Patient cough case study

Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and asked if she could have a refill. You noted the patient’s name on the label, and the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Medical Assistance. You do not recall having discussed this patient with medical assistance nor do the other providers in the practice.

Case Study Questions:

What are the potential ethical and legal implications for each of the following practice members?

Medical assistant
Nurse Practitioner
Medical Director
Practice

What strategies would you implement to prevent further episodes of potentially illegal behavior?

What leadership qualities would you apply to effect a positive change in the practice?  Be thinking about the culture of the practice.

Instruction: scholarly source. One scholarly source for each intervention. If there are 3 parts of the discussion question- you need to make sure you have 1 in-text citation for each part of the question, for a total of 3-intext citation.

APA format. Thank you!

MORE INFO

Patient cough case study

Introduction

Takeaway: Make a note of the following, and make an educated guess:

How did the patient’s cough feel? Did it improve? How long was this cough present?

Were there any exacerbations or remissions with this cough? What were they like (e.g., dry, sputum production, hemoptysis)?

Did the croupier have a winning way of doing things/caring for patients (e.g., smiling, making eye contact)? Would he be able to assist with follow-up care with this patient?

Do you think the Croupier would do well in the emergency department setting—or is it time for him to move on to another career path?

The patient is a 55-year-old man who presents to his primary care physician with a five-day history of cough. The cough is unproductive, worse at night, and has disturbed his sleep.

The patient denies having any other symptoms or illnesses that might be causing him to cough. He does not smoke cigarettes or drink alcohol regularly, but did smoke some marijuana recently (approximately four months ago).

He has had no fever, sputum production, chest pain, or dyspnea. He has not experienced recent weight loss or hemoptysis.

Fever: No
Sputum production: No
Chest pain: No
Dyspnea: Yes, with exercise and deep breathing
Weight loss: None observed by the patient or doctor. The patient feels well otherwise, but has lost some weight recently (about 2 pounds over the past 4 weeks). This could be due to diet changes or increased activity levels in general

There is no history of rhinorrhea or nasal congestion.

You’re listening to a patient who has just been diagnosed with a cough. You know that the cough is most likely caused by an upper respiratory infection, but what are some symptoms of an upper respiratory infection?

Runny nose or congestion would be one symptom of an upper respiratory infection.
The other common symptom is sneezing, which can be quite sudden and intense.

He denies having allergies and environmental changes in the temperature, humidity, or use of heaters in his home.

Although your patient denies having allergies and environmental changes in the temperature, humidity, or use of heaters in his home, it is important to rule out these causes of cough. Allergies can cause nasal congestion and postnasal drip (snot), but this does not always mean a cough. Further testing would be necessary if you suspect an allergy as a possible cause for your patient’s cough.

The patient’s medical history is significant for hypertension and hyperlipidemia, which are well controlled with medication.

The patient’s medical history is significant for hypertension and hyperlipidemia, which are well controlled with medication. He is on medication for these conditions and has been doing so for many years. His blood pressure is well controlled, as are his cholesterol levels.

On examination, he appears comfortable and well nourished but anxious because he has a very important job interview coming up.

He is able to communicate clearly, although his speech is slightly slurred from dehydration. He is alert and oriented to place and person; his eyes are clear; there is no evidence of visual impairment. The patient’s chest is clear, with a normal amount of breath sounds (pulse oximetry readings: 95% oxygen saturation). There is no wheezing present at rest or during exertion; however, wheezing is noted when the patient stands up quickly after lying down for a few seconds (cardiac murmurs are heard).

The physical exam reveals no evidence of wheezing, rales, rhonchi, decreased air entry or dullness to percussion in the thorax.

The physical exam is important for diagnosing cough. The physical exam can be helpful in identifying signs and symptoms of a cough, including wheezing, rales, rhonchi, decreased air entry and dullness to percussion on the chest wall. In addition to these findings on physical examination, there may be other findings such as dyspnea or tachypnea that require further evaluation with more sophisticated tests such as spirometry (forced expiratory volume) or bronchoscopy if you suspect lung disease is responsible for your patient’s cough

No lymphadenopathy is observed on the examination. There are no skin lesions or clubbing of the fingers on examination.

A 55-year-old man presents to his primary care physician with a five-day history of cough. His blood pressure is 120/80 mm Hg, and his heart rate is 70 beats per minute. He has no known chronic illnesses or recent drug therapy.

The patient has no lymphadenopathy on examination and appears to be in good health overall. There are no skin lesions or clubbing of the fingers on examination (see Figure 1). The patient does not smoke; however, he does drink alcohol occasionally and has been treated for hypertension in the past year by taking hydrochlorothiazide (HCTZ) 25 mg twice daily with meals for one week before stopping this medication abruptly because he felt fine without it anymore

This patient’s cough was probably caused by postnasal drip

Postnasal drip is the result of congestion and drainage in the throat, which can cause cough. The patient’s symptoms are consistent with postnasal drip, including nasal congestion, nasal discharge, and a dry cough that worsens when lying down or sneezing. Postnasal drip may also be accompanied by headaches or facial pain.

The medical history is also consistent with postnasal drip: he has had chronic runny nose since childhood; he uses an antihistamine daily; and his physical examination revealed no obvious signs of infection or inflammation (e.g., fever).

Conclusion

This patient’s cough was probably caused by postnasal drip. Postnasal drip is a common cause of cough and can be treated with over-the-counter medications or other home remedies (see our previous blog post on ear infections). The patient will need to continue to use his inhaler and take his medications as prescribed in order to prevent future episodes of postnasal drip. If you have any questions about this patient’s condition, please contact your primary care physician or pediatrician for further assistance.

Nursing Worker

Patient cough case study