Discussion: Shortness Of Breath

NSG 6340 Week 2 Discussion: shortness of breath

This week you learned about common conditions in the adolescent client. Please review the following case study and answer the following questions.

A fifteen-year-old female presents to your clinic complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately, she has felt this way continuously. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms.

Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no other medications. She has had no surgeries. Her mother has allergies and eczema, and her father has high blood pressure. She is an only child. She denies smoking and illegal drug use. On examination, she is in no acute distress and her vital signs are: T 98.6, BP 120/80, pulse 80, and respirations 20. 

Her head, eyes, ears, nose, and throat examinations are essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On auscultation of her chest, there is decreased air movement and high-pitched whistling on expiration in all lobes.

  • Percussion reveals resonant lungs.
  • What is the chief complaint?
  • Based on the subjective and objective information provided, what are your 3 top differential diagnoses listing the presumptive final diagnosis first?
  • What treatment plan would you consider utilizing current evidence based practice guidelines?

Submission Details:

Post your response to the Discussion Area by the due date assigned. Respond to at least two posts by the end of the week.

Shortness of Breath Sample Paper

Probable Diagnosis

The patient most likely has decompensated heart failure. In heart failure, the heart does not pump enough blood to meet the metabolic requirements of the tissues. The ensuing tissue anoxia is what occasions the lethargy and weakness due to impaired metabolism (Groenewegen et al., 2020). These constitute part of the forward symptoms, which arise from inadequate perfusion of tissues and also include syncope and dizziness. 

Additionally, heart failure leads to backward symptoms, such as pulmonary edema due to left ventricular failure, which leads to shortness of breath (Dharmarajan & Rich, 2017). The dyspnea worsens with increased severity of the condition, and is often accompanied by productive cough. Other symptoms include peripheral edema and paroxysmal nocturnal dyspnea. The neurohormonal compensatory mechanisms lead to palpitations and fluid retention through activation of the renin-angiotensin-aldosterone system (Groenewegen et al., 2020). The patient presented is in New York Class III.

Possible Diagnoses

Pulmonary Fibrosis

Idiopathic pulmonary fibrosis (IPF) is a rare lung condition in which the lung compliance function is restricted. Due to the impaired ventilator function of the lungs, the tissues suffer anoxia which causes lethargy and dyspnea. Although patients present with dyspnea, it is typically long-standing (Lederer & Martinez, 2018). It is also not accompanied by palpitations, unless it eventually leads to cor pulmonale, a rare complication.

Valvular Heart Disease

Valvulopathies are common in the elderly subgroup due to degenerative processes. Depending on the valve affected, the clinical presentation varies. The aortic valve is commonly affected in the elderly, leading to stenosis and the attendant forward symptoms of dizziness, lethargy and syncope, as exhibited in this patient (Dharmarajan & Rich, 2017). Importantly, undiagnosed valvulopathies eventually lead to decompensated heart failure.

Management

Investigations
  • Chest X Ray- It is the important initial test for picking out IPF, pulmonary infection or cardiomegaly.
  • Echocardiography- The best imaging modality for assessing cardiac function.
  • Inflammatory markers- They will be elevated in cholecystitis, but are not diagnostic.
  • UECs/CBC/GXM- Are vital as baseline workup.
Treatment
  • Diuresis- The patient is likely fluid overloaded due to the fluid retention hence diuresis is crucial. She will receive IV furosemide 40mg BD.
  • Oxygen supplementation to enhance oxygenation.
  • Propping up the patient.
  • Monitoring of input/output charting.
  • Medications- Enalapril 5 mg OD for heart failure, then addition of carvedilol 3.125 mg after 48 hours or patient stabilization (Rossignol et al., 2019).

References