Family Health – Week 4 Discussion

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Week 4 Discussion

Discussion

This week’s content addressed common chronic diseases.  Please review the case study below and answer the following questions: Family Health – Week 4 Discussion

A sixty-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can’t do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco,Family Health – Week 4 Discussion alcohol, or drug use. Her mother died of a stroke, and her father died from prostate cancer. She denies any recent upper respiratory illness, and she has had no other symptoms. On examination, she is in no acute distress. Her blood pressure is 160/100, and her pulse is 100. She is afebrile, and her respiratory rate is 16. With auscultation, she has distant air sounds, and she has late inspiratory crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an S3 is heard over the apex. Family Health – Week 4 Discussion

1. What is the chief complaint?
2. Based on the subjective and objective information provided what are your 3 top differential diagnosis listing the presumptive final diagnosis first?
3. What treatment plan would you consider utilizing current evidence-based practice guidelines?

Family Health – Week 4 Discussion

Family Health – Week 4 Discussion

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Jessica Alper

Chief complaint
The chief complaint stated in this case scenario is increasing shortness of breath as well as nonproductive cough over the last month.
Presumptive and differential diagnoses Family Health – Week 4 Discussion
The subjective findings provided in this case scenario are the increased shortness of breath the patient is feeling, the fact she has to sleep elevated on a pillow at night to sleep better, but denies chest pain, nausea or sweating. The objective findings include a blood pressure of 160/100, a pulse of 100, a respiratory rate of 16, and she is afebrile. On examination, there is distant air sounds, has late inspiratory crackles in both lower lobes, S1 and S2 sound distant, and an S3 can be heard on the apex of the heart.
The presumptive final diagnosis is congestive heart failure. This condition is described as “a complex clinical syndrome characterized by the reduced ability of the heart to pump and/or fill with blood” (Savarese & Lund, 2017). When a patient is diagnosed with heart failure, the cardiac output that is pumped is inadequate to meet the metabolic demands of the heart. Different classifications of heart failure exist and depends on the progress of the disease. Signs and symptoms associated with this condition include exertional dyspnea and/or dyspnea at rest, orthopnea, chest pain, pressure or palpitations, tachycardia, fatigue and weakness, rales, wheezing, S3 gallop, hepatojugular reflux and more (Dumitru, 2022). Family Health – Week 4 Discussion
A differential diagnosis to congestive heart failure is cardiogenic pulmonary edema. This condition is defined as pulmonary edema that is due to the increased capillary hydrostatic pressure, which is secondary to the elevated pulmonary venous pressure. It is more specifically defined as the accumulation of fluid due to the cardiac dysfunction. Patients with this condition have clinical features of left heart failure. Symptoms include extreme breathlessness, anxiety, with the feeling of drowning. Common presentation includes shortness of breath, as well as profuse diaphoresis, dyspnea on exertion, orthopnea, as well as paroxysmal nocturnal dyspnea. Additionally, cough is a common symptom which can represent worsening pulmonary edema. Pink and frothy sputum may also be seen with advanced disease (Sovari, 2020). Family Health – Week 4 Discussion
