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Case Study 1: Rhinitis Allergy

Case 1 involves a 13-year-old boy with a history of asthma and allergic rhinitis who presents with morning sneezing and runny nose. His examination finds allergic shiners and serous nasal discharge. He is diagnosed with mild persistent allergy rhinitis and is overweight. Case 2 involves a 9-year-old girl with a history of asthma hospitalizations who presents with minimal shortness of breath. Her chest x-ray shows infiltrates and her echocardiogram finds mild pulmonary hypertension. She is diagnosed with persistent asthma, mild pulmonary hypertension, and malnutrition.

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216 views18 pages

Case Study 1: Rhinitis Allergy

Case 1 involves a 13-year-old boy with a history of asthma and allergic rhinitis who presents with morning sneezing and runny nose. His examination finds allergic shiners and serous nasal discharge. He is diagnosed with mild persistent allergy rhinitis and is overweight. Case 2 involves a 9-year-old girl with a history of asthma hospitalizations who presents with minimal shortness of breath. Her chest x-ray shows infiltrates and her echocardiogram finds mild pulmonary hypertension. She is diagnosed with persistent asthma, mild pulmonary hypertension, and malnutrition.

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Asfiksia Neonatorum
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CASE STUDY 1

Rhinitis allergy

Tri Yanti Rahayuningsih


RSUD Chasbullah Abdul Madjid
Kota Bekasi
Identity

◦ Initial : RW
◦ Gender : Male
◦ Age : 13 yo
◦ Height : 170 cm
◦ Weight : 80 kg
Identity
◦ Parent : Both have allergic
Mother : Nummular dermatitis, history of asthma
while pregnancy
Father : Allergic rhinitis
Siblings (20 and 18 yo) : Had childhood asthma
Basic data
◦ History of moderate persistent asthma when age <6 yo
◦ History hospitalization with severe asthma at age 5 yo and given
controller medication for asthma
◦ History of tonsillectomy at 6 yo
◦ After 10 yo mild asthma attack only appeared once a year and
relieved with ß2 agonist nebulization
Basic data
◦ After 10 yo allergic rhinitis develop especially in the morning
(sneezing and runny nose) and diseappear when environment
temperature become warmer
◦ He is an active child and routine bicycling about an hour
everyday
◦ He have cat at home
Basic Data
◦ Chief complaint : Sneezing and runny nose in the morning
◦ Clinical finding :
- Child alert, overweight
- Vital signs : RR 30x/m, HR 88 x/m, BP 100/70 mmHg,
body temperature 36,7˚C
- Head :
Eyes : Allergic shiners (+)
Eyebrow: Seborrhoic dermatitis
Nose : Serous nasal discharge (clear, watery)
Lip : normal
◦ Clinical finding
- Neck : Normal
- Lungs/thorax :
Chest wall symmetrical, no retraction seen
Percussion normal
Breath sounds : vesicular, no rales, no wheezing
- Cardiovascular :
Normal heart sounds, no murmur
- Abdomen : soft, no palpable of liver or spleen, bowel
sounds are normal
- Musculoskeletal : normal findings
◦ Diagnosis :
- Mild persistent allergy rhinitis
- Overweight

◦ Supportive examination : N/A

◦ Therapy :
- Avoidance to allergens suspected (smoke, mite, dust,
animal dander)
- Cetirizin
Problems
◦ Difficult to avoid animal dander, cat in the house, and family
loving it.
◦ Food allergen test?
◦ Weight management
CASE STUDY 2
Asthma

Tri Yanti Rahayuningsih


RSUD Chasbullah Abdul Madjid
Kota Bekasi
Identity
◦ Initial : DA
◦ Gender : Female
◦ Age : 9 yo
◦ Height : 111 cm
◦ Weight : 15 kg
Basic data
◦ History of asthma since age 2 yo
◦ History several hospitalization at PICU with severe asthma at age
6-7 yo and given controller medication for asthma
◦ Father have food allergy
◦ Patient have two sibling, one of them also food al;ergy
Basic Data
◦ Chief complaint : Minimal shortness of breath
◦ Clinical finding :
- Child alert, malnourished
- Vital signs : RR 30x/m, HR 98 x/m, BP 110/80 mmHg, body
temperature 36,7˚C, SpO2 97% (with O2 1 lt/m)
- Head :
Eyes : Allergic shiners (+)
Nose : discharge (-)
Lip : normal
◦ Clinical finding

- Neck : Normal
- Lungs/thorax :
Chest wall symmetrical, minimal substernal retraction
seen
Percussion normal
Breath sounds : vesicular N, minimal wheezing (+) both lungs
◦ Clinical finding

- Cardiovascular :
Normal heart sounds, no murmur
- Abdomen : soft, no palpable liver or spleen, bowel
sound normal
- Musculoskeletal : normal findings
◦ Supportive examination :

Ro thorax :
Infiltrat at supracardial and paracardial
Emphisematous
Prominent of pulmonal region

Echocardiography :
Mild pulmonary hypertension
◦ Diagnosis :
- Persistent asthma
- Mild pulmonary hypertension
- Malnourished

◦ Therapy :
- Avoidance to allergens
- Controller
- Sildenafil
Problems
◦ O2 dependent
◦ Prognosis
◦ Decrease quality of life
◦ Elimination and provocation test for food allergen?
◦ Nutrition management

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