You are seeing an 89-year-old male who has a history of smoking 2 packs of cigarettes a day for 69 years.

You are seeing an 89-year-old male who has a history of smoking 2 packs of cigarettes a day for 69 years.

He quit smoking cold turkey when he was 78 years old.

He is in your office for a general health evaluation.  He reports ongoing challenges with ‘belching’ but other than that he conveys that he is feeling pretty good.

He is on no routine medications.   

During your interview with the patient you note that he utilizes pursed lip breathing.  At times you note a faint ‘whistling’ sound associated with his respiratory effort.

 In conducting your review of systems he reports a cough, particularly in the mornings, productive for thick clear to white sputum.

When queried about shortness of breath he does indicate that he gets SOB more easily than he used to.

His breath sounds are course and diminished in the lower lobes bilaterally.  

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

DQ2 Treatment of URI

Scenario: You are seeing a 34-year-old multi-race female who is a school counselor.

She reports a 3-day history of a sore throat, rhinorrhea, nasal stuffiness and postnasal drip.

She states she thinks she may be running a low-grade fever but reports she has not actually taken her temperature.

She reports feeling tired.

She has a history of migraine headaches for which she utilizes ibuprofen as needed.  She has a script for Maxalt if needed however reports she hasn’t used that in several years.

She is on hormonal contraceptive management.  BP 112/66, P 68, Resp 18, Temp 98.7, SpO2 99% on RA

On your exam you note clear nasal discharge, tympanic membranes are pearly gray, posterior pharynx is erythematous, no tonsillar enlargement noted.

Breath sounds are clear bilateral.

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.