Question

Mrs. J. (age 42) has been married for 20 years to a TV newscaster. She has two 16-year-old twins who are in high school. She's coming in for a routine physical because she said over the phone that she has no energy and has lost some weight. She also thinks she has had a temperature for several days.

CC: "I can't stand sweating at night and think I'm too young for menopause. Besides, I still get my period."

Physical exam:

·        Temperature, 101°F    

·        Weight loss of 10 lbs. since her previous visit last year

·        Flu-like symptoms     

·        Nonproductive cough       

·        Bilateral lymphadenopathy in cervical and supraclavicular nodes    

·        Decreased breath sounds in bilateral bases  

·        White hair-like growth on tongue

Questions:

5. What are the differential diagnoses and your primary diagnosis with rationales?

6. Are there any legal/ethical considerations?

7. What is your plan of care? Always include pharmaceutical and nonpharmaceutical treatments, diagnostic tests, patient/family education, and follow-up plan.

8. Are there any Healthy People 2020 objectives that you should consider?

Answer 1

PAtient signs and symptoms showing lymphadenopathy, it often occur with associated systemic disease.
5, Differential diagnosis:
Malignancy due to leukemias, metastatic, etc.(weight loss, sweating)
Infections may be due to viral, bacterial, and other fungal, scrub typhus, etc.(nonproductive cough,flu-like symptoms)
Autoimmune disorder due to low immune function(weakness, no energy)
Tuberculosis due to nonproductive cough
streptococcal Pharyngitis and upper respiratory infection due to flu-like symptoms, fever, and low breath sound in bilateral bases.
Primary diagnosis: Cervical lymphadenopathy
Lymphadenopathy occurs due to inflammatory process and viral upper respiratory infections.patient will have painless mass over the cervical area that associated with high temperature, flu-like symptoms, and cough, enlarged tender nodes in the cervical area, etc. The patient also having associated symptoms of bilateral lymphadenopathy like night sweats. patient having white, hairy lesions on the lateral border of the tongue showing oral hairy leukoplakia as an oral white lesion due to lymphadenopathy.
6, patient autonomy is important for ethical principles. providing sufficient understandable information important before starting any treatment and getting consent, to tell the truth about their diagnosis and prognosis, it is important to have a concern on ethical consideration regarding patient condition.
7, Lymphaadenppathy diagnosed by a blood test, X-ray, USG, CT, and MRI of your lymph nodes, lymph node biopsy can be done to test the tissue. antibiotics medications treat bacterial infection. Over the counter medications like ibuprofen, acetaminophen controls the pain. Non-pharmacological treatment includes
providing warm compress, using cool packs that help reduce the inflammation, resting help to recover from underlying causes.
Patients and families should be included in the plan of care. explain the patient illness clearly them and ask the patient to describe the problem, find out the patient current stress factors and preexisting problem that affect daily life. encourage patient to share their thoughts and feelings.assess the patient vitals signs, respiratory rate, depth, and rhythm. make the patient comfortable, teach the patient deep breathing exercise to expand the airway. provide oxygen and analgesics and tranquilizers to reduce the pain and anxiety. enroll the patient for counseling. Advice the patient to be safe with medication. advise the patient if they have pain ask them to use a warm compress. Follow-up should be done with the correct routine and contact the doctor if you find any abnormal findings and your health condition is worsening.
8, Healthy people 2020 objectives for this patient to be concerned with social and physical environments consideration that should promote health for her, rest, and healthy social relationships promote goodness for their life.