Description
Peer Responses:
Length: A minimum of 180 words per post, not including references
Citations: At least two high-level scholarly reference in APA per post from within the last 5 years
Relate to another journal reading
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 on this patient based on each differential diagnosis.
The health practitioner may need to ask several questions to make a correct diagnosis. During the health history, the FNP is likely to ask the patient questions such as; What time of the day is your cough worse? Are you on any other medications? Do you have any chest discomfort with your cough? are you experiencing wheezing with your cough? Have you had any infections recently?
Some of the differential diagnoses of a cough can include; Postnasal drip. Usually, when a patient’s sinuses generate extra mucus, the mucus can drip down the back of the throat and trigger a cough reflex. Postnatal drip is managed depending on the cause. Antibiotics can be used to clear a bacterial infection. Similarly, decongestants and antihistamines can help with postnatal drip caused by sinusitis and viral infections(Weinberger et al., n.d). Follow-up should be done to ensure that the patient does not continue experiencing the symptoms for more than 10 days.
Asthma is another differential diagnosis of a cough. An asthma-related cough comes and goes with the seasons. it may also worsen when a patient is exposed to cold air or fragrances. Depending on the clinical findings, the patient should be administered Preventive, long-term control medications to reduce the inflammation in the airways that lead to symptoms. Quick-relief inhalers can be used to open swollen airways that are limiting breathing and allergy medications. Follow-up entails patient education to optimize the control of asthma symptoms, control asthma triggers, and reduce the risk of asthma exacerbations.
Gastroesophageal reflux disease (GERD) is a condition where stomach acid flows back into the tube connecting the stomach and throat (Katzka & Kahrilas, 2020). The constant irritation leads to chronic coughing that can, in turn, worsens GERD. For this reason, the right medical management is needed. Treatment can consist of lifestyle changes and dietary changes, medication, surgery, or endoscopic therapy. Follow-up will entail patient education to recommend lifestyle and dietary changes along with recommending further testing if no improvement is noted after two months.
A cough can occur long after other symptoms of infections of the upper respiratory tract have gone away. Hence, infections are another differential diagnosis. Treatment is dependent on the cause of the infection. A bacterial infection can be treated with antibiotics. Close follow-up is recommended as a simple infection may progress into a systematic illness.
Blood pressure drugs can be a cause of a cough. A study finds that Angiotensin-converting enzyme (ACE) inhibitors are commonly known to cause chronic cough in some people (Ji-Su et al., 2020). For this reason, the physician may recommend another medication type. Follow-up can be done to ensure that the cough has resolved.
References
Ji-Su, S. H. I. M., Woo-Jung, S. O. N. G., & Morice, A. H. (2020). Drug-induced cough. Physiological Research, 69(Suppl 1), S81.
Katzka, D. A., & Kahrilas, P. J. (2020). Advances in the diagnosis and management of gastroesophageal reflux disease. BMJ, 371.
Weinberger, S. E., & King Jr, T. E. Patient education: Chronic cough in adults (Beyond the Basics).
