John is a 13 yr 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 sorethroat, 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. 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 nighttime 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, Zyrtec 10mg QD, Tylenol 500mg -1tab prn for headache and chills.
Family Medical History: Father: HTN; Mom: healthy. 3 siblings-all healthy
Drug Allergy: NKDA
Social History: Denies alcohol or cigarette use. Denies illicit drug use. Occupation: Student.
Vaccination: 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: 22, wt: 132lbs, Ht: 66inches
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 x 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
L.C’s values
WBCs
12,000
Neutrophil
8,500
Lymphocyte
4,500
Platelet
190, 000
Hemoglobin
14
HCT
38%
CXR Result
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. Discuss the pathophysiology of the selected diagnosis.
2. Present and briefly discuss(rationale) 3 differential diagnoses for this patient.
3. Discuss plan of care for this patient-pharmacological, education, referral, and need for further diagnostic testing if any. Discuss thoughts about his asthma?.
3 References within the last 5 years
One of the quickest developing and the most fascinating of roots originate from is Hispanic/Latino Americans. I favored this ethnic gathering as it the greatest developing populaces in the US so I can more beneficial identify with them. Moreover, my consideration after accomplishing my Paralegal degree is inside Human Trafficking just as Sex Trade which connect with this Hispanic/Latino Americans amidst others. Moreover, my child in-law is Hispanic American additionally therefore I might want to realize all the more concerning his way of life.
Being a quickly developing network, somehow, we as Anglo-Non Hispanic Americans have a relationship with them. As far as it matters for me, my child in-law is a Hispanic American, and I need to adapt a greater amount of his rich culture. Additionally, we can see that a great deal of activities are being attempted to make their quality increasingly articulated in the network. It would never again come as an unexpected at that point, if the status and affirmation of their quality would altogether change later on. In this manner, their way of life merits considering. Everything considered, I can say that my explanations behind needing to think about this gathering and their way of life are not only hence. I am keen on a progressively explicit are, which is the contribution of ethnic gatherings in Human Trafficking and Sex Trade. It tends to be seen that these unlawful exercises basically targets people from the minority gathering, and in acquiring my Paralegal degree, I have in excess of a passing extravagant for these worries.
Language and Population: we should initially have an essential comprehension and valuation for their way of life before really expounding on the worries that are as of now being looked by the general population with Hispanic source. This will at that point be our reference in the sort of life they are commonly living. It was referenced before that the Hispanic populace is the quickest developing network in the United States. They establish 11% of the nation’s populace, and overviews have appeared there are around 31 million individuals who have Hispanic starting points (Clutter and Nieto). On the off chance that most races are being recognized fundamentally as a result of their physical properties, the Hispanic Americans have an alternate reason that quandary them together. Japanese, Koreans, and Vietnamese, among others, and basicaly Asians are being distinguished due to their eyes and physical appearance. Africans are recognized in view of the shade of their skin. For the Latinos, it is extraordinary. They can’t follow their inceptions in only one nation (Garcia). When we consolidate a Cuban, an Argentine and an Argentine, we will see different societies that don’t really harmonize. One thing ties them together, and that is their language (Arana). In fact, as most different networks who are adjusting to new societies, this is progressively getting to be overlooked. In any case, it can’t be denied that they are being bound by one language, and this is Spanish (Arana). This is the perspective for the blended and different societies that the Hispanos have.
All things considered, there had been a relentless decrease in the familiarity of communicating in Spanish among the Latinos. This is a direct result of their persistent and expanding collaboration with non-Hispanics, which made their routine with regards to their local tongue constrained. Now, it is useful to take note of the advancement of way the Hispanic Americans see themselves. Progressively, they are getting to be resolved to be brought in a way they think befit them. For one, less and less of them have been allude to themselves as Americans (Englekirk and Marin). The greater part of them are increasingly agreeable in as yet alluding to themselves as Mexicans. Being Hispanic or Latino, is by all accounts increasingly worthy to them, than be recognized to be the Americans.
Contrasts and likenesses between Anglo-Non Hispanic Americans and Hispanics/Latino American are not a few in some cases individuals trait who and what they are today to where they originated from, and what sort of family brought them up. Numerous examinations have endeavored to connect one’s conduct, wellbeing, and different things with family ancestry and hereditary qualities. There still exist the discussions and discourses about nature instead of sustain. In every one of these things, family ancestry, including one’s family tree, ends up unmistakable. Without a doubt, in my very own case as an Anglo-Non Hispanic American, my family turned out to be exceptionally compelling in the individual that I have progressed toward becoming.
