Pulmonary Dyspnea Patient Case Study – Description
Case Study:
The Outpatient Clinic called for direct admission to the Hospitalist service for which you are working as the Admitting Advanced Practice Provider. The Outpatient Clinic would like a patient who is 66 years old with a complaint of non-productive cough, dyspnea on exertion which has now progressed to constant dyspnea without fever or chills for the last 6 months to be admitted for further workup. The patient had been treated several times outpatient for bronchitis with azithromycin but had never improved. Negative COVID test and has had COVID vaccines.
The patient arrives at the Med-Surgical floor under Hospitalist Services with the admission diagnosis of Dyspnea and further history was obtained.
Allergies: Denies seasonal, food, and medication.
PMH: Asthma as a kid but no longer on inhalers.
No surgical history.
Family medical history: Parents both had diabetes and hypertension but no respiratory issues and did not smoke.
Social History: Denies tobacco or illicit drug use. Reports drinking 1-2 glasses of wine a night. The patient lives with their partner in a two-story home. Prior to symptom onset, the patient ran several miles per day (Does several 5Ks per year). Works from home in IT. Denies sleeping with feather pillows/blankets or owning birds.
Pertinent Review of Systems:
Positive fatigue, weight loss.
Denies fever or chills.
Reports decrease sleep due to waking up feeling like they can’t breathe.
Denies using an increased number of pillows.
Denies HEENT.
Reports dyspnea on exertion has progressed to constant with dry non-productive cough.
Denies chest pain.
Denies swelling, and prolonged traveling.
Denies history or family history of pneumonia, tuberculosis, or blood clots.
Reports decrease in exercise tolerance
Denies nausea, vomiting, or diarrhea.
Denies swallowing issues.
Denies increased thirst or urination.
Denies bruising, bleeding, or enlargement of lymph nodes.
Denies headache, dizziness, and anxiety but reports some sadness due to loss of ability to function daily.
Pertinent Physical Examination:
VS: Oral temperature 37 degrees Celsius; Blood pressure 120/76; Heart rate 59 beats per minute; Respiratory rate 24 breaths per minute; Oxygen saturation at rest 89% on RA, placed on 2L of O2 via nasal cannula with oxygen saturation 92%. Weight: 158 lbs., Height: 5’10”
Speaking in short sentences due to dyspnea with talking.
S1/S2, regular; no swelling or clubbing.
Fine bibasilar crackles were noted, and increased respirations which are labored using accessory muscles.
Abd soft, non-tender; bowel sounds present.
No neuro deficits, GCS 15, BUE/BLE 5/5 strength.
Questions:
What diagnostic workup would you complete on this patient including your clinical reasoning for the work-up?
List the indications and contraindications for the specific diagnostic test ordered
What are your differentials regarding the pulmonary complaints?
Include any additional information you would want to obtain to help rule in or out a diagnosis (include your clinical reasoning).
You are also caring for another patient on the Hospitalist service and received a pulmonary function test (see image below: red line = before bronchodilator & green line = after bronchodilator). Give your interpretation of these PFTs.
Pose two open-ended questions for your peers to respond to regarding questions you may have experienced researching the topic or required unit material
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