Case Study Analysis For Patient With Cough And Runny Nose
Case Study Analysis For Patient With Cough And Runny Nose
The case is of a patient (Mrs. Forzani) who reported the onset of symptoms (cough, runny nose) within the past few days and has been mildly symptomatic overall. The patient looks tired, and there may be a new, persistent cough. She was also unable to take her breakfast. This paper will analyze the patient’s situation by suggesting subjective and objective data to be added, diagnostic and screening tests to be conducted, and the treatment plan that would help the patient to recover from the current condition Case Study Analysis For Patient With Cough And Runny Nose.
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What is your chief concern(s) at today’s visit? Explain
My chief concern at today’s visit is that Mrs. Forzani has a new cough, which started today, and that she has refused breakfast this morning. Additionally, her vital signs are within normal limits, but she looks more tired than usual. It is possible that she may have COPD, and her symptoms could worsen if not treated appropriately.
What are the differential diagnoses that you are considering for the chief complaint? (Limit to 4).
The differential diagnoses that I am considering for the chief complaint are asthma, COPD, bronchitis, and pneumonia. Asthma is a respiratory infection characterized by wheezing, chest tightness, and shortness of breath (Sedelmayr et al., 2021). Sometimes, the patient may have a dry cough, rhinorrhea (fluids coming from the nose), and fever. COPD is a chronic respiratory disease characterized by increased levels of mucus in the airways (Vogelmeier et al., 2020)Case Study Analysis For Patient With Cough And Runny Nose. In most cases, the patient has significant breathing problems at rest and has a diminished ability to exercise. Bronchitis is an infection of the bronchi, which are the tubes that carry air from your lungs to the larger air sacs in your chest. The patient may experience a cough, chest pain, and fever. Lastly, pneumonia is an infection of the lungs that can lead to pneumonia, which are serious lung infection. The patient may have a fever, shortness of breath, and chest pain. Many respiratory problems have similar characteristics, and that is why it is usually not easy to determine the respiratory disease that the patient reports to the hospital with a cough.
Is this an emergency?
Based on the case study’s information on Mrs. Forzani, this was not an emergency. This is because Mrs. Forzani did not have chest pain, shortness of breath, or fever. Therefore, she was stable enough to be sent home with instructions to follow up with her doctor. However, since she was losing appetite, there was a need to assess her to determine if she had any other underlying conditions. If Mrs. Forzani does have an underlying condition, her doctor may need to prescribe medication to help with her symptoms.
What additional subjective and objective data would you need to collect?
The additional subjective data that I would need to collect from the patient include whether the patient has micturition, a history of appetite problems if the patient has lost taste or smell, and a history of drug abuse. This information will be key because it will help to determine if there is a physiological reason for the patient’s symptoms or if there may be an underlying medical condition that requires treatment (Di Filippo et al., 2018). Based on the case study, Mrs. Forzani does not appear to have any underlying medical conditions that need treatment. The information may also be helpful in ruling out some diagnoses in an attempt to establish what the patient is suffering from. The additional objective data that need to be collected for with diagnosis of Mrs. Forzani are a physical exam, including a complete blood count (CBC) and urinalysis (Di Filippo et al., 2018)Case Study Analysis For Patient With Cough And Runny Nose. This will help to rule out any underlying medical conditions and assess the patient’s response to medications if needed. Additional tests may also be necessary, such as a thyroid panel or liver function test.
Describe your approach to arriving at a diagnosis in a patient who presents like this. Include any relevant treatment guidelines that may assist with your decision-making.
