Discussion Part 2 (Differential Diagnoses)
In essence, this discussion aims at establishing the primary diagnoses of Katie, who presents with persistent coughing,and her son-in-law, Patrick who presents with a chief complaint of itchy dry flank skin. Additionally, it focuses on presenting evidence-based treatment plans for both Katie and Patrick.
Primary Diagnoses
Based on Katie’s clinical manifestations and chest x-ray results, it is beyond doubt that she is suffering from community acquired pneumonia (CAP). That is for sure since she presents with manifestations and diagnostic findings such as fever, coughing, crackles breath sounds on auscultation and pleuritic chest pain, which are befitting of an individual with CAP (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2013).
On the contrary, Patrick’s clinical portrayal is suggestive of an individual with a primary diagnosis of psoriasis. According to Copstead-Kirkhorn and Banasik, (2014), persons suffering with psoriasis present with symptoms such as pain, and lesions on various body regions such as scalp, chest, elbows, knees, back and buttocks.Concisely,Patrick’s situation (itchy dry flank skin on the elbow and the silvery whitescale) is befitting of psoriasis’ clinical picture.
Evidence-based Treatment Plan
Primarily,the evidence-based treatment plan for both Katie and Patrick will detail various elements that are worth mentioning. They include medications, additional diagnostic tests, patient education, possible referrals, and a plan for follow up.
Katie’sEvidence-based Treatment Plan
Medications.POLevofloxacin 750mg every 48hours or combined therapy of PO Erythromycin 500mg QID x 7-14 days and Ceftriaxone 1-2g OD for 10days (Watkins &Lemonovich, 2011).
Additional diagnostic tests.Sputum for culture and sensitivity given that Katie has a suspected diagnosis of CAP and therefore the need for determining the specific bacterial agent responsible for the infection (Watkins &Lemonovich, 2011).
Patient education.Enlighten Katie on the need of seeking medical intervention if her symptoms fail to improve despite utilizing the prescribed medications. In essence, such a failure may be due to lack of consideration of the fact that Katie has other comorbidities such as renal disease, whichimpair the effectiveness of treatments other than fluoroquonolonessuch as Levofloxacin in the treatment of CAP (Watkins & Lemonovich, 2011).
Possible referrals and Follow upplan.Katie should seek medical intervention if her symptoms persist despite utilizing the prescribed medications. However, if an improvement ofsymptoms is apparent, she should come back after 2weeks for follow up (Buttaro, et al., 2013).
Patrick’s Evidence-based Treatment Plan
Medications. According to Shan,(2016) topical corticosteroids are often the medication of choice in the treatment of psoriasis. A case in point of such corticosteroids include Betamethasone 0.05% (AlphaTrex) applied twice daily for 4weeks.
Additional diagnostic tests.None.
Patient education. Central to the teaching plan for a patient with psoriasis is the subject of the likely side effects of the medications prescribed for the relief of symptoms, which necessitate seeking medical advice from the primary care providers. For instance, long term use of corticosteroids result in side effects such as thinning of the skin and stretch marks(Shan, 2016). As such consulting the primary care providers will give the patient the way forward.
Possible referrals.Refer to a dermatologist for expert opinion about this condition (Buttaro, et al., 2013).
Follow up plan. Patrick should seek medical intervention if her symptoms persist despite utilizing the prescribed medications. A follow up clinic after 2weeks is necessary for the determination of the efficacy of the prescribed medications in relieving the symptoms (Buttaro, et al., 2013).
References
Buttaro, T., Trybulski, J., Bailey, P., Sandberg-Cook, J. (2013). Primary care a collaborative practice (4th ed.). [VitalSource Bookshelf Online]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/978-0-323-07501-5/
Copstead-Kirkhorn, L., & Banasik, J. L., (2014). Pathophysiology (5th ed.).
Shan, Y. (2016). Treatment and management of psoriasis. Primary Health Care, 26(3), 32-41.
Watkins, R. R., & Lemonovich, T. L. (2011). Diagnosis and management of community-
acquired pneumonia in adults. American Family Physician, 83(11), 1299-1306. Retrieved
from http://www.aafp.org/afp/2011/0601/p1299.html
