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A 9-year-old boy A9-year-old boy presents with a complaint of chest tightness, cough, and shortness of...

A 9-year-old boy A9-year-old boy presents with a complaint of chest tightness, cough, and shortness of breath. This usually occurs during periods of exertion, but he has also woken up several times during the night with similar symptoms. His general health has been good and his physical exam, including breath sounds, is normal at this time. What possible diagnosis should be explored?

(a) How should this boy be assessed for airflow obstruction?

(b) What medication, dose, and route of administration would you suggest?

(c) How should he monitor his response to his medication

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Answer #1

Diagnosis: Paroxysmal Nocturnal Dyspnea(Nocturnal Asthma)

a) Paroxysmal Nocturnal Dyspnea in which, patients may have airflow obstruction while sleeping, they will woken up in between.

*Make the child to sleep, assess the recurrence of obstruction.

*Auscultate the lungs for any abnormal sounds

*Monitor vital signs especially respiratory rate

b)*Bronchodilators like Salbutamol 5mg nebulization or puff 100 mcg as a reliever and Stat with long term therapy of preventers of MDI.

*Diuretic therapy, to avoid fluid retention through Intravenously

*Cardiac medication therapy to protect heart from increased blood pressure and heart rate.

C)* Assess the symptoms whether reduced or not

*See the vital signs are normal

*Explain parents to monitor child while sleeping, whether having waking up

*Normal activities of child

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