A 68-year-old male presents to your clinic today. He complains of a cough for the last 2 months that will not go away. He also complains of frequent urination for the last 4 months. PHI only includes HTN diagnosed 5 years ago. He does not know his family history since he was adopted. He has smoked Â½ pack cigarettes for the last 40 years.
What are your differentials and diagnoses? What will be your plan of care for your patient? Include any diagnostic tests and medications.
Length: A minimum of 275 words, not including references
Citations: At least 2 high-level scholarly references in APA-7 from within the last 5 years
A sixty-eight-year-old man presents at the clinic with a cough lasting over two months. He also states that he has been urinating frequently in the past four months. His only previous diagnosis is hypertension, five years ago. Regardless, he still smokes a half packet of cigarettes daily, a habit he has maintained in the last forty years.
The primary diagnoses are diabetes mellitus (DM) and bronchitis. Frequent urination is a common DM symptom, often occurring at the initial stages. Additionally, clinical and epidemiological studies have shown that cigarette smoking enhances the risk of developing diabetes. For instance, nicotine exposure impedes the body’s sensitivity to insulin, resulting in unregulated blood sugar (Maddatu et al., 2017). Smoking also affects pancreatic beta-cell function, further enhancing the risk of developing diabetes. Additionally, the patient has bronchitis. Long-term smoking cause’s bronchial inflammation, hence the chronic cough (Mejza et al., 2017). Hence, smoking is the main cause for the patient’s symptoms.
Some essential differential diagnoses include diabetes insipidus, urinary tract infection, and tuberculosis. However, without tests, one cannot be certain. Diagnosing diabetes would require blood sugar level tests such as A1c, fasting blood sugar test, or the glucose tolerance test. Meanwhile, one can diagnose bronchitis by conducting a physical chest examination, oxygen level tests, lung function tests, and x-ray imaging (Robinson, 2020). Finally, one should perform a mucus test to rule out a bacterial infection.
Plan of Care
The care plan will mainly focus on health behavior adjustment. Thus, the caregiver must aid the patient in gradually reducing their nicotine consumption. The first step would be to eliminate cigarettes and replace them with non-smoke nicotine sources, such as lozenges and patches. In so doing, the coughing should reduce. Total nicotine withdrawal may be slow, and the caregiver should provide moral support. The caregiver should also help the patient develop a healthier dietary and exercise routine, reducing their net glucose intake.
Next, the clinician must administer appropriate medication for bronchitis, including corticosteroids (e.g., Prednisone), expectorants (such as Guaifenesin ER), and antibiotics (e.g., Amoxicillin). They should also administer Metformin for diabetes management. Thus, the health behavior adjustment and the medication would result in better blood sugar control, eliminating frequent urination and slowing down diabetes’ progress.
Maddatu, J., Anderson-Baucum, E., & Evans-Molina, C. (2017). Smoking and the Risk of Type 2 diabetes. Translational Research, 184, 101–107. https://doi.org/10.1016/j.trsl.2017.02.004
Mejza, F., Gnatiuc, L., Buist, A. S., Vollmer, W. M., Lamprecht, B., Obaseki, D. O., Nastalek, P., Nizankowska-Mogilnicka, E., Burney, P., BOLD collaborators, & BOLD study collaborators (2017). Prevalence and Burden of Chronic Bronchitis Symptoms: Results from the BOLD Study. The European Respiratory Journal, 50(5), 1700621. https://doi.org/10.1183/13993003.00621-2017
Robinson, J. (2020, Apr. 02). Bronchitis. https://www.webmd.com/lung/understanding-bronchitis-basics