Consider the patient’s immediate presentation – what are you thinking? Why are you thinking that? Is it a gut feeling, or
is it because you have considered his age and gender and so therefore the most likely diagnosis because of his situation?
• This is to be written as a case study
• Word limit: 1000
• References: Strictly Vancouver
• Font: Arial.
• Professional language is used along with good academic writing skills to be demonstrated
• Peer reviewed research, textbooks, national guidelines etc (these can be Australian/UK/USA guidelines) to be
used. 6-8 references please.
• I have attached the case study I have been provided with by the university, which includes subjective and
objective data about this patient.
• This assignment should describe in detail the following:
1. Definition of each 3 differential diagnosis.
2. Pathophysiology of each of the 3 differentials in detail and the differences in children i.e. anatomy &
3. Epidemiology in Australia and internationally i.e. race, sex and age.
4. Clinical presentation of each condition and how this compares to the child’s signs, symptoms and vital signs in
the case study. Describe what the normal vital signs would be on a 3 yr old child.
5. Causes of each of the differential diagnosis.
6. Demonstrate a confirmed diagnosis and why this diagnosis was chosen (Reactive airways disease is my diagnosis)
i.e. from the child’s previous medical history of the same and subjective/objective data and vitals results. Look at most
important factors of severity i.e. child’s general appearance, mental state and work of breathing.
7. Please also discuss the relevance of the child’s vital signs in this case and their relevance being the most
useful diagnostic aid. i.e. the resp rate and depth, child is tachycardia due to the amount of salbutamol he received??
What SpO2 reading is normal etc etc?
8. Discuss how the patient is still too young to receive a formal diagnosis of asthma and why.
9. Pharmacological: Please discuss the treatment of choice for RAD in children and why i.e. inhaled short acting
beta 2 antagonist, brief description of their action, the recommended dose in children and any side effects.
Paediatric Case Study
PC – Shortness of breath and increased work of breathing
HPC – 3-year-old male presents to the Emergency Department with a two-day history of rhinorrhoea, a productive cough and
fevers. He woke up overnight gasping for breath and required his ventolin inhaler every three hours until 3am when it
became hourly. His mother called an ambulance at 6am. The patient (John) has a twin brother who was admitted to hospital
with the similar issue and was discharged only the previous day.
• Overall general health: Normally a healthy and sociable 3-year-old little boy. Normal weight for age and height.
Good appetite. Sleeps well.
• Immunisations: Childhood vaccinations up to date
• Allergies: Shellfish (urticaria)
• Past hospitalisations: Age 4 months with bronchiolitis, Age 2 x2 admissions with similar symptoms as today and 3
months ago with the same.
• Past medical illnesses: (as above)
• Past surgical illnesses: Nil of note.
• Pregnancy & Birth Hx: First pregnancy with non identical twin boys. Born pre term at 35+4 weeks by emergency
caesarean section for pre eclampsia. John was kept in the special care baby unit for 9 days post delivery. Birth weight
5lb and 6 oz.
• Medications: Fluticasone (Flixotide) inhaler 50mcg via spacer BD & Salbutamol (ventolin) inhaler 100mcg 1-2 puffs
• Social history: Lives at home with his parents and twin brother. Attends kindergarten twice a week.
Review of Systems
• Weight: Currently 15kg. No recent changes.
• Skin: Intact. No rashes, lumps, wounds or bruising.
• HEENT: No headaches or concussion, no visual or hearing problems, no sore throats or tonsillitis.
• Respiratory: Bronchiolitis age 4 months. Recent coryzal symptoms. No wheeze or productive cough.
• Cardiovascular: Nil significant.
• Gastrointestinal: No abdominal pain, diarrhoea, constipation or vomiting.
• GU: Nil significant.
• MSK: Nil significant.
• Vital signs: BP 100/75, HR 165-170, RR 35, T 38.4, SpO2 100% in room air, CRT <2 seconds, weight 15kg.
• General survey: sitting up on the bed watching a movie, alert, cheerful and interacting with myself and others.
• Skin: Looks pale. No obvious rashes, birth marks, scars or bruises. Good skin tugour and warm to touch.
• Head/Face/Eyes: Nil significant.
• Ears: Tympanic membranes intact and clear.
• Nose: clear discharge.
• Mouth & throat: moist pink mucous membranes, throat clear, no erythema or pus evident on tonsils.
• Neck: No cervical or supraclavicular lymphadenopathy. Trachea midline.
• Respiratory: RR 35bpm, SpO2 100% in RA, talking in full sentences. Symmetrical chest expansion, mild dyspnoea and
work of breathing. Mild inter-costal recession. No cyanosis. Auscultation: Equal air entry, no wheeze or stridor.
Productive cough with yellow sputum.
• Cardiovascular: Dual heart sounds. Nil added.
• Abdomen: Soft and non-tender. Active bowel sounds.
• Renal: No urinary symptoms.
• Neuro: GCS 15. Alert. Moving all 4 limbs. Normal gait.
• Endocrine: Nil significant.
• Nutrition: eats a well-balanced healthy diet. 3 meals a day plus snacks.
• Reactive airways disease (RAD)
• Upper respiratory tract infection (common cold)
• Acute bronchitis
• Reactive airways disease (RAD)
1. Management Plan: Non pharmacological oxygen, cardiorespiratory monitoring, pulse oximetry, offer fluid and diet,
monitor vitals every 30 mins or more frequently if his symptoms worsen, reassure child and mother and keep them fully
informed of the patients care, answereing any questions they may have. Look at guidelines for oxygen etc.