Outpatient office with a hacking, raspy cough.
Select one of the following discussion questions below. Post a substantive initial response with references.
Discussion Post #3
Option 1
M.C. is a 69-year-old man who presents to the outpatient office with a hacking, raspy cough.
Subjective Data
PMH: HTN, DM
Cough is productive, bringing up green phlegm
Runny nose, sore throat
Denies fever
Sore throat pain when swallowing
No history of smoking or seasonal allergies
Complains of fatigue
Objective Data
Vital signs: T 37 P 72 R 14 BP 134/64
Lungs: + Rhonchi bilateral upper lobes, wheeze
O2 Sat = 98%
Ears = TM bulging
Nose = + erythema, yellow discharge
Throat = + erythema, – pustules
Medications: Metoprolol 12.5 mg per day, Glucophage 500 mg twice a day
Questions
What other questions should the nurse ask about the cough?
Develop a problem list from the objective and subjective data.
What nursing diagnoses can be derived from the problems list?
What should be included in the plan of care?
What risk factors are associated with this age group?
Based on the readings, what is the most likely cause of this patient’s cough?
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(Image: Female Holding Head in Discomfort)
Option 2
S.P. is a 75-year-old woman who presents to the provider’s office with fatigue.
Subjective Data
PMH: HTN, hyperlipidemia, MI 3 years ago
Fatigue started about a month ago, getting worse
Relieved with rest, exacerbated with activity
Denies chest pain
Ankles swollen
Objective Data
Vital signs: T 37 P 112 R 18 BP 110/54
Lungs: bilateral lower lobe crackles
O2 Sat = 94%
Skin = cool to touch
CV = heart rate regular, positive peripheral pulses, ECG = no changes
+2 edema bilateral ankles
Medications: Metoprolol 20 mg per day, 325 mg of aspirin per day
Questions
What other questions should the nurse ask about the fatigue?
What other assessments are necessary for this patient?
What are some causes of fatigue?
Develop a problem list from the objective and subjective data.
What should be included in the plan of care?
Based on the readings, what is this patient's most likely cause of fatigue?
Sample Solution
Option 1: M.C. with Cough
Additional Questions:
- Onset and duration of cough: How long has the cough been present? Has it become progressively worse, stayed the same, or improved?
- Character of cough: Is the cough dry or productive? If productive, is the phlegm clear, white, yellow, green, or bloody? Is the cough worse at any particular time of day (e.g., morning, night)?
- Other respiratory symptoms: Has the patient experienced any other respiratory symptoms like shortness of breath, wheezing, fever, chills, or chest pain?
- Recent exposures: Has the patient been around anyone with a similar cough or been exposed to any potential irritants like environmental dust, pollutants, or smoke?
Full Answer Section
- Travel history: Has the patient recently traveled, particularly to areas with endemic infectious diseases?
- Change in medications: Have there been any recent changes in medication or dosage that could be contributing to the cough?
- Risk factors for specific conditions: Ask about any history of pneumonia, COPD, asthma, bronchitis, or chronic upper airway infections.
Problem List:
- Acute productive cough with green phlegm
- Runny nose
- Sore throat
- Fatigue
Nursing Diagnoses:
- Ineffective Airway Clearance related to excessive mucus production or altered respiratory pattern as evidenced by productive cough, rhonchi, and wheeze.
- Acute Upper Respiratory Infection (URI) as evidenced by cough, runny nose, sore throat, and nasal discharge.
- Fatigue as evidenced by verbal report.
Plan of Care:
- Respiratory Management: Administer nebulized bronchodilators, encourage increased fluid intake, provide chest physiotherapy if needed, monitor vital signs and oxygen saturation.
- Symptom Management: Encourage throat lozenges for sore throat, consider analgesics if necessary, address nasal congestion with saline nasal spray or decongestant medication.
- Diagnostic Tests: Obtain sputum culture to identify the causative organism, consider chest X-ray if pneumonia is suspected.
- Education: Teach proper cough hygiene, handwashing techniques, and importance of completing antibiotic regimen if prescribed.
Risk Factors for this Age Group:
- Decreased immune function
- Underlying chronic health conditions (e.g., HTN, DM)
- Increased susceptibility to pneumonia
Most Likely Cause:
Based on the presented information, the most likely cause of M.C.'s cough appears to be an acute upper respiratory infection (URI), possibly bacterial in nature due to the green phlegm. However, further assessment and diagnostic tests are necessary to confirm the diagnosis and rule out other potential causes like pneumonia or bronchitis.
Please note: This information is for educational purposes only and should not be used as a substitute for professional medical advice or diagnosis.