Differential diagnosis - Respiratory complication

This is assignment is to respond to those 2 discussion posts posted below. Each answer should be a minimum of 150 words APA format. All replies must be constructive and use literature where possible by extending, refuting/correcting, or adding additional nuance to your peers with at least 2 sources each. Sources cannot be older than 5 years.

Question 1 (RAK)The patient denies having chest pains but admits having a fever. The other subjective data that may be presented by the patient include a cough that is productive and hoarse with throat pains. Also, the patient may indicate producing clear to frothy sputum. Although the patient currently denies having chest pains, progressively, they will complain of shortness in breath with or without activity, which is accompanied by wheezing.

The fever may be accompanied by cold, night sweats, and fatigue (Han & Dransfield, 2019). Other subjective data would include when the symptoms started, which maybe three days ago, the severity, which, in this case, in mild, as well as alleviating factors, which may include exposure to pollen or smoke and the time when the symptoms worsen, in this case, it may be in the early cold mornings and evenings.

The other objective findings I would look for include the skin features such that the surface should be warm and dry with a uniform complexion consistent with ethnicity. Also, the patient’s facial expression should be relaxed, with no signs of apprehension and distress. In case the breathing is seen as a conscious effort, then it is an indication of respiratory or other problems (Hosseinzadeh, 2017). Besides, I would observe the lips, nails, and the conjunctiva for signs of oxygen levels and saturation such that a blue discoloration, which is an indication of either hypoxia or cyanosis with the clubbing of the fingers being a sign of chronic hypoxemia.

The diagnostic exams will focus on the respiration patters. The regular rate that is more than 20 breaths per minute is an indication of pulmonary edema, pneumonia, pain, fever, pulmonary effusion, and carbon monoxide poisoning, among other conditions. Therefore, tests may include a lung function test, which measures the amount of air inhaled and exhaled and whether the lungs and deliver the required amount of oxygen to the lungs (Lloyd & Yadav, 2020).

Another test is the chest X-ray, which rules out lung and heart problems and is aimed at showing emphysema, which is the primary cause of COPD. Also, a CT scan test should be carried out to help in detecting emphysema and determine whether surgery for COPD is a viable option. Other tests include arterial blood gas analysis to ascertain the levels of oxygen and carbon dioxide and laboratory tests for all the collected specimens, including sputum, to determine the presence of any other infection in the respiratory system.

The differential diagnosis for this patient is broad as it presents dyspnea symptoms illustrated by the cough with sputum production. Nevertheless, the three differential diagnoses include chronic obstructive asthma, which is featured by the airway’s swelling, making it difficult to breathe. The second differential diagnosis is for chronic bronchitis with normal spirometry, also referred to as the chronic mucus hypersecretion.

The third diagnosis is for central airway obstruction differential diagnosis.
Chronic obstruction asthma is not distinct from COPD as the symptoms and signs are similar. For example, a patient who has had Atopic Asthma since childhood and has also been smoking for more than ten years could present symptoms and signs that are COPD and Asthma-related (Tucker & Novotny, 2016).

Secondly, chronic bronchitis with normal spirometry is usually present in cigarette smokers who have a productive cough for at least three months but do not have airflow limitations as the case of the patient in this case study. Finally, the central airway obstruction is caused by destructive processes and can appear to resemble COPD, as indicated by the progressive dyspnea and monophonic wheezing as presented by the patient.

Han, K. M., & Dransfield, M. (2019). Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging. Medical, 2 (1), 12-45.
Hosseinzadeh, H. (2017). Self-management and patient activation in COPD patients: An evidence summary of randomized controlled trials. Clin. Epidemiol. Glob. Health, 6 (1), 148–154.
Lloyd, J., & Yadav, N. U. (2020). Do Chronic Obstructive Pulmonary Diseases (COPD) Self-Management Interventions Consider Health Literacy and Patient Activation? A Systematic Review. J Clin Med. , 9 (3), 646-456.
Tucker, S., & Novotny, J. (2016). Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization. A Randomized Study. Am. J. Respir. Crit. Care Med , 194 (1), 672–680.

Question 2 (EL)What other subjective data would you obtain?The first objective data I would obtain is the aggravating factors of the chest pain and the associated symptoms that make the condition worse (Stephens 2019). Usually, there should be factors that make the pain worsen and it is necessary to have clear information of such data for a comprehensive and quality assessment which is fundamental and effective in the management of the challenges.

A history of allergy to medications or other substances can serve a good avenue for useful information in the condition (Kuhlman et al., 2019). For the patient, it is necessary to collect some relevant data associated with chest pain and consider vital aspects that must be implemented in a bid to control the challenge and consider such disease a center of attention.
History of fall or chest infection is an objective data I would collect and document with regards to the nature and the characteristics in place. There are a number of challenges associated with chest injuries and falls hence a needed protocol is required for a successful and effective implementation which is necessary and required as well.

What other objective findings would you look for?The objective findings such as chest X-Ray determining the level of spread of the pain or abnormalities associated with the condition are necessary (Stephens 2019). Some of the most useful aspects associated with the chest examination is getting a detailed report of the origin of pain and considering the right intervention in assisting a controlled process that is necessary and effective in the implementation of key requirements in the diagnoses (Kuhlman et al., 2019).

Secondly, a comprehensive physical assessment from head to toe is recommended in coming up with a perfect and required intervention in the healthcare settings (Stephens 2019). Working from some of the perfect approaches, implemented protocols and measures are necessary in coming to terms with the issues and challenges in place (Kuhlman et al., 2019). An effective and required protocol is necessary in palpation and other determination of the nature of the pain such that accuracy and supplemented information apart from what is described by the patient is put in place.

What diagnostic exams do you want to order?Chest X-Ray Examination.Electrocardiogram test (ECG).A systematic review and bone examination.Name 3 differential diagnoses based on this patient presenting symptoms?Sternal tumor.Sternal bone osteoporosisGive rationales for each differential diagnosis.Costochondritis. In Costochondritis, the sternum is inflamed and there is an acute pain witnessed especially with exertion. Considering the various dimensions of the disease, it is recommended that the right approach is implemented in a supportive and useful technique of managing the condition (Stephens 2019).

The pain is felt in the sternal area and there is a possibility of the infection going overboard and resulting in challenges and other situations that negatively impact the health.Sternal tumor. A tumor in the sternal bone area could result in compression of the nerves hence causing the pain (Stephens 2019). The sternal area has muscles, blood vessels, and nerves that are close to one another in terms of proximity.

Considering the type of chest pain witnessed around the sternum, there is a possibility of either a benign or malignant tumor that is aggravated by exertion.Sternal bone osteoporosis: Pain in the sternal area could be associated with the bone infection of osteoporosis that is slowly progressing. with exertion, the pain could be progressing as a result of the injury and stress on the bones hence the presenting symptoms. 

Kuhlman, J., Moorhead, D., Kerpchar, J., Peach, D. J., Ahmad, S., & O'Brien, P. B. (2019). Clinical transformation through change management case study: Chest pain in the emergency department. EClinicalMedicine, 10, 78-83.
Stephens, G. (2019). Using a structured clinical assessment to identify the cause of chest pain. Nursing Standard, 34(4).

Differential diagnosis - Respiratory complication

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