Question

4/11 10:38pm

Sonia Brown
Week 5 Discussion Post-Thorax and Lungs — required

Week 5 Discussion Post -Thorax and Lungs

M.C. is a 69-year-old man who presents to the outpatient office with a hacking, raspy cough.

Subjective Data
PMH: HTN, DM
Cough is productive, bringing up green phlegm
Runny nose, sore throat
Denies fever
Sore throat pain when swallowing
No history of smoking or seasonal allergies
Complains of fatigue

Objective Data
Vital signs: T 37 P 72 R 14 BP 134/64
Lungs: + Rhonchi bilateral upper lobes, wheeze
O2 Sat = 98%
Ears = TM bulging
Nose = + erythema, yellow discharge
Throat = + erythema, – pustules
Medications: Metoprolol 12.5 mg per day, Glucophage 500 mg twice a day

Questions
1. What other questions should the nurse ask about the cough?
2. Develop a problems list from the objective and subjective data.
3. What nursing diagnoses can be derived from the problems list?
4. What should be included in the plan of care?

Answer 1

1. What other questions should the nurse ask about the cough?

Nurse should collect focused and detailed history about cough to arrive at possible cause or diagnosis for cough. Potential questions she should ask may be:

· When it started gradually or suddenly?

· What was the precipitating event which lead to cough?

· How it progressed after starting?

· Is it seasonal or throughout year?

· What is its frequency or severity?

· Whether it is intermittent or constant?

· What is volume of cough expectorated?

· What is its consistency – thick (difficult to expectorate) or thin?

· Is it blood tinged?

· What are the factors which aggravates cough?

· What are the factors which relieves cough?

· Its association with positioning, time of the day, sleep and food intake etc?

· Any other associated features along with cough like difficulty in breathing, chest pain etc?

· Any prescription or non- prescription treatment taken for cough?

· Any history of recent upper respiratory infection?

· Are you asthmatic?

· Do you have any history of exposure to fumes, dust, pets? If working then what is the occupation?

· Any history of exposure to a patient with tuberculosis or travel history to such areas where tuberculosis is endemic?

2. Develop a problems list from the objective and subjective data.

· Production of green phlegm indicates towards presence of infection.

· Cough may be due to infection, allergy.

· Bilateral ronchi and wheezes may be due obstruction in airway either from secretions or oedema of mucosa or from constriction in airway.

· Bulging tympanic membrane may happen due to extension of infection in eustachian tubes.

· Running nose, yellow discharge from nose and redness of nasal mucosa points towards infection either in upper airway or in sinuses.

· Sore throat, pain during swelling, redness of throat all indicates towards infection.

· Fatigue may be a non-specific symptom of infection or due to interruption in sleep from cough, poor oral intake from throat pain

3. What nursing diagnoses can be derived from the problems list?

• Ineffective airway clearance related to infection/ inflammation as evidenced by production of green coloured sputum and auscultation of ronchi and wheezes (abnormal breath sounds)
• Actual or risk for potential infectious process R/T ineffective airway clearance and poor local tissue defence as evidenced by presence of green colored sputum, nasal drainage, redness of throat, bulging TM.
• Activity intolerance related to exhaustion from excessive coughing as evidenced by verbal report of fatigue

4. What should be included in the plan of care?

Based of presentation and clinical findings and their analysis plan of action include further detailed physical examination and diagnostic tests to arrive at right diagnosis.

Diagnostic plan will include:

Detailed and focussed physical examination including-

· inspection of oropharynx

· palpation of lymph nodes in neck

· inspection for chest movement and symmetry, measurement and comparison of ratio between anterior-posterior and transverse diameter

· palpation, percussion and auscultation of chest

· auscultation of heart

Reassure patient and explain need of further diagnostic tests to arrive at correct diagnosis and its significance in appropriate treatment of underlying cause.

· CBC and differential WBC counts for infection

· Chest Xray for ruling out pneumonia and tuberculosis

· Pulmonary function tests for asthma and other obstructive lung disease

· Sputum examination for culture and sensitivity to identify specific causative organism

Based on results of diagnostic plan, therapeutic and patient education plan will be developed.

Till then symptomatic treatment and other drugs as prescribed should be started. Symptomatic treatment may include proper positioning, control of environmental allergens, humidification of air, steam inhalation to loosen secretions, small frequent, soft and easy to ingest diet, and spacing activity with adequate rest period in between activity.