Theory of The Differential Diagnosis - Assignment Example

Week 7 Case Study TheoryPatient S.F, 70 years of age presents and has a history of significant cigarette use. A seen symptom is dyspnea on exertion, which has been worsening over the last three days. Additionally, the patient has a cough with sputum production; which has a change in characteristics of sputum production. This paper will discuss the differential diagnosis, further review of system, final primary diagnosis, diagnostic workup, medications, referrals, conservative measures, patient education, and a follow-up plan that should be taken by the patient.

Differential diagnosis linked to the patient presenting with dyspnea on exertion includes asthma, myocardial ischemia, COPD, congestive heart failure, pericardial effusion, deconditioning, anemia, pulmonary embolism, pneumonia, and coronary artery disease. The rationale for these diagnoses is that difficulty breathing with exertion explains cardiopulmonary or pulmonary disease. Moreover, pursed-lip breathing is a sign of airflow obstruction. Dyspnea on exertion worsens with the resulting sedentary state.

This is present in patients with cardiopulmonary disease. In regard to this case study, the patient has a past medical history of COPD; thus, skeletal muscle atrophy is a common finding and has been related to low-level systemic inflammation and oxidative stress (Nelson, 2015). To further develop the differential diagnosis, a review of systems ought to be conducted. This entails questions that need to be addressed. Such questions include: dental changes, occupational exposure to dust and chemicals, excessive salt intake, weight gain, increased cough, fever, and increasing sputum production (Markovchick, Pons, & Bakes, 2011).

The final primary diagnosis is COPD. The symptoms include cough, sputum production, and dyspnea on exertion (Osadnik, McDonald, Jones & Holland, 2012). In this particular case, the patient has a significant cigarette smoking history, thus, the worsening dyspnea. This is because the increase in dyspnea is linked with age (the patient is 70 years), deconditioning, weight gain and concomitant comorbid medical conditions. Further diagnostic work-up includes obtaining a spirometry before and after bronchodilator; as the first step.

This step will determine any airflow obstruction thus grant patients immediate therapy. Additionally lung volume ought to be measured, so as to reveal hyperinflation (Buttaro, 2013). Also, thoracic imaging ought to be performed with an MRI, as well as pulse oximetry test and arterial blood gas measurements. Appropriate medications for this condition include bronchodilators, Phosphodiesterase-4 (PDE4) inhibitors, and Corticosteroids. These drugs are intended to improve the symptoms. Pneumococcal and influenza vaccines have to be administered to the patient.

Non- pharmacological therapies include lung volume reduction surgery, supplemental oxygen, and pulmonary rehabilitation (Kew, Dias & Cates, 2014). Patient Education/Health Promotion entails informing the patient on how to live a healthy life. This entails the management of the condition, which ought to begin with correcting airway obstruction (Osadnik et al., 2012). Such tips include:1. Encouragement to quit smoking2. Eliminating environmental irritants3. Engaging in an exercise program, and noting the tolerance level of activities.

Referral and hospital admission is relevant in cases where there is a worsening of dyspnea in patients with a chronic heart or lung condition. This is considered a serious case, as hypoxemia, ventilator failure, or left ventricular decompensation may have occurred. A follow-up plan can determine improvement. This entails knowing how the patient feels, as well as monitoring oxygen saturation (Singh, Loscalzo, & Brigham and Women's Hospital, 2012). ReferencesButtaro, T. M. (2013). Primary care: A collaborative practice. St. Louis, Mo:Elsevier/Mosby.

Kew KM, Dias S, Cates CJ. Long-acting inhaled therapy (beta-agonists, anticholinergics andsteroids) for COPD: a network meta-analysis. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD010844. DOI: 10.1002/14651858.CD010844.pub2.Markovchick, V. J., Pons, P. T., & Bakes, K. M. (2011). Emergency medicine secrets. St.Louis, Mo: Elsevier/Mosby.Nelson, B. D. (2015). Essential clinical global health. Chichester, West Sussex ; Malden,MA : John Wiley & Sons Inc.Osadnik CR, McDonald CF, Jones AP, Holland AE.

Airway clearance techniques for chronicobstructive pulmonary disease. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD008328. DOI: 10.1002/14651858.CD008328.pub2.Singh, A., Loscalzo, J., & Brigham and Women's Hospital. (2012). The Brigham intensivereview of internal medicine. New York: Oxford University Press.