Week 3 Discussion: This discussion examines John Barley’s case study. John is a 58-year-old male who has visited the facility because of progressively worsening cough and shortness of breath for the last one month.

Week 3 Discussion: This discussion examines John Barley’s case study. John is a 58-year-old male who has visited the facility because of progressively worsening cough and shortness of breath for the last one month.

Week 3 Discussion: This discussion examines John Barley’s case study. John is a 58-year-old male who has visited the facility because of progressively worsening cough and shortness of breath for the last one month.

Week 3 Discussion
This discussion examines John Barley’s case study. John is a 58-year-old male who has visited the facility because of progressively worsening cough and shortness of breath for the last one month. The case study examines different domains related to the case study that include history, assessment, laboratory and diagnostic tests.
Domain: History
Two Additional Questions
What factors worsen or relieve the cough?

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How has the problem affected your ability to perform day-to-day activities?
Rationale
The first question will provide insights into any measures the patient has used to manage the cough. It will also help rule out causes such as those associated with environmental exposures, as seen in the case of asthma. The second question will help determine the severity of the health problem and impact on his daily functioning. It will also help in planning the potential referral or interdisciplinary collaboration needed for disease management.
What the Questions Might Reveal
The above questions may reveal the physiological cause of the problem. For example, a cardiac problem could cause a cough. The questions will also provide insights into the impact of the disease on the patient’s quality of life.
Domain: Physical Exam
Reason the Provider Examined Each System
The provider examined the HEENT system to determine abnormalities such as nasal flaring, trauma, cyanosis, oropharynx infection, and ear-related problems. The neck was assessed to detect any potential causes of the problem such as jugular venous distention and lymphadenopathy, which could indicate cardiac issues or an infection. The lungs were assessed to determine if there is fluid or air collection in the lungs and reduced lung filling. The heart was assessed to rule out potential causes of cough such as heart failure. The abdomen was assessed to rule out causes such as aneurysm and ascites, which may contribute to his complaint. Extremities were assessed to rule out peripheral cyanosis and finger clubbing due to poor tissue perfusion (Camoretti-Mercado & Lockey, 2021).
How the Exam Would be Abnormal
The laryngeal height is reduced, which translates into an obstructive pulmonary disease. The AP diameter is increased meaning chronic obstructive pulmonary disease. Crackles imply the presence of fluid in the lung bases while end-expiratory wheezing implies airway narrowing.
Normal Findings for Each System
The normal findings in HEENT include normocephalic, atraumatic head, normal sclera, oropharynx, and conjunctiva, PERRL. Normal findings on the neck include absence of masses, lymphadenopathy, and thyromegaly. Normal findings in heart include regular rate and rhythm while in the abdomen are normal bowel sounds with no tenderness and hepatomegaly.
Diagnostic Instruments
The diagnostic instruments needed include a stethoscope and pulse oximeter.
Domain: Assessment
Pathophysiology of the Diagnosis
The patient has been diagnosed with chronic obstructive pulmonary disease (COPD). COPD is a disease characterized by irreversible obstruction of airflow and abnormal lung inflammatory response. Smoking is the leading cause of COPD, which causes chronic bronchitis, disrupted normal repair of lung tissue and defense mechanisms and tissue destruction (Fazleen & Wilkinson, 2020).
Pathophysiology of Each Differential Diagnosis
Asthma is the client’s differential diagnosis. Asthma develops from one’s exposure to allergen that leads to IgE activation. The accompanying symptoms include airway narrowing, sputum production, wheezing, chest pain, and cough (Camoretti-Mercado & Lockey, 2021; Sinyor & Concepcion Perez, 2023).
Domain: Laboratory and Diagnostic Tests
Labs that should be Ordered
The laboratory investigations that should be ordered include pulmonary function tests and complete blood count to rule out any infection.
Lab Results that Would be Abnormal
Abnormal lab results would include FEV1 less than 80%, FEV1/FVC ratio less than 70% or 5th percentile, and elevated white blood cell levels.
What Abnormal Lab Values Indicate
Abnormal lab values such as FEV1 less than 80% and FEV1/FVC ratio less than 70% would indicated reduced lung function and obstructive pulmonary disease(Venkatachalam et al., 2021). An elevated white blood cell level will suggest a lung infection.
Diagnostic Procedures that Might be Ordered
The diagnostic procedures that may be ordered include chest x-ray. Chest x-ray may help rule out other conditions such as pulmonary fibrosis and pleural effusion.
Conclusion
The client in the case study has been diagnosed with COPD. The client’s history of smoking likely predisposed him to COPD. The laboratory investigations needed include pulmonary function tests and complete blood count. Physical examination performed rule out the secondary causes that could have been attributed to the disease process.

References
Camoretti-Mercado, B., & Lockey, R. F. (2021). Airway smooth muscle pathophysiology in asthma. Journal of Allergy and Clinical Immunology, 147(6), 1983–1995. https://doi.org/10.1016/j.jaci.2021.03.035
Fazleen, A., & Wilkinson, T. (2020). Early COPD: Current evidence for diagnosis and management. Therapeutic Advances in Respiratory Disease, 14, 1753466620942128. https://doi.org/10.1177/1753466620942128
Sinyor, B., & Concepcion Perez, L. (2023). Pathophysiology Of Asthma. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK551579/
Venkatachalam, P., Dwivedi, D. P., & Govindraj, V. (2021). FEV1/FEV6 is effective as a surrogate for FEV1/FVC in the diagnosis of chronic obstructive pulmonary disease. Indian Journal of Tuberculosis, 68(2), 230–235. https://doi.org/10.1016/j.ijtb.2020.09.002

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Aquifer Case Study

The discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.

For this assignment, go to the Discussion Area and post a response to the given question in the Discussion Area by the due date assigned.

To support your work, use your course and text readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

The Aquifer virtual case-study assignments are highly interactive and a dynamic way to enhance your learning. Material from the Aquifer cases may be present in the quizzes, the midterm exam, and the final exam. You must have all Aquifer assignments completed in order to successfully pass the course.

Click here for information on how to access and navigate Aquifer.

Assignment

Complete only the History, Physical Exam, and Assessment sections of the Aquifer virtual case: Family Medicine 28: 58-year-old male with shortness of breath.

You are required to answer all the DISCUSSION QUESTIONS listed below in each domain.

DOMAIN: HISTORY

1a) Identify two (2) additional questions that were not asked in the case study and should have been?

1b) Explain your rationale for asking these two additional questions.

1c) Describe what the two (2) additional questions might reveal about the patient’s health.

DOMAIN: PHYSICAL EXAM

For each system examined in this case;

2a) Explain the reason the provider examined each system.

2b) Describe how the exam findings would be abnormal based on the information in this case. If it is a wellness visit, based on the patient’s age, describe what exam findings could be abnormal.

2c) Describe the normal findings for each system.

2d) Identify the various diagnostic instruments you would need to use to examine this patient.

DOMAIN: ASSESSMENT (Medical Diagnosis)

Discuss the pathophysiology of the:

3a) Diagnosis and,

3b) Each Differential Diagnosis

3c) If it is a Wellness, type ‘Not Applicable’

DOMAIN: LABORATORY & DIAGNOSTIC TESTS

Discuss the following:

4a) What labs should be ordered in the case?

4b) Discuss what lab results would be abnormal.

4c) Discuss what the abnormal lab values indicate.

4d) Discuss what diagnostic procedures you might want to order based on the medical diagnosis.

4e) If this is a wellness visit, discuss what the U.S. Preventive Taskforce recommends for patients in this age group.