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The approach to arriving at a diagnosis in a patient who presents like Mrs. Forzani will vary depending on the underlying cause of the patient’s symptoms. If Mrs. Forzani is suffering from an illness such as pneumonia, a physical exam and other tests may not be necessary. In cases like Mrs. Forzani’s, where it is unclear what the underlying cause of the symptoms is, a comprehensive evaluation by a healthcare professional may be necessary in order to arrive at a diagnosis. A variety of tests may be necessary in order to rule out an underlying medical condition in Mrs. Forzani, including a cold, COPD, bronchitis, asthma, and pneumonia (Joo et al., 2021). The relevant treatment guideline that would assist with my decision-making in this scenario is the American Thoracic Society (ATS) Guidelines for the Evaluation and Management of Pulmonary Disease in Adults. This guideline covers a variety of topics, including the use of spirometry to determine the severity of pulmonary disease, the diagnosis and treatment of common lung diseases, and the use of chest x-rays in the evaluation and management of pulmonary disease (Di Filippo et al., 2018)Case Study Analysis For Patient With Cough And Runny Nose.
What diagnoses, other than the acute concern identified in question 1, will you make today (maximum of 4 additional diagnoses)? For each diagnosis, include any differential diagnoses you are considering. Support your choice of diagnoses with significant positive and negative data provided in the case.
Apart from the acute concerns discussed in question 1, additional diagnoses for Mrs. Forzani should include gastroesophageal reflux disease (GERD), gastritis, and cachexia. Treatment for these conditions may involve medications, lifestyle changes, or surgery. In cases like Mrs. Forzani’s, where the underlying cause of her symptoms is not clear, a comprehensive evaluation by a healthcare professional may be necessary in order to arrive at a diagnosis and appropriate treatment (Joo et al., 2021). For each of the above diagnoses, a differential diagnosis should be made to rule out any of the infections. For GERD, the health provider should assess if the patient had an episode of heartburn recently, if they have reflux with food, and whether they have a history of Barrett’s esophagus. For gastritis, the health provider should ask about the symptoms, such as heartburn, bloating, nausea, and vomiting. For cachexia, the health provider should ask about the patient’s appetite and weight loss. If a diagnosis is not made after ruling out all of the potential causes, a doctor might perform a bronchoscopy to look for changes in the airway (Jiang et al., 2020)Case Study Analysis For Patient With Cough And Runny Nose.
In general, chest x-rays are not typically used to evaluate patients with cough and loss of appetite, as these symptoms may be caused by a number of other conditions. However, if the patient has a history of cancer or another serious illness, the doctor might order a chest x-ray to look for changes in the lungs. In Mrs. Forzani’s case, a bronchoscopy might be necessary to determine whether her cough is caused by GERD, gastritis, or cachexia.
Treatment for each of the above conditions may vary depending on the cause and severity of the condition. Treatment for GERD might include medications to reduce stomach acid, lifestyle changes such as avoiding spicy foods and alcohol, and sometimes surgery (Joo et al., 2021)Case Study Analysis For Patient With Cough And Runny Nose. Treatment for gastritis might include medications to reduce inflammation, surgery to remove stomach ulcers, or a combination of both. Treatment for cachexia might include weight loss, physical activity, and medications to promote weight loss. If a patient has any of the above conditions and signs or symptoms that suggest they may have GERD, they should see a doctor for an evaluation.
Based on risk factors, current presentation, and past medical history, what screening tests and/or tools are warranted for today, and which will you defer for a later visit? Provide rationale and name any screening tests/tools you might use if applicable.
Based on risk factors, current presentation, and past medical history of Mrs. Forzani, the screening tests or tools that would be most likely to help in the diagnosis of the patient include a history and examination for symptoms such as heartburn, belching, regurgitation, and coughing; a diagnostic questionnaire that includes questions about COPD symptoms; and a chest x-ray to rule out other causes of the patient’s symptoms. If any of these tests are positive, further evaluation by a doctor would be necessary to determine the specific cause of the symptoms (Alvarez et al., 2017). Another screening test should be bronchitis. This test will help to rule out other causes of the patient’s symptoms and can also be used to monitor the treatment progress. Bronchitis is a common condition and often clears up on its own without any treatment (Alvarez et al., 2017). If bronchitis is the cause of the symptoms, then appropriate treatment will be given. If bronchitis is not the cause of the symptoms, further testing may be necessary to determine the cause. For Mrs. Forzani, the screening test that can be deferred to a later visit is a CT scan of the chest to rule out other causes of her symptoms. A CT scan is not typically used to screen for COPD but is sometimes necessary to rule out other causes of the patient’s symptoms. It shows the lungs and can help to determine the severity of the patient’s symptoms.
