A 70-year-old male patient presented to your clinic with complaint of a wet cough
A 70-year-old male patient presented to your clinic with complaint of a wet cough for 2 weeks. Confirms fever, mild dyspnea on exertion, chills, tachycardia, and chest congestion. Describes cough as reproductive with clear to yellow sputum. Medical history of Nicotine dependence, 30 years, 1PPD. On inspection, patient appeared to be tachypneic with respiratory rate at 30, appeared to have shallow breathing with crackles heard in all lung fields.
Discuss at least five questions you would ask this patient to elicit a history about the patient’s symptoms.
List three physical findings in the respiratory examination that will concern you as the nurse practitioner
What differential diagnosis would you consider as the nurse practitioner seeing this patient?
Case overview
A 70 years old male patient presents with a productive cough with clear to yellow sputum. The cough is associated with fever, chills, dyspnea on exertion, chest pain, and tachycardia. The patient has 30 pack years of nicotine dependence. On examination, he has tachypnea and shallow breathing with crackles in the lung fields.
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The five questions I would ask to elicit about the patient’s symptoms
- What is the duration of the cough?
- How often do you cough?
- What time of the day is your cough worst?
- Have the symptoms affected your daily activities?
- Have you noticed body weight changes?
The duration, frequency, and timing of the cough help determine the intensity of the disease. For example, the duration, frequency, and timing of the cough in obstructive pulmonary disease and rhinitis are different. COPD presents with a chronic cough over more than two years, the cough may persist throughout the day, and it is worse at night (Obling, et al, 2022). Rhinitis presents with a cough of acute onset, short-lived and triggered by cold air or dust. Effect of the cough of daily activities and body weight changes also determines the diagnosis. A 70-year-old male patient presented to your clinic with complaint of a wet cough
Physical findings (3) in the respiratory examination that will concern me as a nurse practitioner
As a nurse practitioner, I would get worried if the patient presents with severe respiratory, distress, cyanosis, and diminished air entry sounds.
Differential diagnosis
- Chronic obstructive pulmonary disease
- Bacterial pneumonia
- Pulmonary tuberculosis
Chronic obstructive pulmonary disease COPD is a superimposed disease comprising of chronic bronchitis and emphysema. It is common in male patients over the age of 40years with a positive history of smoking. The symptoms of COPD are productive cough, dyspnea, fever, chest pain, chest tightness, sputum production clear and yellow, fatigue, frequent respiratory infections, swollen ankle and feet, and congestion (Obling, et al, 2022). The physical findings include respiratory distress, wheezing, thin barrel chest, hyper-resonant chest, and cyanosis.
Bacteria pneumonia is an infection of the lungs caused by streptococcus pneumonia. It is common in the elderly patients, pediatrics, and immunosuppression. Clinical presentation of bacterial pneumonia are fever, tachypnea, use of accessory muscles for respiration, tachycardia, rhonchi, coarse crackles, and decreased intensity of breath sounds. The patient has similar symptoms except dyspnea on exertion. A 70-year-old male patient presented to your clinic with complaint of a wet cough
Pulmonary embolism is a lodged blood clot in the pulmonary artery blocking blood flow in the lungs. Clinical presentations for pulmonary embolism are fever, productive cough, dyspnea on exertion, seizures, tachypnea, tachycardia, and murmurs. Risk factors for pulmonary embolism are obesity, smoking, coronary heart disease, surgery, and immobilization.
References
Obling, N., Rangelov, B., Backer, V., Hurst, J. R., & Bodtger, U. (2022). Upper airway symptoms and small airways disease in Chronic Obstructive Pulmonary Disease, COPD. Respiratory medicine, 191, 106710. A 70-year-old male patient presented to your clinic with complaint of a wet cough