Information to use (An acute case that I have observed in the clinical setting recently is a case of 57-year-old female with past medical history of pneumonia and smoking for over 30 years who presented to the office with complains of a cough for the past ten days. She has been taking over the counter cough syrup with no effect. She has been also complaining of shortness of breath with activity, fatigue, and congestion. She also admitted to continue smoking. On exam, her lungs were clear to auscultation and congested cough was noted. She was diagnosed with bronchitis and received prescription for Z-Pack and Prednisone taper. Smoking cessation and risk factors associated with smoking were explained in details and extensive education and encouragement regarding quitting smoking was provided. According to Kinkade and Long (2016), cough is the most defining symptom of acute bronchitis. Additionally, patients may complain of fever, headache, or nasal congestion. As this patient has a history of smoking, she is at risk for developing a chronic obstructive pulmonary disease (COPD) (Gentry & Gentry, 2017). It is estimated that 80%-90% of COPD cases are secondary to smoking. Smoking is a major risk factor for COPD, however, other risk factors such as respiratory infections can also lead to this disease development (Terzikhan et al. 2016). Patient described above does have the risk factors for developing COPD which include previous history of pneumonia, current smoking status, and a diagnosis of acute bronchitis. Consequently, the outcome for this patient is to reduce the risk factors in order to prevent or delay the development of the disease and improve health outcomes. Based on studies, individuals who quit smoking and remain cigarette free for several years have similar decline of lung function as those who never smoked.
1 Discuss how this case can develop into chronic disease management?
2What was the evidence that supported the intended outcomes for this patient scenario?
Information to be used( An acute scenario that I have recently observed in primary care involved a patient with acute sinusitis. The patient was a 44 year old who reported with symptoms of headache, facial pain, congestion, post nasal drip, and subsequent cough. The symptoms began after an upper respiratory illness and had been present for approximately 10 days. The patient also complained of intermittent fevers over that past week. Upon exam she exhibited frontal tenderness, postnasal discharge, and pharyngeal erythema.
Acute sinusitis is an infection lasting less than 4 weeks with complete resolution of symptoms (Ferri, 2018). Sinusitis is considered chronic when inflammation of the paranasal sinuses and nasal cavities lasts fora 12 weeks, with persistent upper respiratory symptoms (Ferri, 2018). Most cases of acute sinusitis have a viral cause and will resolve within 2 weeks without antibiotics (Ferri, 2018). Humidification, application of a hot, wet towel over the face, and hydration can help promote sinus drainage (Ferri, 2018). According to the American Academy of Family Physicians (2015) acute bacterial sinusitis should be diagnosed when signs and symptoms (purulent nasal drainage plus nasal obstruction, facial pain-pressure or both) persist without improvement for at least 10 days or if signs and symptoms worsen within 10 days after initial improvement. If deciding to treat with
antibiotics, amoxicillin with or without clavulanate should be prescribed as first-line therapy for 5-10 days (AAFP, 2015).
Acute sinusitis is an infection lasting less than 4 weeks with complete resolution of symptoms (Ferri, 2018). Sinusitis is considered chronic when inflammation of the paranasal sinuses and nasal cavities lasts for > 12 weeks, with persistent upper respiratory symptoms (Ferri, 2018). Most cases of acute sinusitis have a viral cause and will resolve within 2 weeks without antibiotics (Ferri, 2018). Humidification, application of a hot, wet towel over the face, and hydration can help promote sinus drainage (Ferri, 2018). According to the American Academy of Family Physicians (2015) acute bacterial sinusitis should be diagnosed when signs and symptoms (purulent nasal drainage plus nasal obstruction, facial pain-pressure or both) persist without improvement for at least 10 days or if signs and symptoms worsen within 10 days after initial improvement. If deciding to treat with antibiotics, amoxicillin with or without clavulanate should be prescribed as first-line therapy for 5-10 days (AAFP, 2015).
Treatment of chronic sinusitis could include high-volume saline irrigation with topical corticosteroid therapy as first line treatment (Ferri, 2018). A short course of systemic corticosteroids and a short course of doxycycline should be considered for treatment of chronic sinusitis in the presence of nasal polyps (Ferri, 2018). In some cases when chronic sinusitis is resistant to treatment, patients may be recommended for endoscopic sinus surgery which serves to remove nasal polyps or tissue to enlarge the sinus opening and promote drainage (Mayo Clinic, 2018).
1Discuss how this case can develop into chronic disease management?
2What was the evidence that supported the intended outcomes for this patient scenario?