Respiratory Conditions: Tammy Case Scenario
History of the presenting illness
In order to determine the right diagnosis for Tammy, it is essential to point out some of the clinical manifestation. They include a productive cough, scratchy throat. According to Tammy, the cough fits are often prolonged, deep and accompanied with the production of green mucus. Some of the pre- medications are over the counter cough medicines that have had no therapeutic effect. There is no fever, but a cough gets accompanied with a scratchy throat.
Differential diagnosis based on Clinical presentation
One of the likely diagnoses that may be made is bronchitis. Bronchitis often develops after a bout of upper respiratory tract infection. Some of the typical characteristics of a cough that often last for more than three weeks.Chonmaitree& Patel (2016) assert that some of the features that depict bronchitis are the inflammation of the bronchi and get accompanied with either a productive or nonproductive cough. Tammy initial clinical presentation suggests a bout of acute bronchitis. Acute bronchitis, in this case, could either be bacterial or viral. The green sputum that got produced does not essentially indicate an infective but rather suggestive (Korppi, 2012). Tammy initial presentation is highly suggestive of bronchitis. Therefore, the most likely diagnosis is acute bronchitis.
The other potential diagnosis is pneumonia. Most cases pneumonia begins with an upper respiratory tract infection (URTI) and may ape bronchitis or cold. Additionally, pneumonia pathogenesis is often similar with that of the cold.Chonmaitree& Patel (2016) argue that pneumonia is the inflammation of the alveoli, alveolar ducts, bronchioles and other parts of the respiratory exchange pathways. The primary symptoms are often similar to other respiratory tract infections. The main reason why I think that pneumonia is the possible diagnosis is as the result of fever. Tammy complains does not include fever or dyspnea. However, these symptoms but may fall within possible early stages of pneumonia.
The other possible diagnosis is sinusitis. Sinusitis is the inflammation or the infection of the air cavities within the nose. The pathways that are mainly affected are the sinuses. The primary rationale why the sinusitis diagnosis is made is because Tammy had complained of congestion that was contributing to his cough. Additionally, Tammy had also complained of a persistent cough that kept her awake along the night with a scratchy throat. Sinusitis often present with sputum production, compromised sinus drainage, and cough.
Treatment Options for the Patient
After taking the clinical notes on the history of the presenting symptoms, carrying out the necessary physical exam, I would concentrate my therapeutic options on bronchitis. The other investigations that I would take for the patient include the complete blood count so as to determine the white blood cell. An elevation in the level of White Blood Cells would indicate an infection. Additionally, C- Reactive Proteins level would be ideal in determining the inflammatory process in the body. I would also recommend a chest x- ray so as to ascertain the extent of the infection (Niederman, 2011). The pharmacological approach will involve adequate rest, anti-inflammatory drugs, hydration, antipyretics and discouraging smoking if Tammy is a smoker (Chonmaitree& Patel, 2016).
Despite the complaints of fever 100.4, foul-smelling mucous and breath, dyspnea on moderate exertion, significant production of mucus, I do not think I would change my therapeutic approach. The primary rationale is that these symptoms are also present in bronchitis. However, these symptoms would provide a different investigation dimension. I would recommend for a sputum culture so as to aid in the choice of the right antibiotic.
Chonmaitree, T., & Patel, J. A. (2016). Contemporary approaches to upper respiratory tract infections. Contemporary Approaches to Upper Respiratory Tract Infections, 2-4. doi:10.2217/fmeb2013.14.79
Korppi, M. (2012). Diagnosis and treatment of community-acquired pneumonia in children. ActaPaediatrica, 101(7), 702-704. doi:10.1111/j.1651-2227.2012.02648.x
Niederman, M. S. (2011). Respiratory tract infections: Advances in diagnosis, management and prevention. Philadelphia, PA: Saunders.