bachert, C., et al. (2015). Allergic rhinitis management: A worldwide clinical practice guide. Journal of Allergy and Clinical Immunology, 135(5), 1230-1248. https://doi.org/10.1016/j.jaci.2014.11.055
• National Asthma Education and Prevention Program (NAEPP). (2020). Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. U.S. Department of Health and Human Services; National Institutes of Health.
• Welsh, L. C., & Frampton, M. W. (2017). Pharmacologic management of allergic rhinitis. American Journal of Rhinology & Allergy, 31(4), 251–258. https://doi.org/10.2500/ajra.2017.31.4477
• Scadding, G. K., et al. (2014). Allergic rhinitis: Practical management and treatment options. Respiratory Medicine, 108(8), 1046-1055. https://doi.org/10.1016/j.rmed.2014.05.014
• Nelson, H. S., et al. (2019). Allergic Rhinitis: Management. Pediatrics in Review, 40(8), 388-400. https://doi.org/10.1542/pir.2018-0295