In Mrs. Forzani’s case, a CT scan would not be necessary to determine the cause of her symptoms today, as bronchitis is not the cause. However, a CT scan may be necessary to rule out other causes of her symptoms in the future. If Mrs. Forzani’s symptoms persist after ruling out bronchitis as the cause, a CT scan may be necessary to determine the cause of her symptoms (Serena Low et al., 2021)Case Study Analysis For Patient With Cough And Runny Nose. Other tests that could be performed in the future visit include an EKG to measure the heart’s electrical activity, a blood test to measure the level of infection, and an MRI to look at the lungs. Each test has a different purpose and may be necessary in order to provide a complete diagnosis of Mrs. Forzani’s symptoms.
What is your plan of care?
What, if any, additional diagnostic testing will you order if? Will you consider any diagnostics for a later date? Explain.
Apart from the screening and diagnostic tests discussed earlier, there are no other additional diagnostic tests that I would consider now or in the future. This is because Mrs. Forzani ‘s symptoms are typical of COPD, and further testing is not likely to provide a more accurate diagnosis. Therefore, the administration of any medication will be based on Mrs. Forzani’s current diagnosis, as the health provider should avoid any diagnostic errors that may force the future need for diagnosis or change of the treatment plan.
Will you make any changes (i.e., additions and discontinuations) to her medication today? Will you consider other medication changes at future visits? Discuss the evidence that supports your choice(s) in the treatments you have suggested.
Currently, the patient is on several medications, including Lansoprazole 30mg po daily, Synthroid 50 mcg po daily, Atorvastatin 10mg po daily, Ramipril 20mg po daily, Amlodipine 5 mg po daily, Hydrochlorothiazide 12.5mg po daily, Calcium and D3 supplement (500mg/1000mg), and Acetaminophen 500mg-1g PO Q4-6 hours PRN. To help Mrs. Forzani deal with her current health concern, several changes to her medication today should be considered. Firstly, Lansoprazole should be decreased to 15mg po daily as it is effective in reducing stomach cramps and bloat. Secondly, the Synthroid should be increased to 100mcg po daily as it is a hormone replacement therapy that can help to improve overall energy levels. Lastly, Atorvastatin should be decreased to 5mg po daily as it has been shown to increase the risk of heart disease. Other changes that should be considered at future visits include increasing the dose of Ramipril to 40mg po daily, adding Amlodipine to 5mg po daily, and decreasing the dose of Hydrochlorothiazide to 12.5mg po daily. The evidence supports these choices as they are likely to help improve Mrs. Forzani’s health concerns. For instance, according to research, for a person with COPD, decreasing the dose of Atorvastatin to 5mg po daily can improve lung function and reduce the risk of heart disease (Vogelmeier et al., 2020). Additionally, increasing the Synthroid dose to 100mcg po daily may help to improve energy levels and reduce symptoms of depression (Cho et al., 2020). Finally, increasing the dose of Lansoprazole to 15mg po daily may help to reduce stomach cramps and bloat (Cho et al., 2020)Case Study Analysis For Patient With Cough And Runny Nose. These changes should be considered in order to provide Mrs. Forzani with the best possible care. If any of these changes cause adverse effects, they should be discussed with her doctor. Continued monitoring is essential in order to ensure that Mrs. Forzani’s health remains optimal.
What, if any, referrals will you make, if any? Explain.
Mrs. Forzani is at an advanced age, and therefore, some referrals can be done to enhance her recovery from the COPD condition. First, the patient may want to consider seeing a respiratory therapist in order to help with breathing exercises and proper lung function. Additionally, a dietitian may be useful in helping the patient to create a healthy diet that can support the lungs. Mrs. Forzani may also benefit from seeing a counselor or therapist who specializes in COPD. Finally, a physiatrist may be consulted to help with mobility and balance issues that are common in COPD patients. All of these referrals should be considered in order to maximize Mrs. Forzani’s recovery. These professionals can help the patient to better understand the condition and can provide support during difficult times.
