Factors to consider in the care and treatment of the patient

Case Study 1

A 75-year-old patient of Hispanic decent arrives in an immigrant health-care clinic with fever, chills, a sore throat, and a nonproductive cough. She speaks some English. The patient appears very ill, with dry mucous membranes, dark circles under the eyes, and pale skin. The patient appears anxious and is reluctant to make eye contact or speak. The health history reveals that the patient lives with extended family in a home setting, including infants and elderly. All of the family members are undocumented residents of the United States. Further work-up reveals the patient has influenza.

Case Questions

1. What method should be used to ensure full communication with the patient?
2. Because the patient is an undocumented resident of the United States, what factors should you consider in the care and treatment of the patient?
3. Because influenza vaccination has been recommended, how will you suggest the family access influenza vaccinations?
4. What test was likely used to confirm the diagnosis of influenza?
5. What differential diagnoses need to be ruled out for the patient?
6. What self-care management should be explained to the patient?
7. The patient should report the development of what symptoms to the practitioner?

Case Study 2

A 75-year-old man with a history of hypertension, diabetes, environmental allergies, and colon polyps presents to the office with a complaint of persistent dry hacking cough that does not improve with over-the-counter treatment with antitussives and allergy medications. The man reports that he has had the cough for 3 months and is tired of the coughing spells he experiences. His medical history reveals that he started taking lisinopril 6 months before this appointment, has taken an over-the-counter allergy medication for several years, had his last colon polyps removed 6 years ago, and his blood pressure today is 145/70. Other medications include metformin XR 500 mg daily, aspirin 81 mg once daily, and loratadine 10 mg daily. The physical exam is negative for any issues other than his mild neuropathy from long-term diabetes. The cough is noted to be dry and hacking as the patient has described. The man is not in acute distress.

Case Questions

1. What questions would have been asked as part of the medical history?
2. What physical aspects would have been completed as part of the physical exam?
3. Based on the medical history and physical exam, what is the most likely cause of his cough?
4. What other possible diagnoses should be considered?
5. Are there any other tests that should be completed before producing a diagnosis? Why or why not?
6. What is the treatment for this patient, including education?

Sample Solution