NR 507 Advanced Pathophysiology Midterm Exam, 140 Questions and Answers 100- Verified.pdf

NR 507 Discussion Part Two week 2
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Advanced Pathophysiology
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DiscussionkPartkTwok(graded)
Tammykiskak33-year-
oldkwhokpresentskforkevaluationkofkakcough.kShekreportskthatkaboutk3kweekskagokshekdevelope
dkak“reallykbadkcold”kwithkrhinorrhea.kThekcoldkseemedktokgokawaykbutkthenkshekdevelopedkakpr
ofound,kdeep,kmucus-producingkcough.kNow,ktherekisknokrhinorrheakorkrhinitis—
thekprimarykproblemkiskthekcough.kShekdevelopskthesekcoughingkfitskthatkarekprolonged,kverykd
eep,kandkproductivekofkaklotkofkgreenksputum.kShekhasn’tkhadkanykfeverkbutkdoeskhavekakscratc
hykthroat.kTammykhasktriedkover-the-
counterkcoughkmedicineskbutkhasknotkhadkmuchkrelief.kThekcoughkkeepskherkawakekatknightkan
dksometimeskgetsksokbadkthatkshekgagskandkdrykheaves.
Writekakdifferentialkofkatkleastkfivek(5)kpossiblekdiagnosis’skandkexplainkhowkeachkmaykb
ekakpossiblekanswerktokthekclinicalkpresentationkabove.kRemember,ktoklistkthekdifferentia
lkinkthekorderkofkmostklikelyktoklessklikely.
Basedkuponkwhatkyoukhavekatkthektopkofkthekdifferentialkhowkwouldkyouktreatkthiskpatien
t?
Supposeknow,kthekpatientkhaskakfeverkofk100.4kandkcomplainskofkfoulksmellingkmucousk
andkbreath.kIndeed,kshekcomplainskofkproducingkcupskofkmucousksomekdays.kShekhasks
omektroublekbreathingkonkmoderatekexertionkbutkthiskiskonlykakminorkcomplaintktokher.k
Howkdoeskthiskchangekyourkdifferentialkandkwhy?
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Sarah Drum
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9/5/2016 6:11:48 PM
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Week 2 DB 2
Bronchitis

, Bronchitis is an inflammation of the lower respiratory track of the bronchial tubes “Acute
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bronchitis is usually caused by a respiratory virus and occasionally by bacterial infection, although
this occurs in less than 10 percent of cases” (Acute Bronchitis, 2016). The symptoms of bronchitis
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include coughing up mucus that is yellow or green, a runny or congested nose that started a few da
ys before the chest congestion, fatigue, wheezing, shortness of breath with activities, and “coughin
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g fits.” The patient reports having a runny nose about three weeks ago when this started. A runny
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nose was her only complaint when the illness started. Once the runny nose went away, the cough a
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nd chest congestion started. She currently does not have a fever, but her throat is scratchy. Her thr
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oat could be scratchy from all of the coughing she has done. Her symptoms seem to fit all of the sy
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mptoms associated with bronchitis, especially since she is not running a fever and the fact bronchit
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is can last several weeks. The patient is not having any fever or chills, so this could indicate that it
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is viral, and there is no infection.

Pneumonia
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Pneumonia is a lung infection that can have mild to severe symptoms. They symptoms ran
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ge from a cough which can produce yellow, green, or bloody mucus, fever, shortness of breath, chi
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lls, headache, fatigue, loss of appetite, and sweating. Bronchitis and Pneumonia are very similar, t
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hat is why sometimes a person is diagnosed with one when they really have the other. An x-
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ray can rule out or confirm pneumonia. It can begin with a sore throat, dry cough, muscle aches, a
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nd then it will progress to having a productive cough with discolored sputum. It can be from bacte
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ria, viral, or even fungal. The patient is at more of a risk for pneumonia because she did have a col
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d, it could have possibly turned into a pneumonia due to the congestion (Pneumonia, 2016).
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Acute Sinusitis

“Sinuses are hollow spaces in the bones around the nose that connect to the nose through s
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mall, narrow channels” (Sinusitis, 2016). Acute sinusitis is an infection of the sinuses. It affects o
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ne in eight adults every year. What happens is the sinus cavities become inflamed and then are una
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ble to empty mucus. The inflammation could have come from the cold, and now that the sinus cav
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ities are blocked from inflammation, she has developed a sinus infection. Symptoms include cong
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estion (chest or nose), pain, pressure, or fullness in the face, and yellow or green mucus. Bacterial
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sinusitis is suspected if it has been longer than 10 days, and the patient is not better. The patient ha
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s had symptoms for at least three weeks, and so acute bacterial sinusitis should be suspected (Sinus
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itis, 2016).