The husband and wife in this case study are in the same facility but roomed apart on separate floors. Discuss how health policy has resulted in this situation, its impact on the couple (and family), and how current movements within healthcare are looking to change it.
The husband and wife in this case study are in the same facility but roomed apart on separate floors due to healthcare policy. The assigning of different floors helps the couple stay separated as their health is considered to be more important than that of the other spouse. This separation can have a negative impact on the couple, as they are no longer able to share medical information or support one another (Pouyan et al., 2021). The couple is also likely to experience stress due to their separation, and this can have a negative impact on their health. It has resulted in a lot of tension and conflict between the couple because they do not always have access to the same information. Additionally, the wife has to travel quite a distance to get to her husband’s floor, which has an impact on their relationship. Current movements within healthcare are looking to change this situation by focusing on patient-centered care. This means that healthcare providers will be more engaged in the life of their patients, which should help to reduce the amount of tension and conflict that can arise between spouses Case Study Analysis For Patient With Cough And Runny Nose.
References
Alvarez, R., Ramón, C., & Pascual, J. (2017). Clues in the differential diagnosis of primary vs. secondary cough, exercise, and sexual headaches. Headache: The Journal of Head and Face Pain, 54(9), 1560-1562.
Cho, Y. K., Choi, M. G., Choi, S. C., Lee, K. M., Kim, T. O., Park, S. H., … & Song, G. S. (2020). Randomized clinical trial: tegoprazan, a novel potassium‐competitive acid blocker, or Lansoprazole in the treatment of gastric ulcer. Alimentary pharmacology & therapeutics, 52(5), 789-797.
Di Filippo, P., Scaparrotta, A., Petrosino, M. I., Attanasi, M., Di Pillo, S., Chiarelli, F., & Mohn, A. (2018). An underestimated cause of chronic cough: protracted bacterial bronchitis. Annals of thoracic medicine, 13(1), 7.
Jiang, S., Xie, F., Mao, X., Ma, H., & Sun, J. (2020). The value of navigation bronchoscopy in the diagnosis of peripheral pulmonary lesions: a meta‐analysis. Thoracic Cancer, 11(5), 1191-1201.
Joo, H., Moon, J. Y., An, T. J., Choi, H., Park, S. Y., Yoo, H., … & Kim, J. W. (2021). Revised Korean cough guidelines, 2020: recommendations and summary statements. Tuberculosis and Respiratory Diseases, 84(4), 263.
Pouyan, A. E., Ghanbaran, A., & Shakibamanesh, A. (2021). Impact of circulation complexity on hospital wayfinding behavior (Case study: Milad 1000-bed hospital, Tehran, Iran). Journal of Building Engineering, 44, 102931.
Sedelmayr, M., Lenglinger, J., & Juillerat, P. (2021). Cough from the perspective of a gastroenterologist. Therapeutische Umschau. Revue Therapeutique, 78(4), 171-179.
Serena Low, W. C., Chuah, J. H., Tee, C. A. T., Anis, S., Shoaib, M. A., Faisal, A., … & Lai, K. W. (2021). An overview of deep learning techniques on chest X-ray and CT scan identification of COVID-19. Computational and Mathematical Methods in Medicine, 2021.
Vogelmeier, C. F., Román-Rodríguez, M., Singh, D., Han, M. K., Rodríguez-Roisin, R., & Ferguson, G. T. (2020). Goals of COPD treatment: Focus on symptoms and exacerbations. Respiratory medicine, 166, 105938. Case Study Analysis For Patient With Cough And Runny Nose
NURS 528
Assignment 1: Case Study
Fall 2022
In this assignment, you will demonstrate your knowledge of health promotion, illness prevention and clinical care for presentations that you may see in primary care. Be sure to provide rationale for your decisions and choices and always reference your sources. Your answers should reflect the critical thinking that goes into the provision of NP care.