Raised as a Methodist, festivals of Christian occasions, for example, Christmas and Easter occur in our homes as Anglo-Non Hispanic Americans, Perhaps this additional delight to adolescence, as I can’t envision one without the celebrations which conveyed straightforward delights to me at that point. In fact, our own was not an extremely religious family, and I can say that it is more so now than at that point, as we quit going to chapel as a family while I was still in secondary school.
To the extent working is concerned, I can sincerely say that the hard working attitude in my family is surely exceptionally solid as Anglo-Non Hispanic Americans. This is by all accounts the characteristic inclination for the ladies in the family. Evidence to appear, every one of the ladies in our family worked outside the home. This is notwithstanding the duty of dealing with the youngsters and of the homes themselves. My assenting father and mother, in spite of the fact that the last isn’t near me, were educators/managers. My stepmother was utilized in a similar calling as my new parents. Indeed, even my grandmas on the two sides filled in also. This isn’t to say, however, that our own has split far from the customary method for living that has been in presence amid our time. While I was growing up, young ladies were not prepped for school. They were not urged to seek after advanced education so as to have professions of their own. We have not been set to vanquish the world, as the young men in the family do. What occurred in my life was the pattern amid those days. I began working while I was still in secondary school, wedded a while later, and brought up my own kids. At this day and age, ladies never again do that. Professions are being set up as much by men as by ladies.
The nearest likeness between Anglo-Non Hispanic Americans and Hispanics/Latino American is most likely the sentiment of not being acknowledged notwithstanding frequently being rejected. I have felt that path as an Anglo-Non Hispanic American now and again, being embraced however I am certain it doesn’t measure up to the level of their conditions. It resembles salsa and ketchup, which are two altogether different toppings however both have their own critical and striking highlights. As far as concerns them, the Latinos have particular family esteems that are entirely outstanding for sure. Family is the very pith of their living, and this significance and regard that is being concurred to the idea of familial for the most part reaches out to more than the close family. They pass by the traditional standard seeing the dad as the leader of the family. The mother at that point, is accountable for everything that is worried about issues of the home. They feel a solid awareness of other’s expectations for recognizable worries that incorporate, yet are not constrained to, money related issues, medical problems, and such different worries that influence the condition of living at home.
Additionally, they have certain behaviors and convictions that recognize the Anglo-Non Hispanic Americans and Hispanics/Latino American from most societies is the manner in which they converse with one another is one, as they will in general treat each other with convention. On the off chance that we are to contrast this and the American way, which is normally casual and easygoing in nature, there is undoubtedly a huge distinction. It is to be noticed that Latinos talk in a noisy, quick and vivified way when the discussion is casual in nature. At the point when that isn’t the situation, every discussion is then punctuated before all else and toward the end, of confident handshakes. Non-verbal communication and motions like a peck in the cheek connotes how close a Hispanic individual is to the individual one is conversing with. Most striking additionally is the specific consideration given by Latinos to their looks and appearance. This, for them, is particularly regarding honor, pride and poise (Clutter and Nieto). Accordingly, usually to see all around prepped and immaculately dressed Hispanic individuals amid get-togethers, church occasions, and in work. This code of behavior unwinds amid casual occasions, and sneakers and pants are turning into the famous decision of the general population moreover. As far as time the board however, they are more adaptable and less aware of promptness than generally Americans. Being late is a socially worthy conduct for the Hispanic individuals, since that is the sort of culture that they are utilized to. Additionally, we have talked about before that what ties the general population is their language. They stay associated, regardless of the social and verifiable contrasts, on account of this factor. Thinking about this, it would be seen at that point, on the off chance that they attempt to decrease their open talking. It was noticed that by and large, most Latinos are held in open talking, and this is a result of their overwhelming accent (Clutter and Nieto). In spite of the fact that this may even now be valid as of not long ago, we can say this is quickly changing, as the vast majority of the more youthful ages who are inundated in the American culture, tend to be less familiar of their local language, than of English.
Religion is part of their way of life that is important is the religion of the Hispanic people group. The vast majority of them are Roman Catholics, comprising over 90% of the populace, and this by one way or another impacts the other social conventions, practices, and convictions of said people. The center of the Hispanic culture, in this manner, does not simply mean music and sustenance. There is a profound establishment in the vast majority of the things that they do and put stock in. For example, these individuals are known for the inventiveness and promotion that is available in their merriments and festivities. What we don’t understand is that they put more weight and criticalness to the festivals that is connected with religion, similar to supporter holy people’s days, as opposed to birthday celebrations and individual merriments.
The equivalent goes valid for the circumstance that