Asthma

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Even though asthma does not explain all of her symptoms, it is a possibility. The patient ma
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y have asthma and an irritant is exacerbating it, which is causing the sputum. These irritants could
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be pollen, smoke, or house hold chemicals. It also could explain the coughing fits she has at night,
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and the shortness of breath with exertion. Symptoms of asthma include tightness in the chest, wh
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eezing, coughing (sometimes with sputum). Sometimes the patient will experience coughing fits, a
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nd may occur especially in the morning and at night. She has coughing fits at night. She could hav
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e had a case of allergic rhinitis, and not the cold. The allergic rhinitis may have triggered an asthm
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a flare up. The patient would need to find out what is triggering it, and avoid it.
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Allergic Rhinitis
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Allergic rhinitis is an inflammation of the nasal membranes such as the nose, eyes, eustachian tube
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s, middle ear, sinuses, and pharynx that is caused by allergies. The symptoms vary but are sneezin
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g, congestion (chest or nose), headache, red eyes, fatigue, and itchy nose, ear or eyes. Histamine, tr
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yptase, chymase, kinins, and heparin are released in the blood when exposed to an allergen. The r
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elease of these into the blood stream gives the patient symptoms that cause inflammation. Once y
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ou take the allergen away, the allergic rhinitis goes away. Allergic rhinitis affectes roughly 40 mill
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ion people in the United States. (Sheikh, J., MD, & Kaliner, M., MD., 2015). She may be allergic
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to pollen, certain chemicals she has been using lately, or other things such as mold.

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Based upon what you have at the top of the differential how would you treat this patient?
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First, I would get a chest x-
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ray to ensure it is bronchitis and not pneumonia. Then I would prescribe a coughing medication su
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ch as Promethazine DM that helps the patient not cough as much, but helps to thin the mucus and g
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et it up when they do cough. This would help with her coughing fits. We want her to cough and ge
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t the mucus up, but we do not want her to dry heave and gag due to coughing. I would also give a s
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teroid injection such as Kenalog to help dry her secretions up. The patient can then take over the c
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ounter NSAIDS such as Ibuprofen and Tylenol, as well as rest and a lot of fluids. The fluids would
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also help to thin the mucus, which would make it easier to cough up.
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Suppose now, the patient has a fever of 100.4 and complains of foul smelling mucous and
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breath. Indeed, she complains of producing cups of mucous some days. She has some tro
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uble breathing on moderate exertion but this is only a minor complaint to her. How does
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this change your differential and why?

“If it (the cold) hangs around for more than 10 days, or gets worse after it starts to get better
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, there’s a good chance you have sinusitis” (Sinusitis, 2016). I would then treat the patient for Sinu
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sitis because her sinus cavities have had mucus built up for days and bacteria may be starting to gr
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ow; especially since she has a fever now. One of the symptoms of acute sinusitis is foul smelling b
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reath and mucus, along with fever. (Sinusitis, 2016).
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Acute Bronchitis, Symptoms, Causes, and Risk Factors. (2016). American lung association.

http://www.lung.org/lung-health-and-diseases/lunheg-disease-lookup/acute-
bronchitis/symptoms-causes-risk-factors.html.
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Asthma Symptoms, Causes, and Risk factors. (2016). American lung association.

http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/asthma-
symptoms-causes-risk-factors/.
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Pneumonia. (2016). American lung association. http://www.lung.org/lung-health-and-

diseases/lung-disease-lookup/pneumonia/?referrer=https://www.google.com/.
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Sheikh, J., MD, & Kaliner, M., MD. (2015). Allergic Rhinitis.
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http://emedicine.medscape.com/article/134825-overview.
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Sinusitis. (2016). American academy of otolaryngology-head and neck surgery.

http://www.entnet.org/content/sinusitis

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Janet Farrellyreply to Sarah Drum
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9/7/2016 11:27:31 PM
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RE: Week 2 DB 2
Sarah,

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Smoking and Tammy's condition:
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This is a very well written answer as it is easy to follow and it contains a great deal of information!
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After I introduced myself to Tammy though, I would ask her if she smoked. I am one of six childr
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en and only one of my siblings smoke and even though she is not the oldest of us, she looks as thou
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gh she is. Sometimes my other siblings will say, "Oh, I can't believe that she still smokes", but the