fnp 591 Week 2: Discussion Question – HEENT or Respiratory System
REPLY TO EMILY
Case study: A 52-year-old male presents to the clinic with a productive cough for 5 days.
Coughing is a prevalent occurrence. Documenting all symptoms, including the cough’s severity, length, and characteristics, is important. Questions that need to be asked are the following: When did the cough start? What is the mucus consistency and color (check if there is blood)? Ask for allergies and what triggers the cough. Has the patient been in contact with people with respiratory infections? What is the patient’s medical illness? Check if the patient is smoking or using drugs.
Differential Diagnosis
Acute Bronchitis J20.9
Acute bronchitis patients usually have a productive cough, lethargy, trouble breathing,
and wheezing. Usually, the main complaint is a persistent cough accompanied by clear or yellowish sputum output.
- Diagnostic: Measurement of oxygen saturation in addition to pulse rate, temperature, and respiratory rate. The American College of Chest Physicians (ACCP) has developed evidence-based recommendations that, when certain conditions are satisfied HR >100 bpm, RR >24 breaths/min, Temp >38C, + for egophony/fremitus)to obtain a Chest X-ray (Singh et al., 2022)
Laboratory: complete blood count and chemistry panel
Treatment: Acute bronchitis is treated mostly with supportive and symptomatic treatments. Dextromethorphan (with or without codeine) effectively treats chronic bronchitis symptoms (Singh et al., 2023).
Management: There are pharmacological and nonpharmacological ways to treat cough. Nonpharmacological approaches include throat lozenges, honey, ginger, and hot tea.
Upper Respiratory Infection J 06.9
Upper respiratory tract infections are characterized by temporary inflammation and
swelling of the upper airways, resulting in coughing. These infections do not include pneumonia, any other underlying illness that may explain the symptoms, or a history of COPD/emphysema/chronic bronchitis. Upper respiratory tract infections encompass the nasal passages, sinuses, throat, voice box, and the major air passages. Various pathogens, including viruses and bacteria, can lead to upper respiratory tract infections. These pathogens are responsible for various illnesses in patients, such as acute bronchitis, the common cold, influenza, and respiratory distress syndromes (Thomas & Bomar, 2022).
Diagnostics: Nasal aspirates and swabs are the optimal specimens to collect for evaluating newborns and young children. Swabs and aspirates from the nasopharynx are recommended for obtaining samples from older children and adults. Rapid strep swabs can exclude bacterial pharyngitis, potentially reducing prescription medicines for these diseases.
Treatment: Decongestants and combination antihistamine/decongestant medicines help alleviate cough, congestion, and other symptoms in adults. Evidence-based data do not support antibiotics in treating the common cold since they do not enhance symptoms or reduce the duration of sickness. Vitamin C is utilized as a regular preventive measure.
Management: The objective of treating the common cold is to alleviate symptoms. The most efficient way to avoid getting influenza is to be vaccinated.
Pneumonia J18.9
Pneumonia is a contagious respiratory illness that can affect one or both lungs. It leads to the accumulation of fluid or pus in the lungs’ air sacs, also known as alveoli. Bacteria, viruses, and fungi are all potential causes of pneumonia, including cough with or without mucus, fever, chills, and respiratory difficulties (NIH, 2022).
Diagnostics: Physical examination and chest X-ray (CXR)
- Treatment: Antibiotics for bacterial infections, antiviral medications for viral infections, and antifungal drugs for fungal infections. Azithromycin is the preferred first antibiotic for treating uncomplicated pneumonia because it effectively targets most of the possible causes of the infection (NIH, 2022).
Management: Involves implementing home care measures such as ensuring sufficient rest, consuming ample fluids, taking warm baths or showers, using fever-reducing medications, and refraining from smoking. Pneumonia vaccinations may necessitate hospitalization in extreme instances (NIH, 2022).
Asthma J45.909.
Asthma is a persistent medical illness characterized by inflammation and constriction of the air passages in the lungs. It is typically accompanied by wheezing, coughing, shortness of breath, and chest tightness.
Diagnostics: Lung function testing includes spirometry, peak expiratory flow, and allergy tests. Blood tests are conducted to detect the amount of white blood cells (WBC).
