PATHOPHYSIOLOGY NR 507Week 2 - Discussion 2

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PATHOPHYSIOLOGY NR 507Week 2 - Discussion 2 Tammy is a 33-year-old who presents for evaluation of a cough. She reports that about 3 weeks ago she developed a “really bad cold” with rhinorrhea. Th... e cold seemed to go away but then she developed a profound, deep, mucus-producing cough. Now, there is no rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Tammy has tried over-thecounter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves. Write a differential of at least five (5) possible diagnosis’s and explain how each may be a possible answer to the clinical presentation above. Remember, to list the differential in the order of most likely to less likely.  Bronchitis – Usually Bronchitis develops after an upper respiratory infection, such as a cold (What are the signs and symptoms of bronchitis?, 2011) Essentially a cold gone bad. The main symptom of Bronchitis is that of a cough that lasts for several weeks. It is an inflammation of the bronchi and it typically involves the symptoms of cough and productive/nonproductive sputum production (Mossad, 2013). Tammy’s initials symptoms were that of a common cold and now with the complaint for productive sputum I would have to say that she has advanced to that of acute bronchitis which could be either viral or bacterial. The symptom of green sputum does not necessarily indicate an infection (McCance, Huether, & Brahsers, 2013, p. 1275).  Pneumonia – Most cases begin with an upper respiratory infection and can mimic a cold or bronchitis. It is contracted the same way we can contract a cold. Pneumonia is an inflammation of the various parts of the respiratory tract such as the alveoli, alveolar ducts and bronchioles (Kim, 2015). Symptoms of pneumonia are often similar to other respiratory infections. However, pneumonia often has a persistent high fever, around 102 degrees (Mayo Clinic Staff, 2015). Tammy’s symptoms do not include fever or dyspnea but does fall in line with possible early stages of pneumonia.  Sinusitis – An infection or inflammation of the air cavities within the passages of the nose. Tammy had congestion and this can contribute to a cough. Tammy’s symptoms are a persistent cough that can keep her awake at night along with a scratchy throat. Per Goroll and Mulley (2014) sinusitis can present with sputum production due to drainage and this can lead way to a cough.  Pertussis – is a highly contagious respiratory disease (also called whooping cough) which can affect all ages. Symptoms resemble an upper respiratory infection in the early phase and then a persistent cough develops in spells that can linger for several months (Goroll and Mulley, 2014, p.356). Tammy stated that she had had upper respiratory symptoms at the beginning but she does not present with the common whooping cough that is common with pertussis.  Asthma – Asthma is airway hyperactivity which presents with a cough which can be worse at night (Goroll and Mulley, 2014, p. 355). Tammy presents with a cough that does worsen at night. However, asthma is the least likely diagnosis as she also has productive sputum which is not associated with asthma and she is not complaining of difficulty in breathing. This study source was downloaded by 100000830216776 from CourseHero.com on 09-08-2021 15:13:49 GMT -05:00 https://www.coursehero.com/file/14512210/Week-2-Discussion-2/ This study resource wasBased upon what you have at the top of the differential how would you treat this patient? After completing a full history and physical I would concentrate treating bronchitis by actually treating the symptoms. Antibiotics are generally not recommended for bronchitis because most cases are usually viral in nature (How is bronchitis treated?, 2011). However, I would do a CBC to check blood counts to check the white blood count. Bronchitis develops in the airways to your lungs whereas pneumonia develops in your lungs. Therefore, I would want to do a chest x-ray to determine which it could be. Aside from that I would recommend rest, hydration, antitussives, antipyretics and no smoking (if a smoker) (Ratini, 2014). Suppose now, the patient has a fever of 100.4 and complains of foul smelling mucous and breath. Indeed, she complains of producing cups of mucous some days. She has some trouble breathing on moderate exertion but this is only a minor complaint to her. How does this change your differential and why? The additional symptoms could still be that of bronchitis. However, if the chest x-ray was abnormal I would also do a sputum culture in addition to my previous suggestions to determine the pathogen. This would aid in prescribing the proper antibiotic, if needed. Toni References How is bronchitis treated? (2011, August 4). Retrieved from http://www.nhlbi.nih.gov/health/healthtopics/topics/brnchi/treatment Goroll, A. H., & Mulley, A. G. (2014). Primary care medicine: Office evaluation and management of the adult patient (7th ed.). China: Wolters Kluwer. Kim, S. (2015, October 20). Pneumonia: types, symptoms, & treatment. Retrieved from http://www.healthline.com/health/pneumonia#Overview1 Mayo Clinic Staff. (2015, March 14). Pneumonia symptoms. Retrieved from http://www.mayoclinic.org/diseases-conditions/pneumonia/basics/symptoms/con-20020032 McCance, K. L., Huether, S. E., & Brahsers, V. L. (2013). Alterations of pulmonary function. In Pathophysiology: The biologic basis for disease in adults & children (7th ed., p. 1275). St. Louis, MO: Mosby. Mossad, S. (2013, August). Upper respiratory tract infections. Retrieved from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/infectious-disease/upperrespiratory-tract-infection/ This study source was downloaded by 100000830216776 from CourseHero.com on 09-08-2021 15:13:49 GMT -05:00 https://www.coursehero.com/file/14512210/Week-2-Discussion-2/ This study resource was shared via Co [Show More]

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