Another potential differential diagnosis for this patient is acute kidney injury, also known as acute renal failure. It is defined as an abrupt, or a rapidly declining of the renal filtration function. Typical lab values associated with his condition include a rise in serum creatinine concentration or by azotemia. Three categories of acute kidney injury exist, prerenal, intrinsic as well as postrenal. Multiple signs and symptoms are seen with this condition, which include skin problems, eyes and ears, cardiovascular system, abdominal as well as pulmonary problems. Cardiac issues include irregular rhythms, murmurs, pericardial friction rubs or increased jugulovenous distention, rales, and S3. Pulmonary wise, rales and hemoptysis may be observed as well (Workeneh, 2022). Family Health – Week 4 Discussion
Treatment plan
The treatment plan for congestive heart failure is composed of many modalities including nonpharmacologic, pharmacologic as well as invasive strategies in order to limit and hopefully reverse the symptoms.
A first nonpharmacological therapy includes dietary sodium and fluid restriction. Along with that, is physical therapy as appropriate, and paying close attention to the weight gain of the patient. Some pharmacological therapies may include using diuretics, vasodilators, inotropic agents, anticoagulants, beta blockers, ACE inhibitors, ARBS, CCBs, digoxin, nitrates, B-type natriuretic peptides, I(F) inhibitors, angiotensin receptor-neprilysin inhibitors (ARNIs), soluble guanylate cyclase stimulators, sodium-glucose cotransporter-2 inhibitors (SGLT2Is), as well as mineralocorticoid receptor antagonists (MRAs) (Dumitru, 2022). Family Health – Week 4 Discussion
Some invasive therapies for congestive heart failure include electrophysiologic interventions. Some of these include cardiac resynchronization therapy (CRT), pacemakers, as well as implantable cardioverter-defibrillators (ICDs). Some revascularization procedures include coronary artery bypass grafting (CABG) along with percutaneous coronary intervention (PCI). Additional invasive therapies include valve replacement or repair, as well as ventricular restoration (Dumitru, 2022).
When medications and previous treatments have failed or the condition has progressed to end-stage heart failure and the prognosis is poor, heart transplantation may be an option. Mechanical circulatory devices, such as ventricular assist device (LVAD) and total artificial hearts (TAHs) can act as a bridge to a heart transplant (Dumitru, 2022).
It is also important to note that heart failure may come with comorbidities. Coronary artery disease, leading to reduced ejection fraction and angina can coexist in such patients. Valvular heart disease is another comorbidity as it can be the underlying etiology or be an aggravating factor. Sleep apnea is another condition that can develop with congestive heart failure and should be treated aggressively by providing CPAP machines.  Family Health – Week 4 DiscussionAnemia may also develop as a reflection of the degree of the disease. Cardiorenal syndrome may also be significant. It “reflects advanced cardiorenal dysregulation manifested by acute heart failure, worsening renal function, and diuretic resistance” (Dumitru, 2022). Lastly, atrial fibrillation may be diagnosed in patients with heart failure, and the two conditions may adversely affect one another.
References
Dumitru, I. (2022). Heart failure. Medscape. https://emedicine.medscape.com/article/163062-overview
Savarese, G., & Lund, L. H. (2017). Global Public Health Burden of Heart Failure. Cardiac failure review, 3(1), 7–11. https://doi.org/10.15420/cfr.2016:25:2
Sovari, A. (2020). Cardiogenic pulmonary edema clinical presentation. Medscape. https://emedicine.medscape.com/article/157452-clinical
Workeneh, B. T. (2022). Acute kidney injury (AKI) clinical presentation. Medscape. https://emedicine.medscape.com/article/243492-clinical#b3

