Introduction
Proper and comprehensive management of patient conditions is directly related to coming up with the accurate diagnosis. Having the exact diagnosis of the patient means that the clinicians should examine the patient for all the possible conditions that have similar clinical presentation. This is achieved through comprehensive physical examination of the signs and symptoms that the patient presents with. Laboratory services may also be utilized in order to come up with the correct diagnosis. With correct diagnosis, both pharmacological and non-pharmacological approaches are going to be employed in order to relieve the symptoms and prevent further systemic complications for the patient. For the present patient, he reports to have shortness of breath, easily fatigued evidenced by his inability to walk for a short distance. Reports to be having history of COPD, heart failure and an undiagnosed hypertension. The patient also reports to be currently on medications used to treat heart failure and COPD.
Differential diagnosis
Asthma
This is an upper respiratory condition that is usually characterized by shortness of breath. The shortness of breath is caused by the narrowing of the airway which is related to either inflammation of the airway or blockage of the airway by foreign objects such as secretions. Patient with asthma cannot engage in activities that require a lot of oxygen such as walking for a long distance. It is common in patients with history of cigarette smoking and cardiovascular diseases such as congestive heart failure (Divo et al., 2015).The current patient presented with exertion dyspnea and easy fatigue. He has a history of smoking cigarette, COPD, cardiac failure and present unmanaged hypertension. This symptoms can qualify the above patient to be asthmatic
Congestive heart Failure
Congestive heart failure is a cardiovascular disease in which the heart is not able to perfuse all the other systems due to inability of the heart muscles to pump blood out. Patient with heart failure usually present shortness of breath while exercising, coughing and inability to perform mild exercise. The condition is commonly associated other cardiovascular disease such hypertension and lifestyle practices such smoking. Previous history of heart failure can also lead to recurrence of another episode. Currently, the patient has dyspnea, activity intolerance and history heart failure and present hypertension. These symptoms can be used to justify congestive heart failure in the patient.
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Tuberculosis
This is an infectious bacterial disease of the lungs that may also spread to other part of the body. Patients with tuberculosis usually present with cough, shortness of breath as well inability to tolerate any form of mild to moderate physical exercise such as walking for a short distance. The present patient presents with shortness of breath while at rest and during exercise. The patient also reports to have no tolerance to activities such as walking due to dyspnea attacks. From these symptoms, tuberculosis should not be ruled out.
Bronchiolitis
Bronchiolitis is another infectious disease that usually affects the lungs. It is common in children but can also be found in adults and causes acute symptoms among adults. The primary characteristic of this disease is shortness of breath and coughing. Fatigue is another symptoms that is usually observed in patients with bronchitis. The present patient presented with shortness of breath and getting easily fatigued. Therefore bronchitis should also be considered during final diagnosis.
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease is a condition where the airway is acutely reduced in size are completely blocked by foreign objects such as solids or fluids such as secretions like mucus, blood or food substances. Patients present with coughing, dyspnea and activity intolerance. History of previous COPD and heart failure are some of the risk factors of this disease (Divo et al., 2015). The patient in the case scenario meets all the symptoms requirements and therefore this disease should be considered during diagnosis.
Primary diagnosis
Chronic Obstructive Pulmonary Disease.
This disease is characterized by severely narrowed airway leading to inadequate air flow into the lungs. As a result, there signs of impaired gaseous exchange will be observed in the patient. They include dyspnea, coughing and activity intolerance in both mild and moderate occasions (Divo et al., 2015). This disease is associated with several factors. Previous history of the same disease and other cardiovascular conditions can result to emergence or re-emergence of such condition. Use of substance such as cigarettes increases the chances of a person getting such disease. For the above presented patient, his history of smoking, COPD, heart failure and hypertension points towards him developing another episode of COPD. His current symptoms of dyspnea and exercise intolerance further proves that he is suffering from COPD.
Diagnostic test.
Some of the diagnostic tests for the patient include radiological tests such as chest X-ray which will be done to visualize the extent of obstruction and determine the blocking agent. Pulse oximetry should be done to check for the level of oxygen saturation. A saturation of less than 90% should be intervened by oxygen therapy. Spirometry should be done to determine the EFV1 for the patient. The percentage of EFV1 is used to classify and stage COPD (Hillas, Perlikos, Tsiligianni, & Tzanakis, 2015).
Pharmacological and non-pharmacological treatment.
The goal of management in COPD is to eliminate symptoms and prevent further complications of the disease. Pharmacological treatment involves the use of a short-acting bronchodilators such albuterol and systemic corticosteroid such as fluticasone. The drugs are given together to the patient (Hillas, Perlikos, Tsiligianni, & Tzanakis, 2015).
Non-pharmacological management of COPD involves activities are aimed at enhancing quick recovery and preventing disease progression to worst stages. They involve suctioning the patient to remove secretions if they are the agents blocking the airway. Objects should be removed. Oxygen should be administered to the patient as necessary (Bradstreet, & Parkman, 2016).