Chronic Disease Management – COPD, Diabetes, and Lung Cancer

Chronic Disease Management – COPD, Diabetes, and Lung Cancer

Overview of the Theory

Social cognitive theory was postulated by Albert Bandura. The theory asserts that observational learning, social factors, and reciprocal causation correlate with behavior. SCT postulates that people acquire knowledge through the observation of other people’s behaviors, and their environment determines this in matters of thought and action. Some specific concepts that have been proposed are self-effects, modeling, and the reciprocal determinism of personal, behavioral, and contextual influences (Islam et al., 2023).

Reason for Choosing This Theory

Social cognitive theory is useful in explaining how young survivors of mass shootings could end up developing mental health problems through direct and vicarious learning as well as reinforcement by the environment (Sebastian et al., 2021). It is useful for understanding how such a scenario might be incorporated or “taken inside” of a person, resulting in anxiety, PTSD, or other problems. SCT is most appropriate in applied research, aiming at interventions stressing the need to change the context and behavior to enhance the outcome (Devi et al., 2022).

Application to the Topic of Interest

SCT applies to research on the mental health impact of mass shootings on young survivors by explaining how coping behaviors observed in others, including parents, peers, or media representations, might be mimicked. It also helps in understanding how community support systems or media coverage can influence cognitive processing of the traumatic event and subsequent mental health outcomes. Enhancing self-efficacy and providing positive role models in the survivors’ environment might mitigate negative mental health impacts (Metzl et al., 2021).

Summary of Related Research

The findings of studies on the application of SCT in the context of traumatic occurrences demonstrate that persons who attribute limitations in coping with such occurrences are likely to develop mental health problems, including PTSD. However, there is evidence of possible disconfirmation indicating that psychological and biological factors might bear higher relevance; nonetheless, SCT is useful for structuring interventions aimed at the improvement of configuring the environment and behavior to favor the young survivors.

References

Devi, B., Pradhan, S., Giri, D., & Lepcha, N. (2022). Concept of social cognitive theory and its application in the field of medical and nursing education: A framework to guide research. Journal of Positive School Psychology, 2022(4), 5161–5168. https://www.journalppw.com/index.php/jpsp/article/download/4243/2794

Islam, K. F., Awal, A., Mazumder, H., Munni, U. R., Majumder, K., Afroz, K., Tabassum, M. N., & Hossain, M. M. (2023). Social cognitive theory-based health promotion in primary care practice: A scoping review. Heliyon, 9(4). https://doi.org/10.1016/j.heliyon.2023.e14889

Metzl, J. M., Piemonte, J., & McKay, T. (2021). Mental illness, mass shootings, and the future of psychiatric research into American gun violence. Harvard Review of Psychiatry, 29(1), 81–89. https://doi.org/10.1097/hrp.0000000000000280

Sebastian, A. T., Rajkumar, E., Tejaswini, P., Lakshmi, R., & Romate, J. (2021). Applying social cognitive theory to predict physical activity and dietary behaviour among patients with type-2 diabetes. Health Psychology Research, 9(1). https://doi.org/10.52965/001c.24510

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PEER RESPONSE 1

These complaints are chronic, persisting for the last few months. A dry cough has been a constant for the previous two months, while frequent urination has been a regular occurrence for the last four months. The possibility of these chronic conditions being linked to cancer in the respective systems cannot be ruled out, given the patient’s age, social history, and unknown family history. However, expertise and additional information on both complaints are crucial to ensure a more accurate differential diagnosis. Furthermore, it is essential to clarify the type of blood pressure medication, as it could significantly impact the differential diagnosis and treatment plan.

