The use of accessory muscles

read the following clinical case scenario: ____ SUBJECTIVE: Janis, a 59 - year - old female, presents with tachypnea, dyspnea on exertion, and mild chest discomfort. She was diagnosed with emphysema four years ago and was placed on bronchodilator therapy. She has an 80-pack-year history of smoking. â€œ I feel short of breath when I walk, and my chest is sore. â€ She describes her chest soreness as mild pressure, rated as two on a 1 â€“ 10 scale. The pain is over the anterior thorax, more pronounced in the ribs, which she believes has developed from coughing hard. She states that she has had a nonproductive cough for four days and feels more fatigued than usual. Past medical history: She has osteoarthritis in the hands and knees. She has a surgical history of appendectomy and cholecystectomy. In the past year, she has had two exacerbations of her COPD and has attempted to stop smoking, using nicotine gum replacement unsuccessfully. Family history: Noncontributory. Social history: She lives with her husband, who also smokes two packs of cigarettes per day and cares for her elderly mother, who lives with them and is frail but ambulatory. Medications: Albuterol MDI, 90 mcg/inhalation, two puffs as needed every 4 â€“ 6 hours; ipratropium bromide MDI, 18 mcg/inhalation, two puffs four times/day; ibuprofen as needed for arthritic pain. Allergies: Janis is allergic to Keflex and penicillin. OBJECTIVE: General: Janis is dyspneic at rest, sitting. The use of accessory muscles is evident. Pursed lip breathing noted. Vital signs: BP: 122/64; P: 92; R: 26; T: 100.2; SpO2: 88. AP to transverse ratio is 1:1. Skin: Warm and dry. HEENT: Negative. Cardiovascular: RRR: S1/S2; no murmurs, clips, rubs, or gallops. No evidence of peripheral edema. Posterior tibial and dorsalis pedis pulses 2 + /4 + . Respiratory: Lungs have diffused wheezing and crackles in the right upper lobe. Tenderness to palpation along intercostal spaces on the right and left anterior and lateral thorax from the 2nd to 5th intercostal spaces. PFT conducted two months prior to the visit showed obstructive flow patterns and reduced FEV1/FVC. Abdomen: Soft, with bowel sounds; tympanic to percussion. Neurologic: Negative. Based on the described case scenario, please answer two of the following questions: -Which diagnostic or imaging studies should be considered to assist with or confirm the diagnosis? -What is the most likely differential diagnosis, and why? -What is your plan of treatment? -What is your plan for follow-up care? -Are any referrals needed? -What are additional risk factors evident for this patient? -Are there any standardized guidelines that you should use to treat this patient?

Sample Solution

The following diagnostic or imaging studies should be considered to assist with or confirm the diagnosis:

Chest X-ray: This will help to assess the extent of lung damage and rule out other possible diagnoses, such as pneumonia or pneumothorax.
Spirometry: This test measures the amount of air that can be inhaled and exhaled, and can help to confirm the diagnosis of COPD.
Arterial blood gas (ABG): This test measures the levels of oxygen and carbon dioxide in the blood, and can help to assess the severity of the patient's respiratory distress.
Pulse oximetry: This test measures the amount of oxygen in the blood, and can be used to monitor the patient's oxygen saturation levels.

Full Answer Section

CT scan of the chest: This may be done if there is suspicion of a complication, such as a pneumothorax or lung abscess.

What is the most likely differential diagnosis, and why?

The most likely differential diagnosis for Janis is an exacerbation of her COPD. This is because she has a history of COPD, she is experiencing shortness of breath, chest pain, and cough, and her physical examination findings are consistent with COPD. Other possible diagnoses include pneumonia, pneumothorax, and lung cancer. However, these diagnoses are less likely given Janis's history and presentation.

What is your plan of treatment?

The treatment for Janis will depend on the severity of her exacerbation. If her symptoms are mild, she may be able to be treated at home with bronchodilators and antibiotics. If her symptoms are more severe, she may need to be admitted to the hospital for oxygen therapy, IV fluids, and other medications.

The specific medications that Janis will be prescribed will depend on the severity of her exacerbation and her individual needs. However, some of the medications that may be used include:

Bronchodilators: These medications help to open up the airways and make it easier to breathe.
Antibiotics: These medications are used to treat infections, such as pneumonia.
Steroids: These medications can help to reduce inflammation in the airways.
Oxygen therapy: This provides extra oxygen to the blood, which can help to improve the patient's breathing.

What is your plan for follow-up care?

Janis will need to follow up with her doctor regularly to monitor her condition and make sure that her COPD is being managed effectively. She will also need to quit smoking, as this is the best way to prevent further damage to her lungs.

In addition to quitting smoking, Janis can also make other lifestyle changes to help manage her COPD, such as:

Maintaining a healthy weight
Eating a healthy diet
Getting regular exercise
Avoiding secondhand smoke

By following these steps, Janis can improve her quality of life and reduce her risk of complications from COPD.

We are here to help

We have crazy offers

Itâ€™s quick and easy to place an order. We have an efficient customer service that works 24/7 to assist you.Itâ€™s quick and easy to place an order. We have an efficient customer service that works 24/7 to assist you.

We are here and ready to help

Order Now