Differential diagnosis for Patches: Contact dermatitis, Atopic dermatitis, and eczema

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Respond to the 2 following discussion posts separately with separate reference lists. References to be no older than 5 years.
1. rin Wix posted Nov 3, 2022 4:35 PM
The differential diagnoses for this pediatric patient could be asthma, atopic dermatitis, and otitis media with effusion. The atopic triad, which consists of eczema, seasonal allergies, and asthma, is a prevalent association between these three diseases. Although asthma typically first manifests in childhood, when both incidence and prevalence are highest, it can strike at any point in life. Coughing, wheezing, chest tightness, and shortness of breath are common asthmatic symptoms. Symptoms are frequently sporadic and can be brought on by a variety of things, such as exercise, exposure to allergens, upper respiratory tract infections, and airway irritants like tobacco smoke (Martin et al., 2022). A short-acting beta agonist inhaler should be made available to asthmatic children in order to relieve their symptoms. It is necessary to intensify treatment if a SABA inhaler is used on average more than twice a week over the course of a month (Global Initiative for Asthma, 2021). In order to decrease flares and improve symptoms, atopic dermatitis requires both basic skin care and topical anti-inflammatory medications. Applying moisturizer to the child after bathing is advised, and aggravating elements like long, hot showers and irritants like soaps, cleansers, scents, and wool should be avoided (Kapur et al., 2018). Medication for allergies can assist if the patient’s ear pain is caused by fluid in the ear and not necessarily an infection. An antibiotic is necessary, nevertheless, if the patient’s physical examination reveals acute otitis media (Danishyar & Ashurst, 2022).
Ventolin HFA MDI 90 mcg 2 puffs inhaled q4-6h as needed.
Triamcinolone topical ointment 0.025% apply bid
Cetirizine 2.5mL/day PO at night
Acetaminophen 10-15mg/kg PO q4-6 hours for pain
Amoxicillin 90mg/kg/day in two divided doses for 10 days.
Danishyar, A., & Ashurst, J. V. (2022). Acute otitis media. StatPearls[Internet]. https://www.ncbi.nlm.nih.gov/books/NBK470332/
Global Initiative for Asthma. (2021). Global strategy for asthma management and prevention. https://ginasthma.org/gina-reports/
Kapur, S., Watson, W., & Carr, S. (2018). Atopic dermatitis. Allergy, Asthma & Clinical Immunology, 14(S2).https://doi.org/10.1186/s13223-018-0281-6
Martin, J., Townshend, J., & Brodlie, M. (2022). Diagnosis and management of asthma in children. BMJ Paediatrics Open, 6(1), e001277. https://doi.org/10.1136/bmjpo-2021-001277
2. Omowunmi Ajimoti posted Nov 3, 2022 4:07 PM
Hi Everyone and Professor,
In this case-study, the child is presenting with respiratory symptoms, ear infection, and patches of the skin.
The mother mentioned that this happens to her when she gets sick, I am assuming that this is not new. The patient is most likely having acute Asthma attack and this is evidenced by wheezing. Wheezing is caused by narrowing of the bronchiole. According to National Heart, lung, and Blood institute (2022), during Asthma attack, the airways swell and narrow making it harder to breathe (National Heart, lung, and Blood Institute, 2022). You may also see wheezing, breathlessness, chest tightness, and cough in other patients (Tesse et al, 2018). Practitioner must also assess oxygen saturation with an oximeter and may apply oxygen when saturation is low. Bronchodilator should be prescribed
Differential diagnosis:
For asthma: Acute Asthma, upper respiratory infection, and Acute bronchitis.

Rationale: Children in this age category often suffer from respiratory problems. This may be due to upper respiratory infection, viral infection, or other etiology. This patient is having symptoms of acute asthma needs immediate intervention to prevent lung collapse which can lead to death. According to Tesse et al, (2022), treatment decisions on childhood asthma management should be critically made (Tesse et al., 2022).
Treatment for this child will include a bronchodilator. The drug classification in this category is salubutamol or inhaled corticosteroid.
Dosage: Salbutamol syrup 2mg/5ml 3 to 4 times per day.

Ear Pain: Ear pain is common in kids of this age. This could be otitis media and otitis externa.
According to Danishyar & Ashurst (2022), 80% of all children will experience a case of otitis media during their lifetime and 80% and 90% will have otitis media with an effusion before school age. Infection can also be viral or bacteria in nature and practitioner must determine the course of treatment based on the presenting symptoms. Otitis externa (OE) is an inflammation that can be either infectious or non-infectious of the external auditory canal and can extend to pinna or tragus of the ear (Medina-Blasini & Sharma, 2022).

Differential diagnosis for ear pain: Otitis Media, otitis externa, ear infection.

Rationale: Kids have a shorter eustachian tube and are therefore susceptible to infection.
According to Danishyar & Ashurst (2022), the bacteria responsible for ear infection are streptococcus pneumoniae, followed by non-typeable Haemophilus influenzae and Moraxella catarrhalis (Danishyar & Ashurst, 2022).
With ear pain or infection, the first intervention is to do a thorough examination and view the ear canal with otoscopic. With ear infection, the ear is gray pale which can accompany purulent drainage, pain, and fever. Younger children or infant will pull on their ears to signify that they have pain. It is very important to treat the ear infection promptly to prevent complications.
Treatment goal include antibiotic and pain control
For Otitis media: Amoxicillin is a drug of choice for kids of this age.
Rationale: Amoxicillin is effective in treating gram positive infection and most pediatric patient tolerate Amoxicillin very well with fewer side effects.
Amoxicillin 45 to 60mg/kg per day in 3 divided doses and Amoxicillin-clavulanate should be considered with purulent conjunctivitis (Sakulchit & Goldman, 2017).

For Otitis Externa: Polymyxin B, neomycin and hydrocortisone 3 to 4 drops to the affected part four times a day. (Medina-Blasini & Sharma, 2022).

Skin Patches: The third health concern is complaint of patches on the child’s elbows and behind her knees which fit the descriiption of an eczema.

Differential diagnosis for Patches: Contact dermatitis, Atopic dermatitis, and eczema.

Rationale: Older kids and teens usually get the rash in the bends of the elbows, behind the knees, on the neck, or on the inner wrists and ankles (Kids Health, 2019).
Treatment: Oatmeal bath is a gentle way to start treating eczema.
Rationale: This is a natural emollient and can help reduce inflammation. Steroid can be added if emollient is not effective. With eczema, oatmeal bath can help.

In conclusion, patient teaching is very important. The mother can be taught on how to monitor saturation and watch for signs of a severe respiratory problem. Mother should call 911 if patient is desaturating or has shortness of breath.

Danishyar, A. & Ashurst, V. J. (2022). Acute Otitis Media. National Library of Medicine. Treasure Island (FL): StatPearls Publishing; 2022 Jan.

Tesse, R., Borrelli, G., Mongelli, G., Mastrorilli, V., & Cardinale, F. (2018). Treating Pediatric Asthma According Guidelines. Front Pediatr. 2018; 6:234. Doi:10.3389/fped.2018.00234

Sakulchit, T. & Goldman, D. R. (2017). Antibiotic therapy for children with acute otitis media. Can Fam Physician. 2017. Sep; 63(9): 685-687.

National Heart, lung, and Blood Institute (2022). Asthma. NIH. https://www.nhlbi.nih.gov/health/asthma/attacks

Medina-Blasini, Y. & Sharman, T. (2022). Otitis Externa. NIH National Library of Medicine. Treasure Island (FL): StatPearls Publishing; 2022

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