start screaming and pulling at her ears? Cockroach in the ear – diagnosed from across the room. The child who came in on a cold fall/winter night with a low-pitched cough? Croup. It is important in any respiratory disorder to review possible
differential diagnoses before proceeding. Some disorders like epiglottitis, is an emergency and assessment can result in closure of the airway. This client is not demonstrating the classic symptoms seen with this disorder including high fever, sore throat, drooling, muffled voice and a tripod position (Brashers & Huether, 2017). Although there are some symptoms (such as the barking cough) that seem classic, did you entertain the possibility of asthma? What symptoms separate this child’s symptoms from that of asthma? Would more history be helpful? If so, what? In your post you noted the relationship of the genetic variantCD14 to inflammatory respiratory disorders such ascroup or asthma. Although not part of the diagnostic process, it was interesting to see a different single nucleotide polymorphism (SNP) is responsible for the manifestation of croup (CD14 C-159T) verses asthma (CD14 G-1359T) (Rennie et al., 2013). What may be applicable to direct patient care though is sharing with parents the potential link behind croupand later development of asthma. It was noted the risk for development of asthma was four-times higher in children with croup, especially in those from age 7-9 years (Lin, Lin, & Chiang, 2017).ReferencesBrashers, V. L. & Huether, S. E. (2017). Alterations of pulmonary function in children. In S. E. Huether & K. L. McCance, (Eds.), Understanding pathophysiology(6th ed., pp. 715-729). St. Louis, MO: Mosby.Hammer, G. D., & McPhee, S. J. (2014). Pathophysiology of disease: An introduction to clinical medicine(7th ed.). New York, NY: McGraw-Hill Education.Hiemstra, P. S., McCray, P. B., & Bals, R. (2015). The innate immune function of airway epithelial cells in inflammatory lung disease. The European Respiratory Journal, 45(4), 1150–62. Karunanayake, C., Hagen, B., Dosman, J., & Pahwa, P. (2013). Prevalence of and Risk Factors for Self-Reported Chronic Bronchitis in a Canadian Population: The Canadian Community Health Survey, 2007 To 2008. Canadian Respiratory Journal, 20(4), 231–236. Kline, J. M., Lewis, W. D., Smith, E. A., Tracy, L. R., & Moerschel, S. K. (2013). Pertussis: a reemerging infection. American Family Physician, 88(8), 507–14. Retrieved from KRESSIN, N. R., & GROENEVELD, P. W. (2015). Race/Ethnicity and Overuse of Care: A Systematic Review. Milbank Quarterly, 93(1), 112–138. Lin, S.-C., Lin, H.-W., & Chiang, B.-L. (2017). Association of croup with asthma in children: A cohort study. Medicine, 96(35), e7667. Rennie, D. C., Karunanayake, C. P., Chen, Y., Nakagawa, K., Pahwa, P., Senthilselvan, A., & Dosman, J. A. (2013). CD14 genevariants and their importance for childhood croup, atopy, and asthma. Disease Markers, 35(6), 765–71.
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- cough, Upper respiratory tract, lower respiratory tract