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Respond to 2 peers using APA format please site all references     PEER #1 Suel Discuss the Mr

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• Respond to 2 peers using APA format please site all references
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• PEER #1 Suel
• Discuss the Mr. Barley’s history that would be pertinent to his respiratory problem. Mr. Barley reports smoking one to two packs a day for 26 years and now has cut back on smoking to half a pack per day. In addition, he is a farmer who is exposed to chemicals and irritants.

Chief complaint: Productive ough and shortness of breath

HPI: 58-year-old farmer Caucasian male presents to clinic complaining of shortness of breath on exertion and productive cough with white phlegm mainly in the mornings for 2 weeks. Patient reports similar symptoms for the past two winters. Patient reports smoking 2 packs a day x 26 years and now has cut back to half a pack per day.

Social: 40 cigarette pack year, and drinks one beer every few days.

Family: Father died of a stroke at age of 70, mother is alive and suffers from HTN.

Past medical history: Tonsillectomy at 12 years of age.

• Describe the physical exam and diagnostic tools to be used for Mr. Barley.

Common tools used in a physical exam were used such as:

Penlight: conjunctivae and sclerae are normal, PERRL, oropharynx is normal Sphygmomanometer: BP128/78 mmHg

Thermometer: 98.9 Fahrenheit

Stethoscope: Inspiratory crackles at the bases, and end-expiratory wheezing diffusely, Regular rate and rhythm. 2/6 systolic murmur loudest at the right upper sternal border (RUSB) with radiation to the left lower sternal border (LLSB), Bowel sounds normal

Hands: For manual exam- neck is supple without masses, lymphadenopathy, or thyromegaly. Laryngeal height measures 2 cm from sternal notch to the top of the thyroid cartilage upon full expiration. no hepatomegaly, no tenderness, 1+ pitting pretibial edema.

The physical exam for this patient focused on the classic findings of COPD which in the case study was listed as:

Increased anteroposterior (AP) diameter of the chest

Decreased diaphragmatic excursion

Wheezing (often end-expiratory)

Prolonged expiratory phase

Thorat, Salvi, and Kodgule (2017) state, “The most commonly used objective tool to diagnose asthma and COPD is spirometry.” This is the diagnostic tool used on Mr. Barley. However, spirometry may not be readily available in some rural areas or third world countries for several reasons including lack cost and lack of knowledge. Other tools used are pulmonary function test, and an x-ray which does not rule out COPD but may look for other diagnosis that may cause shortness of breath.

Are there any additional you would have liked to be included that were not?

The case study discussed possible tools available to assess lung status and how each served for the diagnosis of other diseases and not COPD, thus feeling content about the route opted for in the scenario. On the other hand, new studies are looking for possible ways to diagnose COPD early as not too much attention has been paid to the pathologic changes in the lungs of young adults with risk factors for COPD. Polverino et al. (2020) states, “In the postsurfactant era, where more young adults will be spirometrically diagnosed with COPD, patients should be classified not only on the basis of their airflow limitation, but also on lung abnormalities identified with safe, comprehensive imaging technologies that allow regular, longitudinal follow-up.” Lung MRI as a potential complementary diagnostic tool for early COPD is a tool that could deem effective in early diagnosis.

• What plan of care will Mr. Barley be given at this visit, include drug therapy and treatments; what is the patient education and follow-up? According to the Global Initiative for Chronic Obstructive Lung disease, all symptomatic patients with COPD should be prescribed a short-acting bronchodilator and in this scenario, Albuterol is prescribed. However, as stated in the case study, “Smoking cessation is single-most important treatment strategy for COPD”. The patient education focuses on smoking cessation and provide patient with information about available smoking-cessation programs. Influenza and pneumococcal vaccines are recommended for adults with COPD to prevent exacerbations. Patient should return for regular check-ups and a follow up to perform another pulmonary function test in six months to a year is needed to determine how well patient is responding to treatment and if the disease is progressing. Follow ups will also monitor nutrition through body mass index (BMI), as good nutrition is especially important in COPD.

References

Thorat, Y. T., Salvi, S. S., & Kodgule, R. R. (2017). Peak flow meter with a questionnaire and mini-spirometer to help detect asthma and COPD in real-life clinical practice: a cross-sectional study. NPJ primary care respiratory medicine, 27(1), 1-7.

Polverino, F., Hysinger, E. B., Gupta, N., Willmering, M., Olin, T., Abman, S. H., & Woods, J. C. (2020). Lung MRI as a potential complementary diagnostic tool for early COPD. The American journal of medicine, 133(6), 757-760.

PEER #2 LorenaChief Complaint: Cough and SOB

HPI: Mr. Barley is 58-year-old male, smoker, who presents at the clinic with complaints of a 2-week productive cough progressively getting worse and shortness of breath on exertion. Symptoms are similar from the past 2 years around wintertime. Pt denies fever, chest pain, recent travel, TB, or recent chemical exposure.

Social History: Mr. Barley is a farmer, married for 35 years with whom he has 2 grown children. He is a smoker and has a 40-cigarette pack-year history. Pt drinks one beer every few days.

Family History: Father died at the age of 70 from a stroke; mother alive with history of hypertension; 2 healthy sisters.

Past Medical History: Denies any significant PMH.

Physical Exam:

Vital Signs: BP 128/78; P94 bpm; T; 98.9 F Wt.; Ht.; BMI.

Physical Assessment Findings:

HEENT: Normocephalic / atraumatic, conjunctivae and sclerae are normal, PERRL, oropharynx is normal.

Neck: Supple without masses, lymphadenopathy, or thyromegaly. Laryngeal height measures 2cm from sternal notch to the top of the thyroid cartilage upon full expiration.

Lungs: Increased AP diameter. Percussion is normal. Inspiratory crackles at the bases, and end-expiratory wheezing diffusely.

Heart: Regular rate and rhythm. 2/6 systolic murmur loudest at the right upper sternal border with radiation to the left lower sternal border.

Abdomen: Bowel sounds normal, no hepatomegaly, no tenderness.

Extremities/Pulses: +1 pitting pretibial edema.

Diagnostic Tools: Pulmonary Function Test (PFT), chest x-ray, and spirometry.

Are there any additional you would have liked to be included that were not? Arterial blood gas test to measure how well Mr. Barley’s lungs are bringing oxygen into his blood and removing carbon monoxide.

Plan of Care

Drug Therapy: Albuterol MDI PRN

Treatments: Smoking cessation and Immunizations (Influenza and Pneumococcal)

Patient Education: Instructions on how to use a meter dose inhaler with spacer; information of the benefits of smoking cessation; information on what is COPD, what to expect, and how to continue treatment. Also, warning signs regarding COPD exacerbation and when to seek help.

Follow-Up: Follow up to be scheduled in 6-12 months for another PFT and overall condition management.