Comprehensive Respiratory Assessment and Cultural Considerations in Diverse Adult Populations

HI Writer,

Please write about half a paragraph in response to each post with a reference. Thanks. You can use the required books for references and maybe from online sources. Thanks

POST 1

Describe the focused physical exam you would perform with rationale for each part. What are the cultural beliefs and practices that may affect health care (positively and negatively) for this patient? Cite references in the literature.

This patient is presenting with productive cough fever and fatigue as well as SOB for 5 days.  For this patient I would begin my physical exam with vital signs, especially a pulse ox to ensure that the patient is able to breathe and there is not a more emergent situation to take care of before jumping into a full exam.  If the patient’s vitals are stable I would move onto a HEENT exam. I would utilize the otoscope to assess the patient’s ears and look in the nares for redness, swelling and drainage.  Then I would look in the patient’s throat to assess for exudate, erythema, or note any other abnormalities (Dains, et. al, 2024).  I would also palpate the patients frontal and nasal sinuses as well as palpate the lymph nodes of the head and neck.  Next I would auscultate the patient’s lungs to assess for abnormal lung sounds such as wheezes or rhonchi (Dains, et. al, 2024).  

Due to culture and diet, patients of Italian heritage have higher rates of heart disease than other cultures (Ojeda-Granados et, al., 2024).  Cardiovascular disease is the number one leading cause of death in Italy, likely due to a higher fat diet.  This can contribute to comorbidities among Italian people.  Another cultural barrier is the large aging population of Italians.  It is part of Italian culture to have a multigenerational household and many older Italians believe in healing through food rather than utilizing medication.  Due to multigenerational housing, this belief is passed down.  Also, the healthcare system in Italy is comparatively worse than other first world European countries and this could be a contributing factor as to why people seek food for healing first.  Due to Italy having universal healthcare, wait times for primary care visits are extremely long and often it is difficult to see a primary care physician (Matranga & Maniscalco, 2022).  This causes people to see at home remedies for routine illnesses before they are able to be seen by a GP.  Even as Italians emigrate to the US, the beliefs and culture are still there. 

POST 2

Case Study 1: Mr. Park, a 75-year-old male of Korean heritage, has a history of cardiovascular disease (CVD) and presents to the clinic complaining of shortness of breath (SOB).

3. List a complete differential using TIC TIP AND VIM for this symptom complaint. For each diagnosis explain the presentation and signs and symptoms of the disease that made you think it could be the cause of his symptoms. What is your leading hypothesis, what are the alternatives and is there a must not miss diagnosis? Given this differential diagnoses what tests should be ordered? MLO5.5, CLO3, CLO4

Using the mnemonic TIC, TIP, AND, and VIM the differential diagnoses for this case study includes pneumothorax (trauma), pneumonia (infection), fibrotic lung disease (congenital), anemia (toxic/metabolic), anaphylaxis (inflammatory), hyperventilation (psychogenic), sarcoidosis (autoimmune), lung cancer (neoplastic), heart failure (vascular), medications or honey (idiopathic), amyotrophic lateral sclerosis (ALS) (mechanical). Patients who present with shortness of breath should be asked about recent blunt chest trauma from a motor vehicle accident or fall due to the possible life threatening, must not miss diagnosis of pneumothorax, tension pneumothorax, or hemothorax. Spontaneous pneumothorax can present with sudden chest pain, shortness of breath aggravated by normal respiratory movement, and absent or decreased breath sounds on the same side of injury (Dains et al., 2020). Pneumonia should be ruled out for this case study and the healthcare provider should further investigate for pleuritic chest pain, cough with green or dark sputum, fever, and chills (Dains et al., 2020). Congenital or systemic illnesses, such as fibrotic lung disease, should also be investigated if the patient presents with chronic progressive dyspnea. Patients presenting with shortness of breath and other associative symptoms such as fatigue, lightheadedness, or palpitations should be worked up for possible anemia (Dains et al., 2020). Shortness of breath that also presents with pruritic rashes, wheezing, fatigue, lightheadedness after possible exposure to known allergens should be emergently assessed for an anaphylaxis reaction (Dains et al., 2020). Dyspnea which presents with other vague symptoms or does not improve, but worsens with rest can be considered as hyperventilation syndrome or shortness of breath related to anxiety (Dains et al., 2020). Shortness of breath may also arise from autoimmune diseases such as sarcoidosis and should be further investigated for symptoms such as dry cough, wheezing, chest tightness, fever, and weight loss (Sreeja et al., 2022). Those who present with dyspnea, cough, wheezing, various symptoms of emphysema and atelectasis, pneumonitis, and hemoptysis should be further assessed for possible lung cancer (Ball et al., 2023). Individuals such as Mr. Park who have a history of cardiovascular disease and present with dyspnea, orthopnea, peripheral edema, weight gain, fatigue, and cough with frothy sputum should be further assessed for heart failure (Dains et al., 2020). Idiopathic causes for shortness of breath can include medications and honey. Honey can be contaminated by Clostridium botulinum which can result in respiratory distress (Dains et al., 2020). Lastly, conditions such as ALS, which affect the neuromuscular system, specifically the diaphragm, should be considered due to the result of respiratory failure. 

