BIOL 3020 – Week 5 Discussion – Homeostatic Imbalance in the Lymphatic and Respiratory Systems

BIOL 3020 – Week 5 Discussion – Homeostatic Imbalance in the Lymphatic and Respiratory Systems

Case Study #1: A 35-year-old Asian male patient presents to the clinic with a complaint of a productive cough x 2 weeks. He states that he has had a mild intermittent fever with myalgia, malaise, and occasional nausea. The patient states he works as a law clerk. On physical exam, he was noted to have a low-grade fever of 99 degrees Fahrenheit; on auscultation, the lungs had mild wheezing and scattered rhonchi.

The advanced practitioner will encounter many disease processes that have similar signs and symptoms and, despite a thorough assessment and history and physical, may require further diagnostic testing to assure an accurate diagnosis. Multidisciplinary collaboration confirms the suspected diagnosis and allows the treatment process to begin. Differential diagnoses can also be determined based on assessment, history and physical, and diagnostics; additional workup may be needed to rule out each diagnosis.

Primary Diagnosis: Acute Bronchitis

Based on the symptoms, assessment, and chest X-ray of the patient, the primary diagnosis would seem to fall in line with acute bronchitis. Acute bronchitis is a self-limiting inflammation of the large airways – bronchi, accompanied by a cough (productive or not) which can last up to 6 weeks, with an absence of tachycardia, tachypnea, fever, and abnormal findings on the chest examination (Harris, Hicks, & Qaseem 2016). A productive cough for two weeks, scattered rhonchi, and a low-grade temperature suggest an infectious process, although the pathogen is usually viral. According to Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook (2017), acute bronchitis may have a productive or nonproductive cough, and chronic bronchitis occurs with a cough beyond eight weeks. An acute cough (<3 weeks) is most commonly due to respiratory tract infections, aspiration, or inhalation of noxious chemicals or smoke (Meeran, Hariharan, & Praveenkumar 2018). The diagnosis of acute bronchitis relies heavily on health history, interview, and physical assessment; diagnostics are rarely ordered. The advanced practitioner may order a lateral chest X-ray if the patient presents with a fever, suspects pneumonia, or suspects underlying lung disease.

Differential Diagnoses

 Bronchiolitis – Bronchiolitis is a common lung infection that causes inflammation and congestion in the small airways (bronchioles) of the lung; it is very common in young children and infants but can occur in adults. The chest X-ray demonstrates some perihilar fullness demonstrated with bronchiolitis. More questions need to be asked of the patient, was he around or inhaled any chemicals when the symptoms began? Has he received his flu shot, does he vape, and does he take any new medications? Any could be linked to the development of bronchiolitis; it could just be a viral infection and is treated with symptom relief, rest, and

Community-Acquired Pneumonia – Community-acquired pneumonia (CAP) is a common infectious disease that affects millions of patients worldwide, and it is associated with significant morbidity and potential long-term Ullah, Khan, Khan, and Hashemy (2017) acknowledge that CAP is diagnosed by recording history, physical examination of clinical features (cough, fever, pleuritic chest pain, etc.), radiological examination (chest X-ray), and laboratory testing (blood culture, sputum culture). With the patient’s symptoms, CAP can be a differential diagnosis until ruled out by testing. If the chest X-ray confirms the diagnosis, then blood cultures and sputum cultures should be sent before starting the antibiotics.

BIOL 3020 – Week 5 Discussion – Homeostatic Imbalance in the Lymphatic and Respiratory Systems

Asthma – Asthma is one of the most common respiratory diseases, with an estimated 300 million people suffering from asthma worldwide and a rising prevalence in developed countries (Wong, Farne, & Jackson, 2016). Asthma is chronic airway inflammation with hyperresponsiveness that presents with the typical symptoms of shortness of breath, chest tightness, cough, and wheezing. A detailed history is key to diagnosing asthma; even though the patient may not have a known history of asthma, every possibility must be explored. In adults of working age, occupational history, symptom variability, and intensity during workdays and holidays should be assessed to exclude occupational asthma (Wong, Farne, & Jackson, 2016).

