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

A 70-year-old male patient visited your clinic with a complaint of a productive cough lasting for two weeks. He reports experiencing fever, mild dyspnea during physical exertion, chills, tachycardia, and chest congestion. He describes the cough as productive, with clear to yellow sputum. The patient has a medical history of nicotine dependence for 30 years, averaging one pack per day. Upon examination, the patient appears tachypneic, with a respiratory rate of 30 breaths per minute and shallow breathing. Crackles are auscultated in all lung fields.

Assignment: Describing Nursing’s Role in Program Design and Implementation

Discuss at least five questions you would pose to the patient to gather information about their symptoms.

List three respiratory examination findings that would raise concerns for you as the nurse practitioner.

What potential differential diagnoses would you consider when assessing this patient as the nurse practitioner?

Case Summary:

A 70-year-old male patient presents with a productive cough, accompanied by clear to yellow sputum, fever, chills, dyspnea on exertion, chest congestion, and tachycardia. He has a significant history of nicotine dependence, equivalent to 30 pack-years. On physical examination, the patient exhibits tachypnea, shallow breathing, and crackles in the lung fields.

The five questions I would ask to elicit information about the patient’s symptoms are as follows:

1. What is the duration of your cough?
2. How frequently do you experience these coughing episodes?
3. Is there a specific time of day when your cough is more severe?
4. Have these symptoms impacted your daily activities or routine?
5. Have you noticed any changes in your body weight recently?

These questions aim to gather details about the cough’s characteristics, frequency, timing, impact on daily life, and any associated weight changes. These factors can aid in differentiating between various respiratory conditions, such as chronic obstructive pulmonary disease (COPD) and acute infections.

Three concerning findings in the respiratory examination for a nurse practitioner would be:

1. Severe Respiratory Distress:

If the patient displays severe difficulty in breathing, such as rapid, shallow breaths, and visible signs of respiratory distress, it would be concerning and may indicate a critical respiratory condition.

2. Cyanosis:

The presence of bluish discoloration of the skin or mucous membranes, especially in the lips and fingertips, can suggest insufficient oxygenation and would be a worrisome sign.

3. Diminished Air Entry Sounds:

If auscultation reveals significantly reduced or absent breath sounds in specific lung areas, it could indicate a blockage or underlying lung pathology, raising concerns.

Differential diagnoses to consider as a nurse practitioner when assessing this patient include:

1. Chronic Obstructive Pulmonary Disease (COPD):

Given the patient’s age, history of nicotine dependence, and symptoms such as chronic cough, dyspnea, and chest congestion, COPD is a likely consideration. Crackles in the lung fields may also align with COPD (Obling et al., 2022).

2. Bacterial Pneumonia:

The presence of fever, chills, productive cough, and tachycardia can be indicative of bacterial pneumonia. While dyspnea on exertion is less commonly associated with pneumonia, it can still be observed in certain cases.

3. Pulmonary Embolism:

Although less common, pulmonary embolism cannot be ruled out entirely, especially considering the patient’s tachypnea, tachycardia, and history of nicotine dependence, which is a risk factor for clot formation (Waheed et al., 2021).

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.

Waheed, S., Sardar, S., Altaf, A., Ali, A., Niazi, K., Khan, A., … & Kamal, A. K. (2021). Risk factors, clinical features, and outcomes of patients with venous thromboembolism in COVID-19: A systematic review and meta-analysis. Vascular Medicine, 26(5), 479-490.