Family Health – Week 4 Discussion

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Ana Claudia Cardoso Gomes
Case Study
The Chief Complaint Family Health – Week 4 Discussion
Having a dry cough just after cold or flu is common. Chronic dry coughs can be caused by a variety of medical issues, including gastroesophageal reflux disease, lung cancer, and heart failure. In addition to a dry cough, one may feel tightness in your chest. In a clinical setting, the onus is on the medical provider to identify the root of the patient’s anxiety over a health issue, as in the study case (H. Ticona et al., 2020). Considering that the patient has been complaining of shortness of breath and a nonproductive cough in the previous month is crucial in this scenario. The patient claims that her inability to breathe and remain productive has greatly impeded her ability to perform her usual activities. Family Health – Week 4 Discussion
The Differential Diagnosis Based on The Objective and Subjective Information Provided
It will be important to incorporate the patient’s input within the test case as you think about a possible diagnosis for the patient. Because of their crucial significance, the supposed final diagnoses will acquire a great deal of attention. Therefore, congestive heart failure is the highly likely final diagnosis based on the data supplied inside the test scenario. According to Cawthon et al. (2020), aortic stenosis (ICD10 Code I35.0), as well as cardiogenic pulmonary edema (ICD 10 Code J81), are two more probable diagnoses. The symptoms and signs of aortic stenosis are rather obvious whenever a patient has an illness. The patient in the research study has reported experiencing nausea, chest pain and tightness, shortness of breath, and fatigue, among other symptoms. Therefore, it is crucial to think about how likely it is that the patient with aortic stenosis would acquire heart failure. The patient also exhibits various signs and symptoms consistent with cardiogenic pulmonary edema. Family Health – Week 4 Discussion
The patient may have symptoms such as exhaustion, inflammation in the legs, difficulty breathing, and shortness of breath. CHF (congestive heart failure) is a medical illness that happens when the heart is unable to pump enough blood to meet the body’s metabolic demands. In addition to that, it is when the is able to do so only intermittently by increasing the diastolic filling pressure. Weakness, exercise-induced dyspnea, palpitations, orthopnea, acute pulmonary edema, chest ache, fatigue, pulse alternans, swollen neck veins, wheezing, peripheral cyanosis, and pressure within the chest, and S3 gallop, are some of the more prevalent warning indicators and symptoms (Falsey & Walsh, 2020). Those with chronic heart failure (CHF) may elevate themselves with pillows during the night to facilitate breathing easier. Signs of CHF (congestive heart failure) are shortened to the acronym FACES and involve dyspnea, congestion, edema, activity restrictions, and fatigue. Clinical criteria for CHF are met in this patient, including dyspnea on exertion, hypertension, orthopnea, tiredness, an S3 gallop, and creaks at the lobes of the lungs.
The Treatment Plan to Consider Based on The Evidence-Based Practice Guidelines Family Health – Week 4 Discussion
The patient in the scenario under test has enough symptoms of stage C heart failure to warrant that diagnosis. In combination with a 12-lead ECG, chest X-ray, and additional diagnostic procedures, the patient may also require blood testing. According to Abel-Ali and Athdi (2022), renal function, complete metabolic panel, full blood count, liver function, brain natriuretic peptide, troponin, and arterial blood gas testing are required. In addition, a fast chest X-ray can reveal if or not the patient has fluid in their lungs and the size of their heart. In some cases, a diagnosis of heart failure cannot be made unless the patient has already had echocardiography. Magnetic resonance imaging (MRI) or computed tomography (CT) may also be recommended, and a stress test could be necessary. Just one way to prevent the patient’s CHF from getting worse is to keep treating it. There is currently no cure or medical treatment for this condition. We must immediately start her on a diuretic as well as a vasodilator and monitor her progress. The amount of salt and water she takes in as a whole ought to be reduced, and she ought to be educated to constantly monitor her weight gain or loss. Her potassium levels may need to be closely watched while she is on the diuretic, and she may also benefit from consuming a potassium supplement. Her ailment calls for a special diet and some counseling, therefore she has to consult a dietician for help.
Most importantly, the doctor in the hypothetical situation may recommend a treatment strategy that entails reducing the patient’s intake of both water and salt. In the event that the patient in the case study lowered their salt intake, this could lead to involuntary fluid retention in their lungs, veins, and other organs. To be more specific, decreasing the amount of sodium consumed by the person through lowering the level of sodium that is contained in the meals they eat can assist to keep the likelihood of heart failure inside the individual under extreme control. Further, being at a healthy weight should be a top priority. It may become more difficult for the body to acquire enough blood and oxygen if the individual is overweight or carries on gaining weight (Boehmer, 2020). Keeping a healthy weight reduces the amount of stress the heart has to work under, improving the patient’s overall well-being. Losing too much weight too quickly might also cause catastrophic heart failure. That is why it is so crucial to keep the patient’s weight stable.
References Family Health – Week 4 Discussion
Abed-Ali, H. N., & Athbi, H. A. (2022). Effect of prostrate position and coughing exercises upon level of dyspnea and persistent cough among non-intubated patients with covid-19. International Journal of Health Sciences, II, 2797–2810. https://doi.org/10.53730/ijhs.v6nS2.5700
Boehmer, T. K. (2020). Changing age distribution of the covid-19 pandemic — united states, may–august 2020. mmwr. Morbidity and Mortality Weekly Report, 69. https://doi.org/10.15585/mmwr.mm6939e1
Cawthon, P. M., Orwoll, E. S., Ensrud, K. E., Cauley, J. A., Kritchevsky, S. B., Cummings, S. R., & Newman, A. (2020). Assessing the Impact of the COVID-19 Pandemic and accompanying mitigation efforts on older adults. the journals of gerontology series a: Biological Sciences and Medical Sciences. https://doi.org/10.1093/gerona/glaa099
Falsey, A. R., & Walsh, E. E. (2020). Respiratory syncytial virus: an old foe in a new era. The Journal of Infectious Diseases, 222(8), 1245–1246. https://doi.org/10.1093/infdis/jiaa362
H. Ticona, J., M. Zaccone, V., & M. McFarlane, I. (2020). Community-acquired pneumonia: a focused review. American Journal of Medical Case Reports, 9(1), 45–52. https://doi.org/10.12691/ajmcr-9-1-12

Family Health – Week 4 Discussion