Treatment: Inhaled short-acting beta2-agonists (SABAs) dilate the airways to facilitate air passage. Oral corticosteroids alleviate inflammation in the airways. Short-acting anticholinergics rapidly dilate the airways.
Management: Involves understanding and identifying triggers, implementing lifestyle changes that include regular exercise, weight management, managing stress, quitting smoking, and ensuring excellent quality sleep. (National Heart, Lung, and Blood Institute, 2022)
Chronic Obstructive Pulmonary Disease J44.9
(COPD) encompasses both emphysema and chronic bronchitis.
Diagnostics: Spirometry is a medical procedure to assess lung function (Centers for Disease Control and Prevention, 2023).
Treatment: Short-acting bronchodilators Beta-2 agonist inhalers, such as salbutamol and terbutaline, and antimuscarinic inhalers, such as ipratropium; Long-acting bronchodilators
- Beta-2 agonist inhalers, such as salmeterol, formoterol, and indacaterol; Antimuscarinic inhalers, such as tiotropium, glycopyronium, and aclidinium; Corticosteroid inhalers;
Theophylline pills(Centers for Disease Control and Prevention, 2023)
Management: quit smoking, avoid pollutants and exposure to smoke, supplemental oxygen
Centers for Disease Control and Prevention. (2023, June 30). COPD: Symptoms, Diagnosis, and Treatment. Centers for Disease Control and Prevention; CDC. https://www.cdc.gov/copd/features/copd-symptoms-diagnosis-treatment.html
National Heart, Lung, and Blood Institute. (2022, March 24). What Is Asthma? Www.nhlbi.nih.gov. https://www.nhlbi.nih.gov/health/asthma
NIH. (2022, March 24). Pneumonia – Recovery | NHLBI, NIH. Www.nhlbi.nih.gov. https://www.nhlbi.nih.gov/health/pneumonia/recovery
Singh, A., Avula, A., & Zahn, E. (2023, December 26). Acute bronchitis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448067/
Singh, A., Avula, A., & Zahn, E. (2022). Acute Bronchitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448067/#
Thomas, M., & Bomar, P. A. (2022). Upper respiratory tract infection. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532961/
2 hours ago
- A 52-year-old male presents to the clinic with a productive cough for 5 days. Describe at least 5 more questions the FNP should ask this patient in the health history. Please generate at least 5 differential diagnoses for a cough. Describe how the FNP would clinically manage and follow up this patient based on each differential diagnosis.
Cough is an innate primitive reflex and a mechanism of our body to protect us from foreign materials. Due to its vagueness and wide variation of clinical associations and etiologies, cough requires a comprehensive medical history and assessment to determine the appropriate treatment and management (Dunphy et al., 2019). Since this patient has had a productive cough for only 5 days, it is considered acute. An acute cough is referred to as acute if it is only present for less than three weeks. It is considered subacute if the cough is present for three to eight weeks and labeled as chronic cough if it is more than eight weeks (Sharma et al., 2023). Here are the following questions a provider should ask the patient in order to come up with the appropriate final diagnosis, according to Dunphy et al. (2019):
“When did your cough first start?” – asking about what precipitated the cough (e.g., recent respiratory infections, exposure to irritants or noxious agents through work or environment, and taking a new medication)
“When does the cough occur?” – does it occur upon arising from bed? During bedtime? While exercising? Or throughout the night?
“What is the quality of the cough?” – Is it dry, hacking, wet, raspy, deep, or throaty?
“If the cough is productive, would you describe the amount of sputum you have per day, its color, and its consistency?”- Is it more productive in the morning or nighttime?
“Have you tried any relieving measures for your cough? – Have you taken any medications for it? Do you get relief when you are in a certain position, such as sitting upright?