My leading hypothesis for Mr. Park would be heart failure due to his past medical history and symptoms of shortness of breath. Although, further history and specific questions would need to be obtained prior to proceeding with this diagnosis. For example, chronic progression of shortness of breath with associative symptoms such as cough, frothy sputum, and peripheral edema would need to be further explored. Diagnostic tests that should be ordered for these specific differential diagnoses include pulse oximetry, chest radiographs, electrocardiograms, hemoglobin and hematocrit levels, spirometry assessments, CT scans, and sputum 

References

Ball, J.W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination an interprofessional approach (10th ed.) Elsevier.

Dains, J. E., Baumann, L.C., & Scheibel, P. (2020). Advanced health assessment and clinical diagnosis in primary care (6th ed.). Elsevier.

Sreeja, C., Priyadarshini, A., Premika, & Nachiammai, N. (2022). Sarcoidosis – a review article. Journal of oral and maxillofacial pathology : JOMFP. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9364657/ 

POST 3

11. When assessing the chest and lungs of an older adult what variations might you expect to see in
your examination? What causes a barrel chest?

When assessing the older adult, chest expansion is often decreased and older adults may be less able to use respiratory muscles because of muscle weakness, general physical disability, or a sedentary lifestyle (Ball et al., 2023). Older adults may have more difficulty with holding their breath or breathing deeply (Ball et al., 2023).  Barrel chest often seen in older adults results from compromised respiration related to chronic asthma, emphysema, or cystic fibrosis (Ball et al., 2023). In barrel chest, the ribs are more horizontal, the spine is kyphotic, and the sternal angle is more prominent (Ball et al., 2023).

Reference:

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination an interprofessional approach (10th ed.) Elsevier.

POST 4

If a patient has a cough, when will a chest x-ray be helpful? When would a sputum test be useful? Why should a patient be required to do at least 3 spirometry tests at one testing session?

When a patient presents with a cough, further imaging such as x rays can be helpful tools to aid with a diagnosis.  When assessing a cough, a chest x ray would be ordered if a patient has a cough that is accompanied by a fever for three days or greater, or if a patient is presenting with an unusual clinical course (ie. bloody sputum) (Dains, et. al, 2024).  

A sputum culture is used to diagnose infectious agents in the pulmonary system (Dains, et. al, 2024).  Sputum cultures can determine macroscopic appearance, cellular composition, and bacterial count.  A sputum culture would be utilized when it is believed that a disease is bacterial and originating in the lungs (Dains, et. al, 2024).  A patient would preform three spirometry tests in one setting in order to mark the patient’s best effort.  This allows the patient to practice and “warm up” so to say by expanding the lungs multiple times to gather the patient’s best attempt.