How to write a nursing essay on Assessment and Management of Cough (Solved)

Case prompt: patient comes in to see you complaining of a cough for three months. How does your assessment of this cough differ from a patient who has had a cough for five days?

Tasks:

What are the potential red flags?
What is important not to miss in your review of systems?
What are the differential diagnosis for a cough lasting three months?
What are the top three causes of a cough lasting three months?
Write a sample HPI for the above patient.

SOLUTION ON Assessment and Management of Cough

How does your assessment of this cough differ from a patient who has had a cough for five days?

Chronic cough is one of the most frequent manifestations of patients treated in primary and secondary care facilities. Chronic cough is defined as one lasting for more than 8 weeks and affects approximately 10% to 18% of the general population (Satia et al., 2021). This cough should be differentiated from an acute cough that lasts less than 3 weeks and is commonly associated with viral upper respiratory tract infections.

The assessment of acute cough lasting for five days will involve components like exposure to allergies, recent travel history, previous respiratory tract infection and inspection of the sinuses, skin for cyanosis, and mouth/throat (Walter, 2021). The healthcare provider will also assess for warning signs like dyspnea, tachypnea, hemoptysis, and fever that will indicate worsening disease. In patients with chronic cough, a careful history and physical examination are critical in evaluation. History of chronic diseases like asthma, COPD, and obesity will be essential components (Walter, 2021). The history should differentiate if the cough is dry or productive and sputum must be examined. Further assessment using tests like pulmonary function tests and chest X-rays will be essential to determine the actual cause of chronic cough.

What are the potential red flags?

Given the number of patients that present each year with cough, it is important to differentiate a cough due to serious underlying illness and a cough from acute illness. In a patient presenting with a cough for more than three weeks, the provider should be wary of excessive sputum production that could be a sign of bronchiectasis (Garner, 2018). Cough accompanied with systemic symptoms like weight loss, night sweats, and fever could be an indicator of pulmonary tuberculosis or lung carcinoma. The patient should report if the cough is dry or the sputum contains blood which will indicate TB or lung cancer (Garner, 2018). Significant symptoms like dyspnea accompanied by chronic cough can indicate conditions like heart failure, pulmonary fibrosis, or COPD. Additionally, a history of smoking especially in adults older than 45 years can suggest serious underlying causes of cough (Michaudet & Malaty, 2017). These red flags will warrant prompt investigation and appropriate management of the patient.

What is important not to miss in your review of systems?

The initial evaluation of a patient presenting with chronic cough involves comprehensive history taking and physical examination. A focused examination and review of the respiratory and cardiovascular systems should be done. It is important not to miss signs of post-nasal dripping, dyspnea, and abnormal breath sounds that could indicate lower respiratory tract infection (Satia et al., 2021). Conditions like asthma can present with a cough that worsens in the morning and is accompanied by wheezing or a tight chest. Chest pain is an important feature that can help to identify illnesses like pulmonary tuberculosis and GERD that can present with chronic cough (Michaudet & Malaty, 2017). It is also important not to miss nasal blockage, peripheral and central cyanosis that can indicate worsening condition.

What are the differential diagnosis for a cough lasting three months?

Upper airway cough syndrome (UACS). Also known as postnasal drip syndrome, UACS is the most common cause of chronic cough (Michaudet & Malaty, 2017). The condition can be caused by chronic rhinosinusitis, allergic rhinitis and presents with other symptoms like sneezing, itching, and postnasal drainage. Diagnosis is often based on physical symptoms like throat clearing, cobblestone appearance of the oropharyngeal mucosa, and drainage in the posterior pharynx. It is commonly observed in immunocompetent patients who do not smoke.

Asthma. Asthma can cause chronic cough and should be suspected in patients with symptoms of wheezing, chest tightness, and shortness of breath. In other cases, cough can be the only observable symptom in cough variant asthma (Michaudet & Malaty, 2017). The diagnosis of this condition is based on physical examination, spirometry tests, and bronchial challenge testing.

Gastroesophageal reflux disease (GERD). GERD is among the conditions that result in chronic cough and failure to consider this differential is a common cause of treatment failure (Satia et al., 2021). Clinical clues for this diagnosis include heartburn, chest pain, hoarseness, and regurgitation. Treatment with antacids and proton pump inhibitors often leads to relief f cough.

ACE inhibitor-related cough. Patients taking angiotensin converting enzyme inhibitors are reported to experience chronic cough. About 5% to 35% of patients on these medications develop a cough that starts hours or months after the first dose (Michaudet & Malaty, 2017). Discontinuation of these drugs often leads to the resolution of the cough.

What are the top three causes of a cough lasting three months?

The three common causes of chronic cough include:

Upper airway cough syndrome (UACS)
Asthma
Long-term respiratory tract infections like chronic bronchitis

Write a sample HPI for the above patient.

Mr. J is a 44-year-old male patient presenting to the clinic with a cough for three months. He explains that the cough was on and off initially and now occurs on a daily basis and is worried he may have an underlying serious pathology. Further questioning reveals that the cough is non-productive apart from early in the morning when he expectorates sputum. For the past couple of months, he has been constantly clearing his throat and has frequently noticed something dripping down the back of his throat. These symptoms started a week after sustaining a cold and have persisted. Since then.

References

Garner, J. (2018). Chronic cough in adults: What’s the diagnosis?. Guidelines in practice. https://www.guidelinesinpractice.co.uk/respiratory/chronic-cough-in-adults-whats-the-diagnosis/454041.article

Michaudet, C., & Malaty, J. (2017). Chronic cough: Evaluation and management. American Family Physician, 96(9), 575-580. https://pubmed.ncbi.nlm.nih.gov/29094873/

Satia, I., Wahab, M., Kum, E., Kim, H., Lin, P., Kaplan, A., … & Field, S. K. (2021). Chronic cough: Investigations, management, current and future treatments. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 5(6), 404-416. https://doi.org/10.1080/24745332.2021.1979904

Walter, K. (2021). Cough. JAMA, 325(22), 2322-2322. https://jamanetwork.com/journals/jama/fullarticle/2780617

How to write a nursing essay on Assessment and Management of Cough (Solved)

SOLUTION ON Assessment and Management of Cough

How does your assessment of this cough differ from a patient who has had a cough for five days?

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