Symptoms
CC: “Cough”
HPI: The patient is Mr. Hendricks – an adult male who developed sudden onset of cough. The pain is described as “with thick green and blood secretions”. It is accompanied by shortness of breath all the time, especially when the patient is walking. The patient tried Tylenol last night because he felt chills and sweats and thought that it was a fever. No data regarding exact age, the onset of symptom, and severity.
PMH: N/A
FH: N/A
SH: N/A
ROS
General–Positive for fevers, chills, and sweats
Cardiovascular–No orthopnea, paroxysmal dyspnea
Gastrointestinal–Negative for nausea, vomiting, diarrhea, and abdominal pain
Pulmonary–Positive for intermittent dyspnea on exertion and cough
Examination Results
VS: BP 128/70; R 20 labored; T 100.9; 02 89% Wt 210lbs; Ht 82
General—Patient is oriented and alert yet anxious. HEENT: Skin: Warm and moist
Cardiovascular–Regular heart rate with good S1, S2; no S3, S4, or murmur. Peripheral vascular: No pedal edema; 2+ dorsalis pedis pulses bilaterally
Gastrointestinal–The abdomen is symmetrical, no masses or splenomegaly; it is protuberant with normoactive bowel sounds auscultated x4 quadrants
Pulmonary— Auscultation and percussion bilaterally revealed diminished breath sounds with rales and expiratory wheezes throughout; thorax symmetrical; no rhonchi; productive and wet cough
Neurologic—Pt appears oriented in place and time
Diagnostic results: CXR – left lung consolidation, emphysematous
changes with mild hyper expansion; Lung ultrasound (LUS) – consolidation (Chavez et al., 2014).
Lab Tests: blood test – infection.
Differential Diagnosis:
Pneumonia
It is an acute lung infection of an infectious-inflammatory nature, in which all the structural elements of the lung tissue are involved, mainly the alveoli and interstitial lung tissue. The clinic of pneumonia is characterized by fever, weakness, sweating, pain in the chest, shortness of breath, and cough with phlegm (Mattila et al.,
2014). The most serious threats are for children and people over 65 years of age. The course of pneumonia is significantly aggravated by the existing chronic diseases such as coronary heart disease (CHD), diabetes mellitus, or chronic obstructive pulmonary disease (COPD).
Acute bronchitis
This is a form of diffuse inflammation of the bronchial tree that is characterized by the increased bronchial secretion and impaired bronchial patency. For acute bronchitis, a sharp onset, respiratory symptoms (runny nose, sore throat, paroxysmal cough with sputum, shortness of breath, chest pain, and bronchospasm) are common as well as and symptoms of intoxication (temperature rise, headache, and weakness) (Hoshina et al., 2014).
Lung cancer
Cough in the late stages of lung cancer from the systemic dry but not delivering serious discomfort goes into a painful seizure and sputum discharge with blood that is the most dangerous symptom, and with this manifestation lung cancer of the third and fourth stages is fixed in most cases (Silvestri et al., 2013). Quite often, pathology is manifested by an increase in lymph nodes located in the supraclavicular area. They are among the first to react to the serious development of lung cancer, although this manifestation is not typical for all cases. In addition to the three above symptoms, signs of lung cancer of early stages also appear with this pathology in the later stages: subfebrile temperature, hoarseness, and a constant feeling of fatigue.
Bronchiolitis
It is characterized by fever, pronounced dyspnea, and superficial breathing with the participation of ancillary musculature. An excruciating cough with scanty mucous sputum, chest pain due to muscle strain, and contraction of the diaphragm appears when coughing (Lee, Rehder, Williford, Cheifetz, & Turner, 2013). Percutary sound with a boxed tint, breathing weakened or hard, and, wheezing in exhalation is noted.
Pulmonary tuberculosis
It is the infectious pathology caused by the Koch bacillus and characterized by clinomico-morphological variants of pulmonary tissue damage. The variety of forms of pulmonary tuberculosis determines the variability of symptoms, including cough, hemoptysis, dyspnea, sweating, weakness, et cetera (Allwood, Myer, & Bateman, 2013).
Primary Diagnosis/Presumptive Diagnosis: Pneumonia
Most patients are effectively treated for pneumonia at home using oral (tableted) antibiotics. The given patient with pneumonia may be hospitalized in the therapeutic or pulmonology department due to his age and severity of the disease. Hospitalized patients are usually given antibiotic therapy in the regimens of intravenous or intramuscular injection. The following medications should be considered: empiric treatment with IV cefotaxime and IV azithromycin as well as Medrol dose pack taper and albuterol nebulizer treatments every four hours PRN (Mattila et al., 2014). The length of the hospitalization of a patient with pneumonia depends on several issues, involving existing chronic lung diseases, a weakened immune system, or pneumonia in two or more segments of the lung.
When pneumonia needs the conduct of detoxification therapy, immunostimulation, the appointment of antipyretic, and mucolytic means should be prescribed. Treatment of pneumonia is performed till the patient’s complete recovery that is revealed by the diagnostic tests and laboratory indicators. Bed rest, high-calorie food rich in vitamins, and copious warm drink are to be prescribed for the period of fever and intoxication. With the outlined phenomena of respiratory failure, the patient with pneumonia should be ensured with inhalation of oxygen.
References
Allwood, B. W., Myer, L., & Bateman, E. D. (2013). A systematic review of the association between pulmonary tuberculosis and the development of chronic airflow obstruction in adults. Respiration, 86(1), 76-85.
Chavez, M. A., Shams, N., Ellington, L. E., Naithani, N., Gilman, R. H., Steinhoff, M. C.,… Checkley, W. (2014). Lung ultrasound for the diagnosis of pneumonia in adults: A systematic review and meta-analysis. Respiratory Research, 15(1), 50-59.
Hoshina, T., Nanishi, E., Kanno, S., Nishio, H., Kusuhara, K., & Hara, T. (2014). The utility of biomarkers in differentiating bacterial from non-bacterial lower respiratory tract infection in hospitalized children: Difference of the diagnostic performance between acute pneumonia and bronchitis. Journal of Infection and Chemotherapy, 20(10), 616-620.
Lee, J. H., Rehder, K. J., Williford, L., Cheifetz, I. M., & Turner, D. A. (2013). Use of high flow nasal cannula in critically ill infants, children, and adults: A critical review of the literature. Intensive Care Medicine, 39(2), 247-257.
Mattila, J. T., Fine, M. J., Limper, A. H., Murray, P. R., Chen, B. B., & Lin, P. L. (2014). Pneumonia. Treatment and diagnosis. Annals of the American Thoracic Society, 11(4), 189-192.
Silvestri, G. A., Gonzalez, A. V., Jantz, M. A., Margolis, M. L., Gould, M. K., Tanoue, L. T.,… Detterbeck, F. C. (2013). Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 143(5), 211-250.