The Differential Diagnoses include:
Acute Upper Respiratory Infection, unspecified (J06.9)
Upper respiratory tract infections are mostly caused by viruses and bacteria and can be classified as self-limiting that irritates and causes swelling of the upper airways associated with cough and no proof of pneumonia, lacking a separate condition to account for the patient symptoms, or with no history of COPD, emphysema, or chronic bronchitis (Thomas & Bomar, 2023). It should be determined if the cause of the cough is viral or bacterial in origin. Antibiotic prescribing for viral infections is known to be ineffective and poses a serious threat to one’s health as it could lead to resistance (Aplin-Snider et al., 2020). Since it has only been 5 days, symptomatic therapy should be advised, such as having adequate rest, drinking plenty of water, having a cool mist humidifier, bathing in hot showers, drinking warm fluids e.g., ginger tea or chicken soup, and taking decongestants and/or expectorants such as dextromethorphan or pseudoephedrine/brompheniramine/dextromethorphan combination therapy may be used every 3 to 4 hours as needed (Dunphy et al., 2019). In addition to this, benzonatate (Tessalon Perles) 100 mg three times a day as needed for cough may also be prescribed. Advise patient to follow up after a week if symptoms don’t improve.
- Acute Bronchitis, unspecified (J20.9)
Acute bronchitis is also conceptualized as a viral infection that affects the bronchi and produces its main symptom: cough (Schubert et al., 2023). This cough can be persistent for a week, leading to several weeks, and maybe with or without sputum production. Because it mainly comes from viral origin and is also considered self-limiting, antibiotics are also not recommended. The same treatment and plan of care may be used with the previously discussed upper respiratory infection and a follow-up appointment of up to a week to re-evaluate the treatment plan if all advised measures are ineffective.
Allergic Rhinitis, unspecified (J30.9)
Allergic rhinitis is an IgE-mediated inflammatory disease of the nasal mucosa triggered by exposure to airborne allergens. It is usually characterized by nasal and non-nasal symptoms, such as itching of the palate, post-nasal drip, and cough (Nur Husna et al., 2022). First and foremost, I would advise the patient to avoid allergens, especially with seasonal symptoms, wash sheets in hot water, and use vacuum cleaners and humidifiers to reduce allergens indoors. Intranasal corticosteroids (mometasone, fluticasone, and triamcinolone) act as first-line pharmacotherapy by suppressing immune cell infiltration in allergic rhinitis are effective for both mild and moderate-severe allergic rhinitis in both children and adults (Nur Husna et al., 2022). New-generation antihistamines (cetirizine, loratadine, desloratadine, fexofenadine) can also be ordered as adjunct therapy as they demonstrate enhanced efficacy and safety profile. Advise patient to follow up after a week if symptoms persist with no improvement.
Acute asthma exacerbation, unspecified (J45.901)
Asthma is a common, non-communicable, and variable chronic disease that can result in episodic or persistent respiratory symptoms, e.g., shortness of breath, wheezing, chest tightness, and cough. It is caused by airway limitation, bronchoconstriction, airway wall thickening, and increased mucus. Inhaled corticosteroids such as fluticasone and beclomethasone are the mainstay in the treatment of asthma to control the symptoms, whereas quick-relief or rescue medicines such as short-acting beta-agonists (albuterol and levalbuterol) rapidly reduce airway constriction, both are used to manage asthma exacerbation (Papi et al., 2020). I will also propose an asthma action for long-term management and regular monitoring of asthma. I will also advise the patient to schedule an appointment after two weeks to see if the asthma guideline followed is effective on him and if there is no recurrence of exacerbation. If symptoms worsen rapidly, he should know when to call EMS or go to the nearest emergency room, especially when he has difficulty breathing and shortness of breath.
Pneumonia, unspecified organism (J18.9)
Pneumonia can be caused by a variety of microorganisms, including viruses, bacteria, and fungi. Common symptoms include fever, chills, shortness of breath, chest pain with breathing, productive cough that produces green or yellow sputum. It is often treated with a macrolide like azithromycin (Z-pack) or doxycycline in the primary care setting (File et al., 2022). Other pharmacologic medications can include benzonatate as needed for coughing, nebulization treatments such as albuterol or Xopenex for bronchodilation, and acetaminophen as needed for pain when coughing. The patient is advised to keep an upright position and drink plenty of fluids to allow respiratory drainage. I will ask him to come back to the clinic after a week if his condition is not improving, and if there is difficulty breathing, shortness of breath, or cyanosis, the patient should go to the nearest emergency room.
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.
