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Case Study -Adult

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Case Study -Adult

Q.1

As part of the medical history, the healthcare provider may have asked the patient questions

such as, what is the onset, duration, and severity of the cough? Are there aggravating factors or

triggers for the cough? Do you experience symptoms of chest pain, shortness of breath, or

difficulty breathing? Are any previous episodes of similar symptoms? Do you have a history of

smoking or exposure to environmental irritants? Have you had any recent changes in

medications? Have you travelled outside the country for the last three months? Did you

experience flu or cold before this cough started? A persistent cough can occur for more than

eight weeks after a viral or other upper respiratory tract infection.

Q.2

During a physical exam, a healthcare provider typically would have conducted a

thorough examination of the head, neck, chest, heart, lungs, abdomen, and extremities. He or she

would have also checked the patient's vital signs such as heart rate, blood pressure, temperature,

and respiratory rate. The skin, ears, eyes, nose, throat, neck, chest, lungs, heart, and abdomen. of

the 75-year-old would have also been assessed. The healthcare provider would have also checked

signs of distress, infection, inflammation, or other abnormalities. In addition, the neurological

system would have also been examined, including reflexes, sensation, muscle strength, and

peripheral neuropathy together with any other symptoms reported by the patient.

Q.3

Based on the patient's medical history and physical exam, the most likely cause of his dry

hacking cough is more connected to the side effect of ACE inhibitors, lisinopril which he has
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been taking for 6 months as this is a known side effect of ACE inhibitors medication. Cough is a

common side effect of the ACE inhibitors class as it is thought to be associated with the

inhibition of the enzymes that break down the mediators of inflammation like tachykinins and

bradykinins ( Yilmaz, 2019). Nevertheless, it is also possible that his cough could also be caused

by long-term use of over-the-counter allergy medication or other underlying conditions such as

chronic obstructive pulmonary disease (COPD) and asthma, or it could be caused by a

complication of his hypertension, diabetes, or colon polyps. However, the specific cause of the

cough can be identified using further diagnostic tests such as chest x-ray, spirometry, or a

bronchoscopy.

Q.4

Other possible diagnoses that should be considered for the patient's persistent dry hacking

cough include:

Asthma: which is described as a chronic lung disease that inflames and narrows the airways,

making it difficult to breathe and it is a common condition among individuals with cough.

Chronic obstructive pulmonary disease (COPD): A progressive lung disease that makes it

difficult to breathe and includes conditions such as emphysema and chronic bronchitis. Both

asthma and OCPD share common symptoms which include breathing difficulties, wheezing and

chronic coughs (WHO, 2022).

Acute bronchitis: An infection of the bronchial tubes that causes inflammation and mucus

production, leading to cough and difficulty breathing.

Pneumonia: An infection in one or both lungs that causes inflammation and fluid build-up,

leading to cough and difficulty breathing.

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Gastroesophageal reflux disease (GERD): A condition in which stomach acid flows back into the

esophagus and causes irritation, leading to symptoms such as heartburn and a chronic cough.

Side effect of other medications: the patient's cough may be an adverse effect of other

medications that he is taking, other than ACE inhibitors.

Tuberculosis (TB) or other lung infections: an airborne bacterial infection that targets the lungs,

may cause persistent cough.

Sarcoidosis: a chronic inflammatory disease that can cause inflammation in many organs,

including the lungs characterized by consistent dry cough.

Q.5

Yes, there are other tests that should be completed before producing a diagnosis for the

patient's persistent dry hacking cough. Some of these tests include:

Chest X-ray: to evaluate the lungs and detect any signs of infection, inflammation, or structural

abnormalities.

Spirometry: a test that measures how much air a person can inhale and exhale and how quickly

they can do it. It can help diagnose and assess the severity of conditions such as asthma and

COPD.

Bronchoscopy: a procedure that involves using a small camera to look inside the bronchial tubes

and lungs. It can help diagnose conditions such as bronchitis, pneumonia, and lung cancer

(Thiboutot & Yarmus, 2022).

Chest CT scan: this can give more detailed information on the lung anatomy and may pick up

certain abnormalities that may not be visible on an x-ray.

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Nasal endoscopy: to examine the inside of the nose and upper airway.

Phlegm analysis: to assess if there's infection or inflammation.

Allergy testing: to assess if the patient's cough is caused by allergies.

Pulmonary function tests (PFT) such as DLCO, help in assessing lung capacity.

All of these tests may be necessary for every patient, and the specific tests that are needed

will depend on the patient's specific symptoms and medical history. Therefore, the healthcare

provider may decide to order some of these tests or none at all based on the context and clinical

judgment.

Q.6

The treatment for the patient's persistent dry hacking cough will depend on the

underlying cause of the cough, which may not be clear yet. The healthcare provider may suggest

some initial treatment options while awaiting the results of any diagnostic tests that have been

ordered. ACE inhibitors-associated cough might be a side effect of the patient's lisinopril

medication, the healthcare provider may suggest switching to a different class of blood pressure

medication or adjusting the dosage (Yilmaz, 2019).

Allergic bronchitis: If the patient's cough is caused by allergies, the healthcare provider may

recommend an over-the-counter antihistamine or a nasal steroid spray to help control symptoms.

Asthma or COPD: If the patient's cough is caused by asthma or COPD, the healthcare provider

may prescribe inhaled bronchodilators or inhaled corticosteroids to help control symptoms and

reduce inflammation in the airways.

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GERD: If the patient's cough is caused by GERD, the healthcare provider may recommend over-

the-counter antacids or prescribe a proton pump inhibitor (PPI) to help control stomach acid.

Sarcoidosis: if this is a possible diagnosis, the healthcare provider will consult with a

pulmonologist or rheumatologist to initiate treatment and monitoring.

In addition, the patient should be educated about their specific diagnosis, the treatment

plan, including any medications and how to use them correctly, and how to monitor their

symptoms. Also, he should be counseled about lifestyle modifications, such as avoiding triggers

and irritants, quitting smoking if applicable, and maintaining a healthy diet and weight. The

healthcare provider has the responsibility of informing the patient about the importance of

follow-up visits and monitoring of symptoms to ensure that the treatment is working as it should

(Siegel et al., 2019).

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References

Siegel, D. A., Jatlaoui, T. C., Koumans, E. H., Kiernan, E. A., Layer, M., Cates, J. E.,

Kimball, A., Weissman, D. N., Petersen, E. E., Reagan-Steiner, S., Godfred-Cato, S.,

Moulia, D., Moritz, E., Lehnert, J. D., Mitchko, J., London, J., Zaki, S. R., King, B. A.,

Jones, C. M., … Koppaka, R. (2019). undefined. American Journal of

Transplantation, 19(12), 3420-3428. https://doi.org/10.1111/ajt.15690

Thiboutot, J., & Yarmus, L. (2022). Interventional bronchoscopy. Encyclopedia of Respiratory

Medicine, 756-764. https://doi.org/10.1016/b978-0-08-102723-3.00147-5

WHO. (2022, May 20). Chronic obstructive pulmonary disease (COPD). World Health

Organization (WHO). https://www.who.int/news-room/fact-sheets/detail/chronic-

obstructive-pulmonary-disease-(copd)

Yilmaz, I. (2019). Angiotensin-converting enzyme inhibitors induce cough. Turkish Thoracic

Journal, 20(1), 36-42. https://doi.org/10.5152/turkthoracj.2018.18014