Bronchiolitis
It is a condition characterized by the inflammation of the bronchioles due to a viral illness. It is common among children under two years and a main cause of respiratory distress in this population. Though the condition is viral, it is common during the winter months.
Pathophysiology and Clinical Presentation
Outbreaks of this condition are linked to a respiratory syncytial virus that causes “inflammation of the lining of the epithelial cells of the small airways in the lungs causing mucus production” (Erickson et al., 2023). One of the most significant clinical presentations is wheezing associated with the inflammation of these cells obstructing the airway hence, the wheezing. The patient will also manifest symptoms like a running nose, reduced appetite, and cough for over three days. Further, they may present nasal congestion, which is linked to the increased production of mucus hence, the congestion. Since the obstruction happens to the tinniest air passages, their blockage can cause shortness of breath and skin discoloration due to a lack of oxygen that warrants emergency treatment. Other clinical manifestations include fever, fatigue, and tachypnea.
Physical Examination and Diagnostic Testing
Physical examination entails listening to the patient’s breathing, where wheezing or abnormality of the lungs can be heard with a stethoscope. The symptoms presented are important physical aspects of the condition, which should be combined with the patient’s medical history. However, this may not be enough to confirm the diagnosis fully; therefore, diagnostic tests like immunofluorescent and enzyme immunoassay techniques should be employed. The two detect any viruses in the patient’s nasopharyngeal specimen because the condition is associated with viral infections (Silver & Nazif, 2019).
Pharmacological and Non-pharmacological Management.
Management of bronchiolitis aims at reducing the possibility of low oxygen in the body or pauses in breathing, especially in infants, which could be fatal. Also, the treatment’s primary focus is relieving symptoms, such as difficulty breathing. The first line of pharmacological treatment is the administration of antibiotics to fight the associated infection. However, Erickson et al. (2023) establish that they should be used when there is another infection on top of bronchiolitis in infants. Further, palivizumab prophylaxis is available to infants at risk, e.g., those born before 29 weeks or who have a chronic lung or heart disease, among other qualifications. In most cases, especially for infants, non-pharmacological management is preferred unless the condition is severe. This includes saline solutions to clear the excess mucus or suction. Insistence on hydration is essential, and close monitoring of the symptoms is vital in managing the condition.
Education /Health Promotion
Patients should be educated on the importance of keeping infants away from people with symptoms of a cough that increases their risk of bronchiolitis. Further, patients should hydrate regularly for effective recovery because the condition reduces appetite and causes fever. It is also important for the caregivers to ensure that the infants are in a humid room which can lighten the excess mucus and reduce obstructions. In this case, patient education aims to ensure close monitoring and reporting of any changes or worsening of the condition, e.g., skin discoloration due to less oxygen.
Need for Referral and Differential Diagnosis
When the condition affects babies involving a pediatrician is necessary; however, the condition is easily manageable by a general practitioner. Bronchiolitis can easily be mistaken for gastroesophageal reflux disease, asthma, and aspiration of a foreign body since it affects the respiratory system.
Pneumonia
This condition is characterized by an infection in the lungs caused by bacteria, fungi, and viruses, causing a build-up of fluids or pus in the alveoli. This condition can happen to both lungs or one, with bacterial pneumonia being the most severe, with approximately one million people being diagnosed with different kinds of pneumonia yearly.
Pathophysiology and Clinical Presentation
The condition compromises the exchange of gases in the alveoli and happens when the immune system is jeopardized. Jain et al. (2022) explain that within the lungs exist organisms at a perfect balance with the body’s immunity that protects the body against foreign organisms. However, when the resident organisms are compromised, the body’s responses cause an inflammatory condition that compromises the lungs. Therefore, some of the clinical presentations of this condition include trouble breathing as the exchange of gases is compromised. Fever with chills, loss of appetite, chest pain, a cough which may produce phlegm or dry cough, and generally feeling unwell.
Physical Examination and Diagnostic Testing
Physical examination involves the clinician asking questions about the symptoms experienced, including the duration of the cough or chest pain that worsens when breathing in or out. Further, with a stethoscope, the clinician will listen to the chest for differences in breathing. Also, they may tap lighting at the chest where compromised lungs, especially one with fluid, sound different.
Pneumonia shares symptoms with other respiratory conditions, thus the need for further diagnosis, including a chest x-ray for inflammation of the lungs. This can show any abnormalities in the chest, including pneumonia-associated infection. Pulse oximetry is a blood test that measures the amount of oxygen n the blood (NHLBI, 2022).
