Reply to my peers

Week 2 Discussion

1. Discuss the Mr. Barley’s history that would be pertinent to his respiratory problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

Mr. Barley is a 58-year-old male with a chief complaint of cough that is accompanied by white phlegm. He also has shortness of breath while walking quickly and climbing stairs and the dyspnea worsens the further he goes. He has no major medical history, but did have a tonsillectomy as a child. He states the cough has occurred the past two winters and is worse in the morning. Mr. Barley is a farmer with exposure to irritating chemicals and is also a smoker of 26 years. His familial history includes his father having a stroke and his mother having hypertension.

2. Describe the physical exam and diagnostic tools to be used for Mr. Barley. Are there any additional you would have liked to be included that were not?

Review of systems:

General: Patient denies fever and weight loss at this time

HEENT: Laryngeal height measures 2 cm from sternal notch to the top of the thyroid cartilage at full expiration. No complaints; WNL

CV: Mild shortness of breath. Denies chest pain. +1 pretibial pitting edema noted. Denies palpitations.

Respiratory: Shortness of breath. Increased AP diameter. Inspiratory crackles at bases. End-expiratory wheezing diffusely. 

GI: WNL

GU: WNL

Musculoskeletal: WNL

Psychiatric:  WNL

Neuro: WNL

Endo: WNL

Hema: WNL

Skin: WNL

Diagnostic tools to be used to assess Mr. Barley is a pulmonary function test, EKG, and chest x-ray. The use of a pulmonary function test is important because it will help differentiate Mr. Barley’s lung dysfunction as restrictive or obstructive (Mirsadraee et al., 2019). I realize an EKG was not mentioned in the case study, but I feel it is necessary. The patient is not complaining of chest pain but he is complaining of shortness of breath, which can be associated with cardiac dysrhythmias (Ozturk et al., 2016). Finally a chest x-ray. Chest x-rays are not typically used in diagnosing COPD, but can reveal other concerning diagnoses like a mass.

3. What plan of care will Mr. Barley be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

The number step in Mr. Barley’s plan of care will to get him to stop smoking. The next would be to prescribe him both a long acting muscarinic antagonist (Spiriva) or a combination medication like (Symbicort); these medications are some of the drugs of choice for treating COPD (Moser Woo & Robinson, 2019). A short acting beta -2 agonist is also necessary for acute episodes of airflow restrictions. The most common example of this type of medication is albuterol Hfa (Moser Woo & Robinson, 2019). For any inhaler use it is important the patient uses a spacer to ensure proper and complete inhalation of the medication. Other patient education would include increasing fluid intake to keep mucous thin, medication compliance, and smoking cessation. I would probably schedule a follow up in about 2 weeks to see if the medications are benefitting the patient or if a change is needed at this time. I would also refer the patient to a pulmonologist, but follow the patient closely.

 

 

 

 

References

Mirsadraee, M., Asnashari, A., & Attaran, D. (2019). The accuracy of FEF 75-25 /FVC for primary classification of pulmonary function test. Journal of Cardio-Thoracic Medicine, 7(4), 509–517.

Moser Woo, T., & Robinson, M. V. (2019). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.). F.A. Davis Company.

Ozturk, S., Turhan, H., & Yetkin, E. (2016). Where to begin: From the electrocardiogram or the symptoms? International Journal of Cardiology, 216, 16–17. https://doi.org/10.1016/j.ijcard.2016.04.147