Chronic Cough Differentials:

COPD: The patient, in this case scenario, has a long history of smoking, and COPD can also be most likely diagnosis. However, there is no information about chest pain, abnormal breathing sounds, or sputum production. According to Kahnert et al. (2023), Bronchial obstruction, a feature of COPD, is a long-term, ongoing lung and airway condition that bronchodilators cannot reverse. In addition to asking the patient about their exposure history, smoking status, including the number of pack-years, and the clinical features defined, such as delayed expiration, barrel chest, or expiratory wheezing (Kahnert et al., 2023), a clinical examination should be performed

Lung Cancer: His age, history of smoking, and unknown family history may put him at high risk of lung cancer. According to Nooreldeen & Bach, (2021), people die from lung cancer because it is often not diagnosed until the cancer is at an advanced stage. Detailed pathogenesis, effective early detection, and suitable drugs help in effectively treating lung cancer. Therefore, timely diagnosis of lung cancer is crucial, especially in screening high-risk populations. By screening high-risk groups, the disease can be caught early and treated. High-risk involves heavy smoking (more than 30 pack-years), current smokers, or smokers who stopped less than 15 years ago, and 55–80 years old. Annual lung cancer screening by X-rays can reduce 25% lung cancer mortality for patients who are screened every year (Nooreldeen & Bach, 2021).

Postnasal Drip: Subacute and chronic coughs are commonly caused by upper airway cough syndrome associated with postnasal drip. Acute nasopharyngitis, sinusitis, allergic, persistent nonallergic, and vasomotor rhinitis are the underlying causes of postnasal drip

Treatment, Education, Follow Up: CVS, Respiratory HEENT and General examination should be done to explore any positive findings. This can detect any fluids or drainage from the nose or ears. Turbinate size, shape, and colour can give information about allergies. At the same time, a respiratory assessment can detect any abnormal lung sounds. Congestive heart failure (CHF) patients may present with bilateral lower leg swelling, difficulty in breathing and nocturnal dyspnea. These findings can be picked up on general examination. According to Kahnert et al. (2023), chest X-rays and CT scans can be done to exclude lung pathology such as infections, masses, pneumonia, and COPD. CBC and electrolytes can rule out infectious processes. Sugar-free hard candy or lozenges might provide relief. COPD patients should constantly be assessed for sleep problems, snoring, and daytime drowsiness. CPAP treatment treats it quickly. All smokers should receive counsel on quitting, and behavioral therapy, pharmaceutical support, and digital health applications may help. Follow STIKO’s recommendations for COVID-19, pneumococcus, influenza, and pertussis vaccination. Physical activity benefits all patients, regardless of age or ailment severity. Individuals should exercise within their capabilities. His medications should be reviewed. Spirometry helps to diagnose FEV1 and FEV for obstructive lung disease. The patient can be started on albuterol if this treatment does not affect the blood pressure. For postnasal drips, take antihistamines and be encouraged to drink plenty of water. Patients can be given anti-tussive syrup until all labs, imaging, and other results return (Kahnert et al., 2023). The patient can be followed up in one week or sooner if needed, as results will be available then. The patient will be referred to Nicotine Anonymous, which is a 12-step program for smokers.

Frequent urination for the last four months Differentials:

BPH- Benign prostatic hyperplasia (BPH): This is most likely diagnosis because he has increased frequency of urine for several months.  According to Hata et al. (2023), BPH, or benign prostatic hyperplasia, is a degenerative disorder that affects older men and is characterized by an elevated frequency of urination. Benign prostatic hyperplasia (BPH) is a long-lasting condition characterized by uncontrolled prostate gland growth, specifically the expansion of glandular epithelial cells due to excessive proliferation of both epithelial and stromal cells, with a higher proportion of stromal cells. Autoantigens linked to the progression of BPH may serve as new treatment targets for BPH if they are specifically inhibited. While it is typically seen that androgen levels in men decline as they age, there is a paradoxical rise in prostate weight among individuals with benign prostatic hyperplasia (BPH). However, empirical evidence from clinical practice has demonstrated that a 5α-reductase inhibitor (5AR-I) can successfully decrease the concentration of dihydrotestosterone (DHT) in prostate tissue and mitigate the likelihood of benign prostatic hyperplasia (BPH) advancing (Hata et al., 2023).

