Please Reply to the following TWO Discussion Post
Please Reply to the following TWO Discussion Post
Requirement
APA format with intext citation
Word count minimum of 150 words per post
References at least one high-level scholarly reference per post within the last 5 years in APA format.
Plagiarism free.
Turnitin receipt.
DISCUSSION POST # 1. Reply to Talia
A 52-year-old patient that presents to the clinic with a cough for five days should be interviewed by the Nurse Practitioner (NP) and asked about additional descriptive details. The NP should take a complete health history and complete a medication reconciliation. The NP should ask the patient to describe the cough using the OLDCART method. This would include if the cough were productive or not, and if it is, what color is the sputum? What factors make the cough worse or better? Other important questions are, has the patient had a recent upper respiratory tract infection, and does the patient have a history of asthma? The most common causes of an acute cough in adults are an acute upper or lower respiratory tract infection such as the common cold, or an exacerbation of a chronic condition like asthma (Wolters Kluwer Health, 2023).
Differential diagnoses for this patient include:
· Acute bronchitis: This condition is characterized by a cough lasting one to three weeks, with or without sputum production and is normally self-limiting. Symptom control and patient education are the bases of care. Most patients will not require follow-up but must be educated on when and why to return, such as the onset of fever, or increased work of breathing (Wolters Kluwer Health, 2023).
· Pneumonia: Abnormal vital signs and fever accompanied by a cough may suggest the possibility of pneumonia, and a chest radiograph should be attained for confirmation (Wolters Kluwer Health, 2023). The antimicrobial of choice for community acquired pneumonia is amoxicillin and a follow up appointment should be scheduled as patient tend to recover within 48 hours of treatment (Wolters Kluwer Health, 2023).
· COVID-19: The coronavirus may present as an acute upper or lower respiratory tract infection. Cough and other symptoms such as dyspnea and fatigue can persist for prolonged periods following acute infection (Wolters Kluwer Health, 2023). Testing with a nasal swab is recommended.
· Post-nasal drip syndrome: The common cold or rhinitis may be the cause of an irritating postnasal drainage causing the patient to clear their throat and cough frequently (Wolters Kluwer Health, 2023). Supportive care and symptom management is recommended (Wolters Kluwer Health, 2023).
· ACE inhibitor use: Up to 15% of patients treated with ACE inhibitors may experience a dry nonproductive cough (Wolters Kluwer Health, 2023). Treatment includes discontinuing the medication and the cough typically resolves within one to four days (Wolters Kluwer Health, 2023).
DISCUSSION POST # 2. Reply to Astrid
Developing appropriate cough treatment requires accurately assessing symptoms, concomitant diseases, and medications. There are many different ways that a cough can present itself; some are more bothersome than others, but many resolves on their own without medical intervention. Therefore, the family nurse practitioner (FNP) must obtain a thorough health history and physical examination and generate different diagnoses to analyze the subjective and objective data that will guide care.
It is essential to ask the patient with a chief complaint of "productive cough for five days" about the history of present illness using open-ended questions to encourage him to be as descriptive as possible about his symptoms. The FNP should inquire about the characteristics of the cough and sputum, such as type, color, and odor. It is also important to ask the patient about aggravating and relieving factors. Another important question to ask the patient is if he has taken any medications for the cough and any other current medications, including prescribed, over-the-counter, and supplements. The FNP should inquire about the severity of his symptoms (how bothersome is the cough, does it interfere with his daily activities, does it wake him up at night). Additionally, it is important to inquire about the patient's signs and symptoms associated with the cough, such as dyspnea, chest pain or tightness, pedal edema, fatigue, dizziness, fever, chills, or wheezing.
The FNP must ask about the patient's past medical history, including family and social history, to assess for any potential correlations that would indicate if the patient has had any conditions that have affected his airway in the past. For example, cough is often caused by several conditions, such as cystic fibrosis, chronic obstructive pulmonary disease, gastroesophageal reflux disease, or lung cancer (Dunphy et al., 2019). Another part of the history taking is asking the patient if he has any food, drug, or environmental/seasonal allergies. Jo & Song (2019) state that cough has been linked to exposure to various environmental factors such as air pollutants and irritants, cigarette smoke, animals, and dust.
One of the differential diagnostics for this patient with productive cough is asthma. Asthma is a chronic inflammatory disease marked by reversible hyperreactivity of the bronchi and bronchioles to allergens and environmental factors, infections, and psychological factors (e.g., stressful events) (Dunphy et al., 2019). Inflammation of the airways contributes to bronchial hyperreactivity, airflow restriction, and the resulting asthmatic symptoms: wheezing, shortness of breath, chest constriction, and cough. The gold standard diagnostic test is spirometry to evaluate the patient's forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). It measures how much air the patient can inhale and exhale and how quickly he can exhale. If the FEV1 increases post bronchodilation, the airway blockage is said to be reversible, which is a sign of asthma.
Moreover, whether the patient is experiencing acute asthma attack or chronic asthma, good symptom control and reducing the risk of future asthma-related mortality, exacerbations, persistent airflow limitation, and treatment-related side effects are the ultimate objectives of asthma management (Global Initiative for Asthma, 2022). It is also essential to determine the patient's desired outcomes related to asthma management. Once the patient is diagnosed with asthma, GINA (2022) recommends low-dose inhaled corticosteroids (ICS)-formoterol as needed to relieve symptoms and, if needed, before exercise. Formoterol is a long-acting beta2 agonist that acts on the bronchial smooth muscle to dilate and relax the airways. The as-needed low-dose ICS-formoterol prevents exacerbations and mortality in patients with mild or infrequent symptoms. However, if the patient has had more than one exacerbation in the previous year, ICS-formoterol maintenance and reliever therapy is recommended (GINA, 2022).
Furthermore, it is vital to educate the patient about self-management and prevention of acute asthma attacks, the proper use of the metered-dose inhaler and handheld peak flow meter, performing breathing exercises, engaging in regular physical activity, healthy nutrition, positive coping mechanisms, and avoiding triggers, such as exposure to smoke, indoor and outdoor allergens (GINA, 2022). The patient must also be offered the influenza vaccine yearly according to recommendation of the Disease Control and Prevention (CDC) (2022a). If the patient has never received any pneumococcal conjugate vaccine, the CDC (2023) recommends PCV15 or PCV20 for adults 19 – 64 years old with risk factors and chronic medical conditions (diabetes, chronic lung, heart, or liver disease, alcoholism, or cigarette smoking). The CDC (2022b) also recommends one shot of the tetanus, diphtheria, and pertussis (Tdap) to all adults who have never received whooping cough vaccines. Therefore, the patient should be offered the Tdap vaccine if he has never received the whooping cough vaccines. Additionally, following up with the patient within one to two hours or the following day to assess progress is essential (Cash et al., 2021).