Case Study Analysis (80%)
The case study provides a detailed history and physical followed by questions to be answered in your paper. You do not need to restate the case in your paper.
Scholarly Writing (20%)
Twenty percent (20%) of the marks for your case study will be awarded for appropriate writing style. You may use some point form statements, bulleted lists, tables, or charts to present your discussion – a narrative format is not required. Do not include an abstract. Word count maximum 3,000 (not including reference pages, title page and appendices)Case Study Analysis For Patient With Cough And Runny Nose. Please see the Assessment Overview for more information.
The Case: Mrs. Forzani – 78 years
Mrs. Forzani is a 78-year-old woman, who resides in the retirement wing within a multilevel facility in Edmonton, Alberta where you are the Nurse Practitioner.
You have been asked by staff to assess her today as they noticed she has a new cough. The staff tell you she has had a runny nose for a couple of days and seems more tired than usual. The cough started today. She refused breakfast this morning.
Pertinent history:
- Mild to moderate dementia, needing some cuing for ADLs.
- Lives in a small 1-bedroom suite, with full kitchen and living room. Occasionally hosts friends for tea or prepares small snacks in kitchen.
- Receives meals in a communal dining room. Feeds herself and walks independently around the facility. PSW attends her room to cue and ensure safety for shower every second day.
- Wears device in case of falls while alone in room or on property.
- Conversation composed primarily of congenialities. Usually pleasant and cooperative.
- Goals of Care: Full care except CPR – (M1)
Social history:
- Married to Bill who is frail. He resides in a LTC room on a separate floor within the same facility.
- Lived in DAL for last 3 years.
- Grade 8 education, no outside of the home employment
- 2 children- one daughter and son.
- Life-long non-drinker, non-smoker. No longer able to drive.
- His son serves as POA Case Study Analysis For Patient With Cough And Runny Nose
Past medical history:
- Dementia – Alzheimer’s type (last MMSE 1 year ago with a score of 20)
- Hypothyroidism
- Osteoarthritis in hips and knees
- TIA 2 years ago
- HTN
- Dyslipidemia
- GERD
Medications (all chronic):
Lansoprazole 30mg po daily
Synthroid 50 mcg po daily
Atorvastatin 10mg po daily
Ramipril 20mg po daily
Amlodipine 5 mg po daily
Hydrochlorothiazide 12.5mg po daily
Calcium and D3 supplement (500mg/1000mg)
Acetaminophen 500mg-1g PO Q4-6 hours PRN
Allergies: Penicillin – facial swelling
Immunizations: Flu shot last fall, Td booster five years ago, Zostavax two years ago
ROS:
- Height 176cm, Weight 59kg, BMI: 19.8
- General: Tired, poor sleep, weight loss – clothes feel bigger. Poor appetite.
- CNS: No changes/No concerns.
- HEENT: Eyesight and hearing unchanged. No difficulty swallowing. Often wakes up with a headache.
- CVS: Denies chest pain or palpitations. No reported edema.
- RESP: Increasing SOB and cough started today. Denies sputum.
- GI: Continent of bowels. Occasional constipation uses prunes or ex-Lax prn. Denies pain or bloody stools. Denies nausea. Stress incontinence, not treated, wears underwear pad.
- GU: No concerns.
- Skin: Dry but no acute concerns.
- MSK: Bilat mild knee and hip pain.
