591_ week 2 Aquifer case study 13-2
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Date
Dec 6, 2023
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6
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1
Family Medicine 13: 40-year-old man with a persistent cough
United States University
FNP592: Common Illnesses Across the Lifespan
Dr. Jeazale A. Julian, DNP, APRN, FNP-C, PHN
September 9, 2023
2
Aquifer Week 2 Case 13: Respiratory
As part of the body's response to disease, coughing is essential because it clears mucus,
bacteria, and foreign objects from the respiratory system, reducing inflammation and lung
infection risk. Underlying diseases can bring on coughs, which can lower the quality of life. For
proper diagnosis and treatment, it is crucial to accurately analyze symptoms, coexisting diseases,
and treatments.
A 40-year-old man named Mr. Dennison appeared with wheezing for two months, as well
as a strong cough that became worse at night. He denies any chest pain, fever, or breathing
difficulties. High-risk factors for asthma include his poorly managed allergic rhinitis, family
history of asthma, obesity, and sensitivities to dust mites and pollen. Spirometry is a diagnostic
method to test lung function and gauge the severity of lung damage in asthma, both with and
without bronchodilators (Cash, 2019).
1.
Differential Diagnosis
1)
Chronic sinusitis rationale and supporting evidence
●
Clear nasal discharge that has not been well-controlled
●
Persistent nasal discharge with noisy breathing
●
Cough productive of clear sputum that is worse at night
a.
Physical exam findings for the differential diagnosis
●
There is no nasal mucosal pallor, no expansion of the inferior turbinates (+), no
pain in the front or maxillary sinuses, and no fever. A headache and postnasal
discharge are denied by the patient (Battisti et al., 2023).
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2) COPD rationale and supporting evidence
●
Productive cough over 2 months
●
Wheezing
a.
Physical exam findings for the differential diagnosis
●
Patient is overweight, short of breath, and claims to have never smoked (CDC,
2023).
3) Leading diagnosis
: Symptoms of clear nasal discharge include wheezing, a cough that
worsens at night, and a family history of asthma.
a.
Findings from the physical examination included wheezing, an enlarged inferior
turbinate, and the FEV1/FVC ratio with and without bronchodilators.
2. Diagnostics Plan
a.
Chest X-ray: Rule out lung abnormalities, pneumonia, COPD, CHF, or other respiratory
conditions.
b.
Spirometry: "Gold standard" asthma diagnostic test. Medical professionals use a lung
function test to validate the diagnosis and assess how well the asthma treatments work.
c.
Labs: The CBC can rule out the diagnosis of infection by analyzing blood components
like WBCs, leukocytes, lymphocytes, and neutrophils.
d.
Check Peak Flow Meter: Measure the forced vital capacity (FVC) and forced expiratory
volume in one second (FEV1) using a peak flow meter before and after the client inhales
a short-acting bronchodilator (SABA). The patient had wheezing and an FEV1/FVC ratio
of 58% (average: 75%) (ALA, 2022).
3. Treatment plan
a.
Mild asthma: no long-term preventive medication.
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●
As a last resort, use short-acting beta agonist (SABA) bronchodilators.
●
Two puffs of albuterol (Proair, Salbutamol, or Ventolin), as needed, every four to
six hours.
b.
Mild to moderate: Leukotriene, theophylline, and low-dose anti-inflammatory
medications reduce swelling and mucus production, such as budesonide, a corticosteroid.
●
A class of medications known as anticholinergics prevents the muscles around the
airways from constricting. For long-term control, medical recommendations
advise daily administration of low-dose inhaled corticosteroids, such as
budesonide, coupled with either a theophylline or leukotriene modulator.
c.
Moderate: Based on Mr. Dennison's symptoms, the appropriate level of medical care.
●
Utilize a low-dose long-acting beta 2 agonist (LABA) and ICS: 1-2 puffs BID of a
LABA, such as Formoterol (Foradil), plus two puffs of albuterol as a rescue
inhaler.
●
ICS at a medium dose + theophylline or a leukotriene modifier: In addition to the
leukotriene inhibitor montelukast (Singulair) 10 mg PO once daily in the evening,
patients should take ICS-Budesonide (Pulmicort) 2 puffs BID (ALA, 2022).
4. Education: Keep asthma symptoms under control
●
Develop a strategy with your healthcare practitioner to manage your asthma,
including important information.
●
Assess and monitor control: A cough, a tightness sensation in the chest, wheezing,
decreased activity, and weariness are typical asthma symptoms. Keeping an eye
on symptoms will help you stay in control.
●
Asthma triggers can be lessened by recognizing them, learning ways to reduce
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exposure, or avoiding them altogether.
●
Educate on asthma self-management techniques, including an online course on
asthma basics (ALA, 2022).
5. Follow up: Regular care is part of the asthma treatment plan.
●
List the symptoms and indicators that most concern him. Keep track of their onset
and aggravating or mitigating circumstances (ALA, 2022).
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References
Association, A. L. (2022).
How is asthma diagnosed?
. American Lung Association.
https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/symptoms-diagno
sis/how-is-asthma-diagnosed
Battisti, A. S., Pangia, J., & Modi, P. (2023, March). Sinusitis - NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK470383/
Cash, J.,Glass, C., & Mullen, J. (2019). Family Practice Guidelines (5th ed). Springer Publishing
Company.
Centers for Disease Control and Prevention. (2023, June 30).
COPD: Symptoms, diagnosis, and
treatment
. Centers for Disease Control and Prevention.
https://www.cdc.gov/copd/features/copd-symptoms-diagnosis-treatment.html
Rhoads, J., & Penick, J. C. (2018).
Formulating a differential diagnosis for the advanced
practice provider
. Springer Publishing Company, LLC.
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