Diabetes mellitus: Even though increased micturition is a usual marker of diabetes, other warning signs, such as polyphagia and polydipsia, that are associated with the condition are not present. However, it should be evaluated owing to the age and the Hx of hypertension. A straightforward A1C test can be performed to rule out the risk of diabetes, and a Urine Analysis test is required to assess the presence of glucose or proteins.

Prostate Cancer:  The patient has increased urination, a symptom that could potentially indicate a serious condition. No other symptoms are present, but it’s important to be vigilant. Several symptoms may be concurrent with prostate cancer. These indications may include hematuria, inability to void, incontinence, erectile dysfunction, weight loss, pain, weariness induced by anemia, or symptoms associated with chronic renal failure. The family history of any cancer is unknown. According to Sekhoacha et al. (2022), Prostate cancer is more likely to happen if you have a close family history of it. Cancer is 50% more likely to happen to men whose close relatives have had prostate cancer than to men whose families have never had prostate cancer. People with their first-degree cousins who have had prostate cancer in multiple generations are more likely to get it early (Sekhoacha et al., 2022

Treatment, Education, Follow Up: The provider examines the urogenital system, palpation, and percussion of the bladder and gives information about the emptiness or fullness of the bladder. A bladder scan is done to check if any residual urine is present. BPH is usually present with incomplete emptying of the urinary bladder. CBC can tell you about infections, while UA can tell about  UTIs or hematuria. CBC also tells us about anaemia, which may be a warning sign of any cancer. The absence of anaemia in CBC results can provide reassurance. Hematuria is a sign of BPH, prostatitis and prostate cancer. PSA can be ordered that is elevated both in BPH and prostate cancer. The absence of elevated PSA levels can also provide reassurance. Prostate cancer does not have a single, particular test for diagnosis. However, it is conventionally identified by a digital rectal examination (DRE). An A1C test can be used to rule out diabetes mellitus. According to Sebastianelli et al.(2020), Tamsulosin is commonly used as the initial treatment for benign prostatic enlargement (BPE) or blockage and is classified as an α1-blocker. If BPH is very likely to be present, Tamsulosin will be the drug of choice. As with terazosin and doxazosin, Tamsulosin relaxes the smooth muscle of the prostate. However, it does not cause changes in blood pressure, especially orthostatic hypotension. The patient is advised to follow up in four weeks or sooner if needed  Sebastianelli et al., 2020).

PEER RESPONSE 2

Depending on duration, cough can be acute, subacute, or chronic. Acute coughs are caused by viral diseases like colds and bronchitis and last less than three weeks. A three- to eight-week sub-acute cough is commonly caused by respiratory diseases like asthma or bacterial sinusitis. More than eight weeks of coughing can indicate asthma, COPD, GERD, or persistent rhinitis (Walter, 2021). Frequent urination—more than eight times a day—can indicate many disorders and greatly impair daily life. Several causes could have increased this patient’s urine frequency over the past four months. UTIs, diabetes, overactive bladder, interstitial cystitis, and enlarged prostates are common reasons (Cameron et al., 2024).

Therefore, some of the differential diagnoses that can be considered for this patient are:

1. COPD: Due to patient’s long history of smoking and chronic cough.
2. LungCancer: Persistent cough in a long-term smoker can raise concerns about lung cancer.
3. Medicationside effect: Although less common, but valsartan can cause dry cough.
4. DiabetesMellitus: Duration of patient’s urinary frequency suggest diabetes.
5. UTI: less likely but can be considered due to frequent urination.
6. BPH: Due to patient’s age as BPH is common in older men and urinary frequency is a symptom.

Most likely Diagnoses

1. COPDGiven his smoking history and chronic cough, COPD is highly likely.
2. DiabetesMellitus: The frequent urination could be a sign of undiagnosed diabetes.

