What questions should be asked, and which body parts should be examined?
When a patient arrives with a cough, several questions must be asked. For example, when did the cough begin? Has it lasted less than three weeks or longer? Is there anything that could have caused the cough? Is your cough productive or ineffective? If you are successful, could you please describe the amount of sputum, its color, odor, and consistency? When does the coughing start? Is it 24 hours a day, seven days a week? Do you suffer from reactive airway disease? Is there anything that can help? Have you taken any cough medication? Do you have a tendency to cough more when you’re lying down? Do you have any other symptoms, such as shortness of breath, fever, or wheezing, along with your cough? What prescriptions do you have, and do you use any over-the-counter medications? Do you use tobacco? OLDCARTS is also being used to collect subjective data from the patient.
The mouth/throat, ears, neck, nose, thorax, and chest are among the body parts that must be examined. Examine the ears for cerumen or hairs that may be impinging on the tympanic membrane (Dunphy, Winland-Brown, Porter & Thomas, 2015). Any discharge, edema, or sinus tenderness in the nose should be evaluated. Examine the throat for signs of postnasal drip. The neck should be palpated and any enlarged lymph nodes or masses should be evaluated (Dunphy et al., 2015). The thorax and chest should be examined to determine whether the patient has any cardiac or pulmonary issues. Auscultation of the heart and lungs is recommended. Listen for any abnormalities, such as fluid or rhonchi in the lungs or heart murmurs.
What diagnostic tests are required, and why?
If the patient exhibits signs and symptoms of pneumonia, a chest x-ray should be performed to confirm the diagnosis (Dunphy et al., 2015). It may also detect other things, such as a hidden tumor. To diagnose or rule out a bacterial infection, a complete blood cell count must be obtained. If the patient is able to cough up a sputum sample, it should be sent to be cultured. A chest computed tomography (CT) scan can detect small peripheral lung nodules and differentiate the chest wall from other areas of pleural or parenchymal disease (Dunphy et al., 2015). This scan can also be used to rule out pulmonary thromboembolism. If the patient has a history of chronic postnasal drip or chronic sinus infections, sinus films can be used to rule out sinusitis. To determine whether the patient has COPD or restrictive lung disease, spirometry should be used. This test can detect COPD even before symptoms appear.
How would you handle an unusual discovery?
I would handle abnormal findings by investigating them and making a diagnosis. I would also try to determine the cause of the abnormal findings and order additional testing, such as a bronchoscopy, if necessary to make a diagnosis. I would then explain to the patient the abnormal findings. I will develop a treatment plan with the patient based on the abnormal findings. If necessary, I will consult with a pulmonologist.
What will be your differentials list?
A viral upper respiratory infection is the most common cause of acute cough. Acute exacerbation of chronic pulmonary disease (COPD), pneumonia, or pulmonary embolism can also cause it (Silvestri & Weinberger, 2019). Other differential diagnoses would be acute bronchitis, postnasal drip, asthma, medication use such as an ACE inhibitor, post infection, GERD, and occupational/environmental factors (Dunphy et al., 2015). Tumors, aortic aneurysms, tuberculosis, and lung abscess are some of the more serious causes of coughing. Cough can also have a cardiovascular cause and be a sign of left-sided heart failure (Bickley, 2017)