Cough and Difficulty breathing

Case Study Week 7

Emily, age 6 presents to the clinic with her mother with complaints of cough and difficulty breathing. Two days prior, Emily developed a nonproductive cough (which is worse at night), clear rhinorrhea, and a fever with a maximum temperature of 102 °. The mother has treated the fever with Tylenol 320 mg every 4 hours, as needed, when the temperature was greater than 101 °.

Vital signs: Temperature 38 °, pulse 72, and respirations 28 per minute with a blood pressure of 100/52 in the left arm. The O2 saturation is 94%, and weight is 25 kg.

HEENT: Normocephalic with no evidence of trauma or lesions. Eyes show no signs of drainage, sclera white, with pink conjunctiva. Otoscopic examination reveals tympanic membranes gray bilaterally with positive light reflex and normal pinnae. The nose has clear rhinorrhea, no nasal polyps with pink turbinates. Examination of the throat shows a cobblestone appearance in the posterior pharynx, uvula midline, tonsils size 0/4 with no exudate or erythema, moist mucous membranes; and the trachea is midline.

Respiratory: Bilateral inspiratory and expiratory wheezing; mild intercostal retractions; mild shortness of breath; no rales, crackles or nasal flaring.

Questions

1. What diagnostic or imaging studies should beconsidered to assist with or confirm the diagnosis? Oxygen saturation, Chest X- ray or Nasal pharyngeal culture.

2. What is the most likely differential diagnosis and why? Foreign body aspiration, Bronchiolitis, Asthma or GERD.

3. What is the plan of treatment?

4. What is the plan for follow – up care?

Use APA 7th Edition Format and support your work with at least 3 peer-reviewed references within 5 years of publication. Remember that you need a cover page and a reference page. All paragraphs need to be cited properly. 
Please use headers.  All responses must be in a narrative format and each paragraph must have at least 4 sentences. Lastly, you must have at least 2 pages of content, no greater than 4 pages, excluding cover page and reference page.