NR 511 Week 2 SNAPPS Oral Presentation Template Assignment

Cough, with yellow-grey mucus,

Sore throat and

Wheezing

Chest pain

The patient reports that their symptoms began approximately one week ago with the gradual onset of a persistent cough, which has been getting progressively worse and chest pain. The discomfort associated with the cough is primarily located in the chest area, which they describe as a tightness or pressure.

The cough, mucus production, and chest discomfort have been ongoing for the past week without significant improvement. The cough is productive, with the patient frequently coughing up yellowish-green mucus. They also mention occasional wheezing when breathing. The symptoms worsen when the patient engages in physical activity or lies down. In addition, exposure to cold air exacerbates the cough. The patient has tried over-the-counter cough syrup, but it provides only minimal relief. Rest does not alleviate the symptoms. The symptoms have been fairly consistent over the past week, with no specific pattern related to time of day. The patient rates the severity of their cough and discomfort 5/10, but they mention that it has been interfering with their daily activities.

BUY A CUSTOM PAPER HERE ON; NR 511 Week 2 SNAPPS Oral Presentation Template Assignment

1. Respiratory:

   – The patient reports a persistent cough with mucus production.

   – They mention occasional wheezing when breathing.

   – There is no history of shortness of breath at rest.

2. Constitutional:

   – The patient has experienced a low-grade fever.

   – They report decreased energy levels and overall fatigue, which they attribute to their symptoms.

3. Gastrointestinal:

   – The patient denies any nausea, vomiting, diarrhea, or abdominal pain.

4. Cardiovascular:

   – The patient does not report any palpitations or swelling in the legs.

1. Respiratory:

   – Auscultation of the chest reveals bilateral wheezing, suggesting airway constriction.

   – Crackles are heard on lung auscultation, indicating the presence of mucus and inflammation in the airways.

2. General:

   – The patient appears mildly fatigued but is alert and oriented, indicating a decrease in energy levels due to their illness.

3. Vital Signs:

   – The patient’s vital signs are within normal limits except for a slightly elevated body temperature, consistent with a low-grade fever.

   – Blood pressure, heart rate, and respiratory rate are within expected ranges for their age and health status.

Acute Bronchitis

Positive Findings: Persistent cough, mucus production, and bilateral wheezing heard on lung auscultation. Crackles on lung auscultation also support the presence of mucus or inflammation in the airways. The low-grade fever aligns with the inflammatory nature of acute bronchitis (Widysanto & Mathew, 2022).

Negative Findings: There is no history of recent travel or exposure to individuals with similar symptoms, reducing the likelihood of an infectious cause. Vital signs, apart from a slightly elevated body temperature, are within normal limits.

Pneumonia

Positive Findings: While some symptoms overlap with bronchitis, such as cough and fever, pertinent positive findings include focal chest findings on physical exam, such as localized crackles or increased respiratory rate. Pneumonia often presents with more severe systemic symptoms, such as high fever and chills (Jain et al., 2023). The absence of these severe systemic symptoms in the patient’s presentation suggests a milder respiratory condition.

Negative Findings- The absence of significant focal chest findings, severe systemic symptoms, or evidence of consolidation on imaging reduces the likelihood of pneumonia.

Chronic Obstructive Pulmonary Disease (COPD) Exacerbation

Positive Findings: The patient’s history of a chronic cough, especially if they are a smoker or have a history of smoking, may indicate underlying COPD. Bilateral wheezing and crackles on lung auscultation can be present in both bronchitis and COPD (Kelly et al., 2021). The patient’s decreased energy levels and fatigue may be consistent with a COPD exacerbation.

Negative Findings: Unlike acute bronchitis, COPD is a chronic condition, and patients often have a prior diagnosis and a history of recurrent exacerbations. The patient’s age and risk factors, such as smoking history, play a role in considering COPD as a differential diagnosis.

Analysis of the Differential Diagnosis for Bronchitis

Acute Bronchitis Positive Findings Supporting Diagnosis

The chief complaint of a persistent cough, mucus production, and bilateral wheezing on lung auscultation align with the typical symptoms of acute bronchitis. Crackles heard during lung auscultation are evidence of inflammation and mucus in the airways. A low-grade fever is also consistent with the inflammatory nature of this condition.

