· You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response) and should include at least 2 references each.
· All replies must be constructive and use literature where possible.
Response 1
Additional Subjective Information
I will inquire if the patient is taking any medications that could have negative side effects. Since the patient has a history of chronic obstructive pulmonary disease (COPD), I will inquire as to whether he has any breathing issues. I’ll inquire about the patient’s withdrawal symptoms once he stops smoking. In order to better understand the patient’s hunger, I will ask him if he is interested in food. When the patient coughs or at any other time, I’ll ask them to explain the severity of their chest pain.
Additional Objective Findings
I’ll assess how much chest pain there is when I cough, which causes tissues to bleed a dark color. I’ll examine the withdrawal effects of giving up smoking. In order to spot any respiratory issues, I will watch the patient breathe. I’ll check the patient’s breathing rate. I’ll look into the patient’s high blood pressure’s reasons.
Differential Diagnosis
Consideration should be given to the three differential diagnoses of COPD, pulmonary TB, and congestive heart failure. Consistent coughing that persists despite the use of cough suppressants, breathing difficulties, and sputum production when coughing are some of the signs of COPD. The patient exhibits all of the mentioned symptoms, including chest discomfort (CDC, 2022).
Chest pain, breathing issues, and coughing up blood-tinged mucus are all symptoms of pulmonary tuberculosis. Given that the patient is exhibiting every symptom listed, a differential diagnosis should be considered. Chest tightness, coughing, and difficulties breathing are all symptoms of congestive heart failure. Congestive heart failure causes a dry cough.
Radiology Examinations or Additional Diagnostic Studies
To identify the cause of chest pain during coughing, a chest X-ray will need to be ordered. Additional issues with the heart, lungs, blood vessels, and airways will be discovered with the use of the chest X-rays. Learn more about the heart and what is causing high blood pressure with the use of an electrocardiogram. Finding difficulties in the respiratory organs located around the chest will be possible with the use of a chest ultrasound. To find out more, tests should be performed on the bluish tissues coughed up.
Treatment and Prescription Information
Exacerbations should be treated with antibiotics. Consistent coughing and breathing problems can be treated with antibiotics. Breathing problems will be addressed with bronchodilators, which will open the airways for simple air passage. It will also be advantageous to request a short-acting bronchodilator to provide the sufferer quick relief..
Potential Complications
When antibiotics are used for longer periods or wrongly, infections become resistant. Bronchodilators have side effects such as dry mouth, coughing, abnormal heartbeats, nausea, and muscle discomfort (NHS, 2022).
Additional Laboratory Test  
One of the additional laboratory tests I will order is the test for the dark-colored blood produced when coughing. The test will help eliminate pulmonary tuberculosis or COPD. Another laboratory test that will be useful is an arterial blood gas to determine the body’s oxygen and carbon dioxide levels. The test will also help determine the acidic and base stability of the blood.
If chest X-ray, electrocardiogram, and chest ultrasound tests reveal any complications in the organs around the chest, such as the lungs and heart a consult will need to be placed. The specialists will help in understanding the damaged organs and how they impact the patient’s health. A consult to a pulmonologist to explain the impacts of lung damage and any other breathing organ will be effective.
Response 2
Subjective Information
 To gather the information that is considered subjective from the patient, it is required to question the patient regarding the duration of his symptoms and the symptoms associated with his productive cough. Inquiring about any things that may be related to the signs that either make them worse or better is also very important. Inquiries should also be made regarding the patient’s lifestyle, exercise capacity, and sleeping patterns. Other questions that could be asked include how the patient’s cough affects his day-to-day activities and whether or not he is experiencing any other symptoms related to the cough, such as chest pains, wheezing, or shortness of breath (Lin et al., 2019). In addition, it can be helpful to know whether the patient takes any over-the-counter medications or any other prescriptions besides those he is already on to have a complete picture of his current state.
Objective Findings
In terms of the patient’s physical examination, it is essential to look for any indications or symptoms of distress, such as tachypnea, the use of accessory muscles for respiration, signs of cyanosis, and the presence of wheezing or rhonchi. Other signs of distress include using auxiliary muscles for respiration. It is essential to perform auscultation to identify any audible breath noises. In addition, evaluations should be conducted to discover whether the patient is experiencing any crepitus, heat, redness, or swelling in connection with chest pain. In addition, evaluations must be carried out to check for any indications of either malnourishment or dehydration. It is also a good idea to determine the patient’s finger oxygen saturation if it is required.
Differential Diagnosis
 Some possible diagnoses that could be considered in this scenario are bacterial pneumonia, aspiration pneumonia, acute bronchitis, smoking-related chronic obstructive pulmonary disease (COPD) exacerbation, congestive heart failure, acute pulmonary embolism, and lung cancer. All of these diagnoses should be taken into consideration.
Radiological Examinations and Other Diagnostic Studies
 In order to make an accurate diagnosis of the patient’s condition, a chest X-ray should be conducted (Setiawati et al., 2021). This imaging study can detect structural abnormalities, such as pneumonia or atelectasis. Other diagnostic studies may also be performed. In order to determine whether or not the patient is experiencing an exacerbation of COPD, pulmonary function testing (PFT) should be conducted so that the patient’s lung response to bronchodilators can be measured. Sputum gram stain and culture, complete blood count (CBC), and arterial blood gas (ABG) analysis are among other diagnostic procedures that might be conducted.
Treatment and Prescription Information
 The treatment plan for this patient should include a prescription for bronchodilators such as beta-2 agonists, anticholinergic, or theophylline. These are all examples of medications that relax the muscles in the airways and make it easier for patients to breathe. In addition, antibiotics might be administered to the patient depending on the sputum culture and gram stain findings. Oxygen therapy as a supplement may be required to help enhance oxygenation and reduce dyspnea. In addition, the patient should be told to increase their fluid intake in order to alleviate chest congestion, avoid passive smoking, and cease taking any over-the-counter medications that they may be taking.
Potential Complications of Treatment
Treatment’s possible side effects include nausea, vomiting, diarrhea, dizziness, headaches, palpitations, sleeplessness, tremor, tachycardia, and hypertension. Bronchodilators and antibiotics both have the potential to cause these side effects. Respiratory depression, pulmonary edema, cardiac dysrhythmias, and cardiac arrest are the most severe problems that could arise due to this condition.
Additional Laboratory Tests
Additional laboratory tests that should be conducted include a complete blood count (CBC), a basic metabolic panel, and a sputum smear or culture to evaluate renal function.
It is recommended that this patient receive a consultation with a pulmonary medicine specialist. The consultant will be able to conduct a more in-depth evaluation of the patient’s current state and devise a treatment plan that suits the patient’s COPD exacerbation. If there is even the slightest possibility that a patient has lung cancer, they must see an oncologist immediately.


(USA, AUS, UK & CA PhD. Writers)


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