Pharmacological and Non-pharmacological Management
Pharmacological treatment depends on the causative factor making antibiotics, antiviral and antifungal drugs the first-line treatment. Jain et al. (2022) argue that when there is no underlying condition, an individual should respond effectively to pharmacological treatment; however, people with compromised immunity are at risk of complications, including a lung abscess. Non-pharmacological treatment addresses the signs, but plenty of rest and frequent hydration is necessary. Hydration is necessary to keep up the body fluids, especially with a reduced appetite.
Education/ Health Promotion
Patients with pneumonia should rest until they feel better because somebody’s activities require more oxygen, thus, straining the lungs. Smoking worsens the condition; thus, smoking cessation is mandatory for quick and healthy recovery. Diets with high proteins, like white meat, have anti-inflammatory properties that can help with the condition. Also, ensuring the patient is hydrated may include small amounts of fluids frequently. Using a humidifier helps open up the airways that are filled with fluids (NHLBI, 2022). Medication adherence is essential because bacteria that are not effectively eliminated may become resistant and recurrent, complicating future treatment. Reducing exposure to people with flu-like conditions or covering one’s mouth when sneezing may be a health promotion measure.
Need for a Referral and Differential Diagnosis
The need for a pulmonologist occurs when the patient has other conditions like asthma to ensure proper handling of both conditions. In severe cases of pneumonia, one needs to be treated in the hospital. Differential pneumonia diagnoses include COPD, pulmonary embolism, bronchiolitis, and other respiratory conditions.
Pleural Effusion
This condition is characterized by fluid build-up in the space between the lungs and the chest cavity. This condition is often caused by heart failure, cancer, or leakage into the cavity, interfering with normal breathing by reducing the capacity of the lung.
Pathophysiology and Clinical Presentation
Krishna et al. (2023) explain that the pleural cavity normally has minimal fluid necessary for the lubrication of the lungs and chest cavity. The hydrostatic pressure regulates this fluid, and any excess is absorbed into the lymphatic system. The excess occurs when the hydrostatic pressure or the absorption process is compromised, hence the accumulation. This situation presents itself in chest pain, especially during a cough which is also a symptom. The individual experiences shortness of breath or fever.
Physical examination and diagnostic testing
Through a light tap to the chest may indicate the presence of fluids in the lungs. Using a stethoscope, the clinician can listen to the difficulties in breathing. Further diagnosis is important where a chest CT or an x-ray are the golden standard tests as they present images of the lung situation. Jany & Welte (2019) highlight that fluid analysis is necessary to check the condition of the fluids, especially for infections or cancer. Also, patients with pneumonia, in addition to pleural effusion, are at increased mortality.
Pharmacological and non-pharmacological management
The goal of treatment is to ensure the proper functioning of the lungs by bringing the fluid to normal levels. Treatment depends on the underlying cause, where severe cases mandate a manual draining of the excess using a chest tube and antibiotics. Non-pharmacological management involves treating the symptoms where rest is most recommended to reduce straining the lungs, causing chest pain and coughs.
Education/ Health Promotion
The patient needs to have plenty of rest and avoid physical activities that strain the lungs through increased oxygen demand. The fluid may interfere with breathing, with the patient taking shallow breaths to avoid pain. Therefore, deep breathing exercise is important to ensure normal breathing. Smoking may interfere with the healing process or worsen the conditions; thus, smoking cessation is mandatory.
Need for Referral and Differential Diagnosis
A pulmonologist may be involved in severe cases, or when under other conditions like cancer or heart disease are involved. The differential diagnosis for pleural effusion includes pneumonia, atelectasis, injury to the diaphragm or congestive heart failure, diaphragmatic paralysis, or mesothelioma.
References
Erickson EN, Bhakta RT, & Mendez MD (2023). Pediatric Bronchiolitis. StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK519506/
Jain V, Vashisht R, Yilmaz G, et al. (2022). Pneumonia Pathology. StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK526116/
Jany, B., & Welte, T. (2019). Pleural effusion in adults—etiology, diagnosis, and treatment. Deutsches Ärzteblatt International, 116(21), 377. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647819/
Krishna R, Antoine MH, & Rudrappa M (2023). Pleural Effusion. Treasure Island (FL): StatPearls Publishing: https://www.ncbi.nlm.nih.gov/books/NBK448189/
National Heart, Lung and Blood Institute (2022). What is Pneumonia? https://www.nhlbi.nih.gov/health/pneumonia
Silver, A. H., & Nazif, J. M. (2019). Bronchiolitis. Pediatrics in review, 40(11), 568-576. https://renaissance.stonybrookmedicine.edu/system/files/Acute%20Bronchiolitis.pdf
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