- Mood: Admits to feeling lonely and a bit blue at times. No suicidal ideations. No previous mental health admissions or suicide attempts. No history of DSM diagnosis. Geriatric depression score: 5 Case Study Analysis For Patient With Cough And Runny Nose
Pertinent Labs – from yesterday
| WBC | 7 ×109/L | BUN | 8.1 mmol/L | |
| Hgb | 120 g/L | Creatinine | 100 µmol/L | |
| EGFR | 52 | Sodium | 142 mmol/L | |
| B12 | 103 pmol/L | Potassium | 4.0 mmol/L | |
| TSH | 3 mU/ml | Calcium | 2.15 mmol/L | |
| Urinalysis
pH 6.0 S. G. 1.030 Pro – neg Gluc- neg Blood-neg Leuks- neg WBC- 1-3 |
Magnesium | 0.9 mmol/L | ||
| Albumin | 30 g/L | |||
| Alkaline phosphate | 92 IU/L | |||
| ALT | 36 IU/L | |||
| AST | 30 IU/L | |||
| LDL-C | 4 mol/L | |||
| HDL | 0.8 mmol/L | |||
| Triglycerides | 1.98 mol/L | |||
| BNP | 108 pg/ml | |||
Physical Exam:
Vital signs: T 36.2; HR 90 and regular; BP 100/58; RR: 24/min; Sp02: 93% on room air
Weight: 48 Kg; Height: 154 cm
General: Tired looking woman sitting quietly in an occasional chair in her room. She looks a bit older than her stated age but is in no distress.
CNS: Equal motor strength bilaterally 5/5 to arms and legs with normal tone normal. Follows commands.
HEENT: Loss of upward gaze, corneal arcus bilaterally, full dentures; no lesions in mouth, mucous membranes tacky. Thyroid not palpable. No cervical nodes. Clear nasal discharge. Tympanic membranes normal bilaterally.
CVS: +1 pulses peripherally. S1S2 normal with a mid-systolic click, followed by a uniform, high-pitched murmur heard at the apex. Radiates to the carotid. Normal JVP. Normal ECG on the chart from last year.
CHEST: Respirations quiet, no accessory muscle use. Chest has inspiratory fine crackles posteriorly from the bases bilateral to just below the scapula. Loose cough; no stridor or wheeze. Breasts: not examined
GI: Abdomen soft, non-distended. No CVA tenderness.
GU: Not examined. No sexual activity for past 11 years.
Skin: Slightly pale. Numerous seborrheic keratosis on trunk. Moderate elasticity. Normal turgor.
MSK: Bulky knees with significant crepitus on passive flexion. Internal rotation of hips normal but external rotation obviously painful. Heberden’s nodes all fingers. No redness, heat, bruising or swelling seen. Some atrophy of quadriceps noted bilaterally.
Case Study Questions
Taking a holistic view, and using an evidenced based approach, answer the following questions providing rationale for your answers (80 marks) Case Study Analysis For Patient With Cough And Runny Nose
- What is your chief concern(s) at today’s visit? Explain.
- What are the differential diagnoses that you are considering for the chief complaint? (Limit to 4).
- Is this an emergency?
- What additional subjective and objective data would you need to collect?
- Describe your approach to arriving at a diagnosis in a patient who presents like this. Include any relevant treatment guidelines that may assist with your decision making.
(This section 15 marks)
- What diagnoses, other than the acute concern identified in question 1, will you make today (maximum of 4 additional diagnoses). For each diagnosis, include any differential diagnoses you are considering. Support your choice of diagnoses with significant positive and negative data provided in the case. (15 marks)
- Based on risk factors, current presentation, and past medical history, what screening tests and / or tools are warranted for today, and which will you defer for a later visit? Provide rationale and name any screening tests / tools you might use if applicable. (10 Marks)
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- What is your plan of care? (20 marks)
- What, if any, additional diagnostic testing will you order, if any? Will you consider any diagnostics for a later date? Explain.
- Will you make any changes (i.e., additions and discontinuations) to her medication today? Will you consider other medication changes at future visits? Discuss the evidence that supports your choice(s) in the treatments you have suggested.
- What, if any, referrals will you make, if any?
- This husband and wife in this case study are in the same facility but roomed apart on separate floors. Discuss how health policy has resulted in this situation, it’s impact on the couple (and family), and how current movements within healthcare are looking to change it. (20 marks) Case Study Analysis For Patient With Cough And Runny Nose