Nr601Week 2: COPD Case Study Part 1
Nr601Week 2: COPD Case Purpose
Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
- Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1) (CO,2,3,4,5)
- Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO 2.2) (CO 2,4)
- Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)
Case Study – Part 1
Date of visit: November 20,2019
A 62 year-old Caucasian male presents to the office with persistent cough and recent onset of shortness of breath. Upon further questioning you discover the following subjective information regarding the chief complaint.
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Physical exam reveals the following:
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Requirements/Questions:
- Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. May use approved medical abbreviations. Avoid redundancy and irrelevant information.
- Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement (2-3 sentences) of pathophysiology for each.
- Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.
- Rank the differential in order of most likely to least likely.
- Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based practice (EBP) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBP evidence.Nr601Week 2: COPD Case
Nr601Week 2: COPD Case Answer
History and Physical Assessment (H&P) – Differential Diagnosis
Presenting Complaints:
The client reports an intermittent morning cough accompanied by worsened shortness of breath during physical activity, which subsides with rest. Despite attempting self-medication with Robitussin DM, there is no improvement. The persistent cough with white-yellow phlegm has endured for six months, coinciding with episodes of shortness of breath. Past medical history reveals the use of Metoprolol succinate ER for primary hypertension, a history of Cholecystectomy and appendectomy, and a significant smoking history. Family history includes the father’s demise from MI & CHF at 59, and the mother’s ongoing battle with osteoporosis.Nr601Week 2: COPD Case
Physical Examination:
Throat appears moist and healthy; Cardiopulmonary examination shows clear heart sounds (S1 and S2) without murmurs, while lungs exhibit faint wheezes bilaterally. Respirations are within normal limits, and no leg edema is observed. Other systems, including stomach, neck, head, and ears, present as unremarkable.Nr601Week 2: COPD Case
Differential Diagnosis:
Chronic Obstructive Pulmonary Disease (COPD): COPD encompasses a spectrum of lung conditions such as chronic bronchitis, emphysema, and chronic obstructive airways disease (Global Initiative for Chronic Obstructive Lung Disease [GOLD], 2022). Symptoms align with the client’s reported cough, exertional dyspnea, and smoking history.
Heart Failure (HF): Considering the family history of CHF and the client’s shortness of breath, further evaluation for heart failure is warranted. HF may present with similar symptoms and can be influenced by comorbid conditions (Yancy et al., 2017).
Asthma: Wheezes on lung examination raise the possibility of asthma, especially considering the intermittent nature of symptoms. Asthma exacerbations can present with cough and wheezing (Global Initiative for Asthma [GINA], 2022).
Next Steps:
Further diagnostic tests, including pulmonary function tests, imaging studies, and cardiac evaluations, will aid in confirming or ruling out these potential diagnoses. Collaboration with specialists may be necessary for a comprehensive assessment.
References: Global Initiative for Asthma (GINA). (2022). Global Strategy for Asthma Management and Prevention. https://ginasthma.org/
Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2022). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. https://goldcopd.org/
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., … & Wilkoff, B. L. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 136(6), e137-e161.
