solved Weekly Discussion #3What additional subjective information will you be asking

Weekly Discussion #3What additional subjective information will you be asking of the patient? Additional subjective information to ask the patient would be about allergies | immunizations such as flu or pneumococcal vaccine also if receieved Covid Vaccine | has been in contact with anyone that had Covid – pneumonia or TB | recent illnesses or hospitalizations | has he traveled recently to foreign countries | Any weakness – fatigue | SOB | has there been difficulty breathing when doing daily activities or normal talking | What type cough medication has he taken | Has he resumed smoking cigarettes | Has there been any weight loss.What additional objective findings would you be examining the patient for? Additional objective findings to examine for would be O2 saturation & temperature. I would take notice of the respiratory effort given by the patient. Look at the rate and ease of respirations at rest, while speaking if there are breathing problems, any use of accessory muscles, posture, color, pursed lips, circumoral or nail bed cyanosis, and capillary refill during the visit. Inspect the chest and upper back for symmetry. Palpate the posterior chest to confirm equal chest expansion. Percussion of the posterior chest for resonance and symmetry is the next step. Auscultation of posterior breath sounds for symmetry, presence or absence of adventitious sounds (Kennedy-Malone, p. 164, 2019). Additionally we would assess HEENT for any other abnormal findings.What are the differential diagnoses that you are considering?Differential diagnosis that are being considered are Acute Bronchitis J20.9 | COVID-19 Z20.822 | HIV B20 | Lung Cancer C34 | Pneumonia J18.9 | Tuberculosis A15.9 | Upper Respiratory Infection J06.9.What radiological examinations or additional diagnostic studies would you order?Spirometry is the gold standard for measuring airflow limitation | CBC to check for infection and H&H to see if results are abnormal | Xray of chest | Sputum test | PFT | (ABG’s) Arterial Blood Gases (Kennedy-Malone, p. 166, 2019).What treatment and specific information about the prescription will you give this patient? In my opinion; I feel as if I am unable to provide a specific treatment or prescription without further information from the diagnostic tests. The differential diagnostics are too similar. If I had to treat the current complaint, which is a cough and coughing up blood, I’d order antibiotics; “Most pulmonologist recommend the empiric use of antibiotics to treat acute episodes when the patient’s cough increases and the character and amount of sputum change…even in the absence of fever (Dunphy, Winland-Brown, Porter, & Thomas, p. 413, 2019).” Doxycycline 100mg 10 tablets | by mouth | every 12 hours | x5 days | 0 refills. – take the complete course even if feeling better. Drink plenty of water to help clear lungs (Dunphy, Winland-Brown, Porter, & Thomas, p413-414, 2019). Take with food to lessen GI side effects. What are the potential complications from the treatment ordered? Side effects include anorexia, nausea, vomiting, epigastric distress. This drug class can potentiate the effects of warfarin by impairing Vitamin K production (Arcangelo, p. 125, 2017).What additional laboratory tests might you consider ordering? A gram stain is indicated with the sputum taken. Due to the current pandemic; I would consider a test to check for COVID-19 (Molecular (RT-PCR) tests, which detect the virus’ genetic material | Antigen tests that detect specific proteins on the surface of the virus). Also the Mantoux tuberculin skin test to check for TB. This test is the most accurate for TB skin testing and is easily performed and there are no risks to the patient (Dunphy, Winland-Brown, Porter, & Thomas, 2019).Will you be looking for a consult? A pulmonologist referral may be indicated; the cough has been more than a few weeks and has a history of COPD and smoking. “You should see a pulmonologist if the cough persists for more than 3 weeks, or if it becomes severe (Seladi-Schulman, 2020)”.ReferenceArcangelo. 2017. Pharmacotherapeutics for advanced practice: a practical approach (4th ed.). Wolters Kluwer Health. Dunphy, Winland-Brown, Porter, & Thomas. 2019. Primary care: the art and science of advanced practice nursing – an interprofessional approach. F.A. Davis Company.Kennedy-Malone, L. (2019). Advanced practice nursing in the care of older adults. (2nd ed.). F.A. Davis Company.Seladi-Schulman. 2020. Cough: When to see a doctor, symptoms to watch out for. Healthline. Retrieved from https://www.healthline.com/health/cough-when-to-see-doctor#medical-treatment