discussion week 4

APA format, 2 pages, 3 references. PLEASE ANSWER ALL THE QUESTIONS SO I CAN RECEIVE FULL CREDIT

A sixty-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can’t do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke, and her father died from prostate cancer. She denies any recent upper respiratory illness, and she has had no other symptoms. On examination, she is in no acute distress. Her blood pressure is 160/100, and her pulse is 100. She is afebrile, and her respiratory rate is 16. With auscultation, she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an S3 is heard over the apex.

  1. What is the chief complaint?
  2. Based on the subjective and objective information provided what are your 3 top differential diagnosis listing the presumptive final diagnosis first?
  3. What treatment plan would you consider utilizing current evidence based practice guidelines?

Expert Solution Preview

Introduction:

A 60-year-old female patient presents with complaints of shortness of breath and nonproductive cough over the last month. She reports feeling tired and having to sleep upright in her recliner at night to breathe. The patient has a past medical history significant for high blood pressure, coronary artery disease, and hysterectomy. On examination, the patient has late inspiratory crackles in both lower lobes and a distant S1 and S2 with an S3 heard over the apex. The following questions will address the patient’s case.

1. What is the chief complaint?

The patient’s chief complaint is increasing shortness of breath and nonproductive cough over the last month, which limits her ability to do daily activities.

2. Based on the subjective and objective information provided, what are your 3 top differential diagnosis listing the presumptive final diagnosis first?

Based on the symptoms and examination findings, the three top differential diagnoses are as follows:
– Heart failure: The patient’s presenting symptoms of shortness of breath, fatigue, and bilateral inspiratory crackles are indicative of heart failure. The distant S1 and S2 with an S3 suggest a left ventricular dysfunction.
– Chronic obstructive pulmonary disease (COPD): The patient has a history of smoking, which is one of the main risk factors for COPD. The symptoms of shortness of breath and nonproductive cough are also indicative of COPD.
– Pulmonary fibrosis: This is a less likely differential diagnosis, but it cannot be ruled out based on the examination findings. Pulmonary fibrosis can present with inspiratory crackles, and the patient’s age and past medical history also put her at risk for developing this condition.

3. What treatment plan would you consider utilizing current evidence-based practice guidelines?

The initial management plan for suspected heart failure would include the following:
– Diuretics: Diuretics, such as furosemide, can help relieve symptoms of fluid overload and reduce blood pressure in patients with heart failure.
– ACE inhibitors/ARBs: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are recommended as first-line agents for patients with heart failure and reduced ejection fraction.
– Beta-blockers: Beta-blockers can improve symptoms and reduce morbidity and mortality in patients with heart failure with reduced ejection fraction.
– Oxygen therapy: Oxygen therapy can be administered to alleviate symptoms of dyspnea in patients with hypoxemia.

The patient should also follow lifestyle modifications such as limiting salt intake, monitoring fluid intake, and regular exercise. The patient should be monitored closely for adverse effects and improvement in symptoms. Referral to a specialist, such as a cardiologist or pulmonologist, may also be necessary for further evaluation and management.

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