Description
Peer Responses:
Length: A minimum of 150 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
Relate to another journal reading
Week 2: Discussion Question – HEENT or Respiratory System
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.
As with any illness, the most crucial part of any medical assessment is gathering a complete and thorough medical history and doing a suitable physical examination. A clear clinical finding is the diagnosis of a cough. Coughing isn’t a sign of a sickness; it’s a symptom. Therefore, rather than coming for a cough diagnosis, many patients come for examination of the secondary or underlying consequences of cough. A history-taking session should include the following essential information: duration of cough, cigarette smoking, usage of angiotensin-converting enzyme inhibitors, weight loss, employment, and any accompanying dyspnea (Sharma et al., 2023).
5 Differential Diagnosis and describe how the FNP would clinically manage and follow up on this patient based on each differential diagnosis.
1. Acute Bronchitis (J20.9): Acute bronchitis patients often have a variety of symptoms, such as wheezing, dyspnea, fever, and a productive cough. The most common complaint is usually a persistent cough that produces clear or yellowish sputum (Singh et al., 2023).
The general course of treatment for acute bronchitis is supportive and symptomatic care, as the illness usually resolves on its own. Both natural and pharmaceutical methods may be taken into consideration for treating coughs. Natural medicines like honey, ginger, hot tea, and throat lozenges are examples of nonpharmacological tactics. The fact that clinical trials have not been used to assess the effectiveness of these therapies is significant. Based on findings from studies on cough associated with the common cold and antitussive drugs’ efficacy in controlling symptoms of chronic bronchitis, researchers often employ dextromethorphan (with or without codeine) to suppress cough in clinical practice (Singh et al., 2023). Patient should be scheduled for a follow-up after 1-2 weeks to assess for improvement or worsening of symptoms.
2. Acute exacerbations of chronic obstructive pulmonary disorder (J44. 1): When chronic obstructive pulmonary disease (COPD) is acutely exacerbated, symptoms usually include increasing dyspnea, a persistent cough, and/or increased production of sputum with increased volume and/or purulence (Acute Exacerbation of Chronic Obstructive Pulmonary Disease – Symptoms, Diagnosis and Treatment | BMJ Best Practice, n.d.).
Antibiotics, systemic corticosteroids, and bronchodilators are used as treatments. In cases when exacerbations are suspected to be caused by bacteria, antibiotics may be taken. A sudden shift in the sputum’s color and volume suggests the presence of a bacterial trigger (Acute Exacerbation of Chronic Obstructive Pulmonary Disease – Symptoms, Diagnosis and Treatment | BMJ Best Practice, n.d.). Patient should be scheduled for a follow-up after 1-2 weeks to assess for improvement or worsening of symptoms.
3. Allergic rhinitis (J30. 9 ): During a physical examination, providers would notice dark circles under the eyes (allergic shiners), frequent sniffling and/or throat clearing, and mouth breathing (Akhouri & House, 2023).
Avoiding triggers is advised. However, it is not always feasible, particularly for people who have seasonal symptoms. Dust mites, animal dander, and upholstery may be avoided with precautions, but doing so may require substantial lifestyle adjustments that the patient may not be able to tolerate. Leukotriene receptor antagonists (LTRAs), immunotherapy, intranasal steroids, and antihistamines are among the pharmacological possibilities (Akhouri & House, 2023). Patient should be scheduled for a follow-up after 1-2 weeks to assess for improvement or worsening of symptoms.
4. Congestive heart failure (150.22): A recumbent cough may be the presenting symptom of orthopnea in some people. In addition to indications of organ hypoperfusion or cardiogenic shock, acute CHF is predominantly characterized by congestion. Breathlessness is the most often mentioned symptom. Excertional, positional (orthopnea), and whether acute or chronic must be further categorized (Malik et al., 2023).
Reducing hospitalizations, increasing cardiac mortality, and improving symptoms and quality of life are the objectives of treatment for chronic CHF. Pharmacologic treatment aims to manage symptoms and start and increase medications that lower mortality and morbidity in heart failure (Malik et al., 2023). Patient should be scheduled for a follow-up after 1-2 weeks to assess for improvement or worsening of symptoms.
5. Community Acquired Pneumonia (J18. 9): Common symptoms include fever, chills, coughing up purulent sputum, dyspnea, pleuritic chest discomfort, and weight loss (Regunath & Ob, 2023).
Monotherapy with doxycycline or a macrolide (erythromycin, azithromycin, or clarithromycin) is advised for outpatients (Regunath & Ob, 2023). Patient should be scheduled for a follow-up after 1-2 weeks to assess for improvement or worsening of symptoms.
References
Acute exacerbation of chronic obstructive pulmonary disease – Symptoms, diagnosis and treatment | BMJ Best Practice. (n.d.). https://bestpractice.bmj.com/topics/en-gb/3000086
Akhouri S, House SA. Allergic Rhinitis. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538186/
Malik A, Brito D, Vaqar S, et al. Congestive Heart Failure. [Updated 2023 Nov 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430873/
Regunath H, Oba Y. Community-Acquired Pneumonia. [Updated 2022 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430749/
Sharma S, Hashmi MF, Alhajjaj MS. Cough. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493221/
Singh A, Avula A, Zahn E. Acute Bronchitis. [Updated 2023 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448067/