Negative Findings: The absence of significant focal chest findings, severe systemic symptoms, or history of recent travel or exposure to infectious individuals makes other diagnoses like flu, COVID-19, or pneumonia less likely.

Pneumonia Positive Findings Supporting Diagnosis

While there is symptom overlap with bronchitis (cough, fever), localized crackles, focal chest findings, and a more severe presentation with high fever and chills may point toward pneumonia.

Negative Findings: The absence of significant focal chest findings, severe systemic symptoms, or evidence of consolidation on imaging reduces the likelihood of pneumonia compared to bronchitis.

Chronic Obstructive Pulmonary Disease Positive Findings Supporting Diagnosis

A chronic cough, particularly in patients with a history of smoking or known COPD, can be indicative of a COPD exacerbation. In addition, bilateral wheezing and crackles on lung auscultation may occur in both bronchitis and COPD exacerbations. The patient’s decreased energy levels and fatigue could be consistent with a COPD exacerbation.

Negative Findings: COPD is typically a known chronic condition with a history of recurrent exacerbations, whereas bronchitis tends to have an acute onset. Patient age and risk factors, such as smoking history, play a significant role in considering COPD as a differential diagnosis.

Ranking the Diagnoses

Based on the presented evidence, the differential diagnoses can be ranked in order of likelihood:

1.    Acute Bronchitis- This is the most likely diagnosis as it aligns well with the patient’s symptoms, history, and physical exam findings.

2.    COPD Exacerbation-While possible, it is less likely than acute bronchitis due to the patient’s age and the absence of a known history of COPD.

3.    Pneumonia-This diagnosis is the least likely given the absence of focal chest findings, severe systemic symptoms, and consolidation on imaging.

2. Should we consider further imaging for a more definitive diagnosis? While the physical examination findings provided valuable information, including bilateral wheezing and crackles, the absence of focal chest findings makes us wonder if additional diagnostic tests, such as a chest X-ray or CT scan, are warranted. How do we decide whether further imaging is necessary, and at what point should it be considered to rule out conditions like pneumonia or other lung pathologies? Balancing the benefits of additional information against potential risks and costs is essential.

3. What role does the patient’s smoking history play in the differential diagnosis? The patient’s chronic cough raises questions about their smoking history. How might this information impact the likelihood of COPD exacerbation as a differential diagnosis? Understanding the significance of smoking history in this context is crucial for accurate diagnosis and treatment planning.

  The diagnosis of bronchitis is made clinically based on the patient’s history, physical examination, and typical symptoms (Widysanto & Mathew, 2022). However, if there is uncertainty or if other conditions are suspected, further testing is considered, such as a chest X-ray, laboratory tests to rule out pneumonia or other underlying issues. For acute bronchitis, the main treatment is symptom management. Over-the-counter medications such as cough suppressants (e.g., dextromethorphan) and expectorants (e.g., guaifenesin) can be recommended based on the patient’s age and preferences.

Educating the patient about the viral nature of acute bronchitis and the importance of rest, hydration, and good nutrition to aid recovery is important. Emphasize the need to refrain from smoking or exposure to secondhand smoke, as these can exacerbate symptoms and prolong healing. In addition, explain the proper use of any prescribed medications, including inhalers, to ensure the patient understands how to manage their symptoms effectively.  Schedule a follow-up appointment within 1-2 weeks to assess the patient’s progress and ensure that symptoms are improving.

Self-Directed Learning; Antibiotic Stewardship in the Management of Acute Bronchitis

One critical aspect of healthcare practice that demands ongoing attention is the appropriate use of antibiotics. For patients with acute bronchitis, which is primarily viral in origin, antibiotics are generally not indicated (Worrall, 2019). Antibiotic resistance is a growing global concern, driven in part by the overuse and misuse of antibiotics. Acute bronchitis is one of the most common respiratory infections for which antibiotics are inappropriately prescribed (Baillie et al., 2022). Understanding the principles of antibiotic stewardship in managing bronchitis is crucial for healthcare providers to optimize patient care, prevent unnecessary antibiotic exposure, and mitigate the development of antibiotic resistance.