Plan

Diagnostics

To accurately diagnose the patient’s condition, I would order the following diagnostic tests. First, a pulmonary function test (PFT) which is essential to assess for chronic obstructive pulmonary disease (COPD) or other respiratory conditions given the patient’s history of smoking and persistent cough. A chest X-ray to rule out lung cancer, interstitial lung disease, or other pulmonary abnormalities. Additionally, if the patient produces sputum, a sputum culture and cytology to evaluate for possible infection or malignancy (GOLD, 2024).

Given the patient’s complaint of frequent urination, it is prudent to screen for diabetes mellitus with a hemoglobin A1c test and fasting blood glucose level. These tests will help determine if the patient has undiagnosed diabetes. A urinalysis to rule out a urinary tract infection and to check for the presence of glucose in the urine, which could further suggest diabetes (ElSayed et al., 2023). I would order prostate-specific antigen (PSA) test and perform digital rectal exam (DRE) to evaluate the prostate gland and rule out BPH. These diagnostics will provide a comprehensive understanding of the patient’s health issues and guide the subsequent treatment plan (Sandhu et al., 2024).

Treatment

The treatment plan for this patient will be based on the potential diagnoses of COPD, hypertension, and diabetes mellitus. If COPD and diabetes are confirmed, the primary goal of treatment is to reduce symptoms and prevent exacerbations. A key intervention for all COPD patients who continue to smoke is smoking cessation, which is where treatment begins. Healthcare providers play a crucial role in delivering smoking cessation messages and interventions and should encourage patients to quit at every available opportunity (GOLD, 2024).

For COPD management, the patient may be prescribed a short-acting bronchodilator (SABA) such as Albuterol, with a dosage of 90 mcg per actuation, inhaling 2 puffs every 4-6 hours as needed to manage increased cough or shortness of breath. Inhaled corticosteroids (ICS) may also be prescribed depending on the severity of the disease or the frequency of exacerbations. A common option is Fluticasone/salmeterol (ICS/LABA) at 100/50 mcg, with 1 inhalation twice daily. Additionally, the patient should be educated about the importance of vaccinations, particularly Pneumococcal and Influenza vaccines, as part of their COPD management (GOLD, 2024).

For hypertension (HTN) management, the patient should continue taking Valsartan at a dose of 120 mg daily. If blood pressure remains uncontrolled, the dosage may be increased as needed. If diabetes mellitus is confirmed through lab findings, the first-line therapy would be Metformin. The initial dosage would be 500 mg taken twice daily with meals to reduce gastrointestinal side effects. The dose can be gradually increased to a maximum of 1000 mg twice daily, depending on tolerance and blood sugar control. It is important to monitor kidney function with eGFR before and during treatment (ElSayed et al., 2023).

If benign prostatic hyperplasia (BPH) is suspected, an alpha-blocker such as Tamsulosin may be prescribed at a dose of 0.4 mg orally once daily, taken 30 minutes after the same meal each day. This regimen will help manage symptoms related to BPH effectively (Cash, 2024).

Resources: There are several options and support groups for smokers in Stockton, CA, where I’m doing my clinical rotation. Free tobacco cessation programs from San Joaquin County Public Health Services include counseling and personalized support groups. Smoking cessation seminars at Dignity Health St. Joseph’s Medical Center emphasize behavior modification and support. Online assistance and the Freedom via Smoking program, an organized quitting method, are available locally via the American Lung Association. These resources and medical support can dramatically improve smoking cessation rates.

Referral:

• Pulmonologist for further evaluation and management of respiratory symptoms
• Endocrinologist if diabetes is confirmed
• Urologist if BPH is suspected

Education:

• Smoking cessation counseling
• COPD management and proper inhaler technique (if diagnosed)
• Diabetes education (if diagnosed)
• Importance of medication adherence
• Lifestyle modifications (diet, exercise)

Follow–up:

• Schedule a follow-up appointment in 2 weeks to review test results
• Monthly follow-ups for the first 3 months to monitor progress and adjust treatment as needed
• Quarterly follow-ups thereafter, or more frequently if needed