Please Reply to the following 2 Discussion posts:
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DISCUSSION POST # 1 Reply to Ella
According to (UCLA Health, 2023), most coughs following an upper respiratory infection are caused by the infection itself. But in some cases, the persistent cough may be a symptom of pre-existing asthma (made worse on by the recent virus) or a secondary infection that took hold while your immune system was distracted.
Upon evaluating the 68-year-old male patient’s presenting symptoms, which include a persistent cough for two (2) months and frequent urination for four (4) months, several potential differential diagnoses need to be considered. Additionally, the patient’s past medical history, smoking history, and age are crucial factors in determining an accurate diagnosis and devising a comprehensive plan of care.
Chronic Obstructive Pulmonary Disease (COPD) – J44. 9: Considering the patient’s extensive smoking history and persistent cough, COPD becomes a primary concern, necessitating additional evaluation via pulmonary function tests and chest X-ray.
Chronic cough R05. 3- As per the Mayo Clinic (n.d.), identifying the exact cause of a chronic cough can be challenging; however, it is commonly attributed to tobacco use, postnasal drip, asthma, and acid reflux. Thankfully, addressing the underlying issue usually leads to the resolution of the chronic cough.
Benign Prostatic Hyperplasia (BPH)- N40.0: BPH is a possible cause due to patient’s frequent urination for the last four (4) months.
Plan of Care:
My approach to care is centered around the final diagnosis of Chronic Obstructive Pulmonary Disease (COPD). This comprehensive plan aims to alleviate symptoms, enhance respiratory function, and improve the patient’s overall quality of life.
Lung (pulmonary) function tests
Arterial blood gas analysis
The patient will initiate treatment with a combination of an anticholinergic agent and a beta2-adrenergic agonist, specifically albuterol and ipratropium (Combivent Respimat). The prescribed dosage involves inhaling one dose four times daily, to commence.
Oxygen – nasal cannula 2 – 3 Liters per minute PRN
Medication Continuation: The patient will adhere to the prescribed blood pressure medication, Hydrochlorothiazide, as directed by their cardiologist.
Smoking Cessation: The patient will receive comprehensive education regarding the significance of quitting smoking to enhance his quality of life, particularly given his COPD condition.
Based on the conclusive test results, the patient may be recommended for pulmonary rehabilitation, aiming to enhance his physical well-being.
The patient will receive guidance on COPD management.
The patient will demonstrate proficiency in the correct usage of his inhaler and recognize early signs of exacerbation.
The importance of receiving annual flu and pneumococcal vaccines will be emphasized.
The patient will be educated about taking Hydrochlorothiazide in the morning, avoiding late-day administration.
Regular Follow-Up: A follow-up appointment will be scheduled for the patient in 7 days.
DISCUSSION POST # 2 Reply to Jinkee
The case discusses a 68-year-old man with a persistent cough and frequent urine. We’ll review the preliminary and conclusive findings and lay out a detailed treatment strategy, including medical procedures and prescription drugs.
The patient's frequent urination and chronic cough could be signs of several underlying diseases. The following differential diagnoses have to be taken into consideration in light of the facts provided:
COPD: Given the patient’s extensive smoking history, COPD, a common respiratory ailment characterized by emphysema and chronic bronchitis, maybe a possible diagnosis (Agarwal et al., 2022).
Chronic Bronchitis: This disorder causes the bronchial tubes to become inflamed and overproduce mucus, which results in a persistent cough. Chronic bronchitis is another possible cause of the persistent cough.
Prostate Issues: Males over 50 may experience frequent urination due to prostatitis, an inflammation of the prostate gland, or prostate hypertrophy (Ng & Baradhi, 2022).
Diabetes Mellitus: Frequent urination is also a symptom of diabetes, particularly type 2 diabetes mellitus, which is more prevalent in older people.
UTI : Older persons are more likely to get UTIs, which might make them urinate more frequently.
The eventual diagnosis for this patient is likely to be COPD and Benign Prostatic Hyperplasia (BPH), following a comprehensive physical examination and pertinent diagnostic testing (Agarwal et al., 2022).
Plan of Care
Management of COPD
Lifestyle Modifications: Tell the patient to stop smoking immediately to prevent their lungs from worsening.
Bronchodilators: To improve lung function and lessen symptoms, prescribe long-acting bronchodilators such as tiotropium and short-acting bronchodilators like albuterol (Agarwal et al., 2022).
Inhaled Corticosteroids: Consider prescribing inhaled corticosteroids (e.g., fluticasone) to reduce airway inflammation and exacerbations.
Pulmonary Rehabilitation: Refer the patient to a pulmonary rehabilitation program to improve exercise tolerance and overall quality of life (Agarwal et al., 2022).
Vaccinations: Administer influenza and pneumococcal vaccinations to reduce the risk of respiratory infections.
Management of BPH
Alpha-Blockers: Prescribe alpha-blockers (e.g., tamsulosin) to relax the smooth muscles of the prostate, relieving urinary symptoms (Ng & Baradhi, 2022).
5-Alpha Reductase Inhibitors: Consider prescribing 5-alpha reductase inhibitors (e.g., finasteride) to shrink the prostate gland and improve urinary flow.
Monitoring: Schedule regular follow-ups to monitor the progression of BPH and adjust medications as needed (Ng & Baradhi, 2022).
The health care provider need to perform the following test. Perform Pulmonary Function Test to assess lung function and confirm the diagnosis of COPD (Agarwal et al., 2022). Conduct a chest X-ray to evaluate the presence of lung abnormalities and rule out other lung conditions. Measure Prostate-Specific Antigen levels test to screen for prostate cancer and assess the severity of BPH (Ng & Baradhi, 2022). Lastly, perform a urinalysis to check for signs of infection or other urinary abnormalities.
Albuterol: Short-acting bronchodilator for relieving acute bronchospasm.
Tiotropium: Long-acting bronchodilator to improve lung function and reduce COPD symptoms.
Fluticasone: Inhaled corticosteroid to reduce airway inflammation in COPD (Agarwal et al., 2022).
Tamsulosin: Alpha-blocker for alleviating urinary symptoms associated with BPH.
Finasteride: 5-alpha reductase inhibitor to manage BPH and improve urinary flow (Ng & Baradhi, 2022).
In conclusion, the 68-year-old male patient likely suffers from COPD and BPH. The comprehensive care plan includes interventions for managing COPD and BPH, regular follow-ups, and lifestyle improvements to enhance the patient's quality of life and overall health.
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