Sarcoidosis – Sarcoidosis is a multisystem disease that generally affects patients between twenty and sixty years of age. Research by Carmona, Kalra, and Ryu (2016) acknowledges that sarcoidosis can be difficult to diagnose because it can mimic many other diseases, including lymphoproliferative disorders and granulomatous infections, and because there is no specific test for diagnosis, which depends on the correlation of clinicopathologic and

histopathologic features. Cough, dyspnea, and wheezing are common symptoms, and chest X-ray may reveal infiltrates, but the diagnosis is based on the exclusion and thorough physical examination. On physical examination, evidence of lymph node enlargement and skin, eye, and joint involvement should be routinely sought; lung examination often underestimates parenchymal involvement because most patients have a paucity of physical signs, sometimes even in the presence of extensive parenchymal disease (Carmona et al., 2016).

Treatment of Acute Bronchitis

The treatment of acute bronchitis is symptom management and education for the patient. The patient should get plenty of rest and stay hydrated; additionally, the patient can use humidification. The patient should attempt to drink eight to twelve glasses a day; hot fluids like tea and soups can help thin the mucus and make it easier to expectorate. The patient should be educated to avoid caffeine and alcohol while symptomatic. The most recent recommendations by the American College of Physicians state that antibiotic therapy should not be initiated in patients with acute bronchitis unless pneumonia is suspected (Harris, Hicks, & Qaseem, 2016). Lozenges for sore throat, Tylenol or Ibruprofen for aches, pains, inflammation reduction, and fever control are all over-the-counter options. Education about hand hygiene and covering the mouth when coughing should be reinforced.

BIOL 3020 – Week 5 Discussion – Homeostatic Imbalance in the Lymphatic and Respiratory Systems

Conclusion

The advanced practitioner will encounter many disease processes that have similar signs and symptoms and will have to rely on extensive health history, interviews, and physical examinations to guide their decision-making. Diagnostic tests that support or exclude differential diagnoses can be ordered based on physical assessment findings and health interview questioning. Once a diagnosis has been determined, the advanced practitioner must still evaluate and determine the treatment process that will be best for the patient. Taking into account allergies, past medical history, and drug interactions to provide the patient with the best healthcare outcome.

References

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.

Carmona, E. M., Kalra, S., & Ryu, J. H. (2016). Pulmonary sarcoidosis: diagnosis and treatment. Mayo Clinic Proceedings, (7), 946. https://doi- org.ezp.waldenulibrary.org/10.1016/j.mayocp.2016.03.004

Harris, A. M., Hicks, L. A., & Qaseem, A. (2016). Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Annals of Internal Medicine, 164(6), 425. https://doi org.ezp.waldenulibrary.org/10.7326/M15- 1840

Meeran, A. S. S., Hariharan, A., & Praveenkumar, M. (2018). Study of various X-ray presentations for the symptom of cough of more than two weeks duration in a tertiary care hospital. International Archives of Integrated Medicine, 5(10), 10–13. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx? direct=true&db=a9h&AN=132649441&site=eds-live&scope=site

Ullah, S., Khan, J., Khan, A., & Hashemy, I. (2017). Assessing decision of inpatient or outpatient care in community-acquired pneumonia: APT care study. JPMA. The Journal of the Pakistan Medical Association, 67(3), 380-385. Retrieved from https://search-ebscohost- com.ezp.waldenulibrary.org/login.aspx? direct=true&db=edswsc&AN=000399242300011&site=eds-live&scope=site

Wong, E. H. C., Farne, H. A., & Jackson, D. J. (2016). Asthma: diagnosis and management in adults. Medicine, 44(5), 287–296. https://doi- org.ezp.waldenulibrary.org/10.1016/j.mpmed.2016.02.021

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Explain whether the health condition has a direct or indirect effect on the system you chose, explaining why this system was impacted more than the other systems studied during this week.