Differential Diagnosis and treatment
Differential diagnosis and treatment.
Differential diagnosis is the process of evaluating the probability of the presence of a disease against another. Often conditions with similar presentation causing illness in a patient are considered. Jane is suffering from Chronic Obstructive Pulmonary Disease (COPD), a group of lung diseases that develops over time leading to breathing problems. Smoking is a major predisposing factor for COPDs occurrence.
The onset of chronic asthma is delayed, and the same case applies to COPD, development takes a long period of the manifestation of symptoms. However in Asthma an allergic reaction is associated, symptoms are more profound in the morning and evenings. In some cases, Asthma is genetics, and typical symptom involve difficulty with inhalation in the presence of an allergen Wibberley et al. (2014). Another distinction between Asthma and COPDs include lungs functioning testing that determines the capacity of the lungs in diffusing carbon (11) oxide. Treatment for Asthma requires anti-inflammatory drugs that prevent an Asthmatic attack, bronchodilators help in relaxing airway muscles during an attack to restore breathing. The Triggers of Asthma such as stress, medication such as aspirin, irritants in the air like smoke and extreme climatic conditions. Avoiding the triggers can be the ultimate treatment. Sublingual tablet for allergens like some types of grass is recommended. Sublingual treatment is not recommended for patients uncontrolled Asthma. Allergy shots can be applied in circumstances where the asthma is allergy related.
The onset is in younger individuals who do not smoke. This is a peculiar lung disease as a result of inflammation of bronchioles and air sacs with the connective tissues. Fever and cough are some of the presentation, an x-ray, and a CT scan are required to show dense hypo regions of the lungs. A biopsy is recommended for confirmation tests. A history of fume exposure is considered in diagnosing Bronchiolitis Obliterans while in COPDs a history of smoking is crucial Wibberley et al. (2014). Treatment involves corticosteroids and immunosuppressant. The problem requires management since it cannot be reversed, staying away from toxic fumes can help slow the progression. Lungs transplants can be used as treatment.
Patient present with a production of copious purulent sputum associated with bacterial infections, clubbing on auscultation, and bristly crackles. On CT scans, their chest images appear abnormal revealing bronchial dilation and thickening of bronchial walls. The airway of Patients with bronchiectasis have problems clearing the sputum due to the infection by bacteria growing in the accumulating sputum. Chest x-rays can help, and the treatment include antibiotics to clear the infection and chest physical therapy to clear the sputum. Some handheld devices like the Acapella and the flutter can be used to remove mucus from the lungs.
CONGESTIVE HEART FAILURE
Patients suffering from this disease breathe with a wheezing sound. A history of dyspnea is critical during diagnosis. A device, peak flow meter, establishes the patient’s expiratory peak flow rate. If the peak expiratory rate is below 150-200, then the condition is a COPD. Higher records than that may suggest that the patient has congestive heart failure. Treatment depends on the level of development, where the amount of alcohol (not more than one drink in a day 150 ml of wine with 12% alcohol content for women and not more than two for men) consumption to be monitored as a key challenge Campbell et al. (2014). The intake of excessive salt should be controlled. Aldosterone action inhibitors like Aldactone and inspra can be used to reduce sodium retention after using salt. Application of dietary sodium can be used, should pay keen on gaining weight, and fluid restriction for non-pharmacologic therapies. Some of the invasive treatments include pacemakers, ventricular restoration, and cardiac resynchronization therapy.
The onset of Tb is at any age; patients present with coughing, fever and production of sputum that is blood-stained with progression. If it were a COPD, there could symptoms of difficulty in breathing. An x- ray can be used to establish the lungs infiltrates with microbial. Treatment with isoniazid and rifampicin over a period of six months is used for pulmonary Tb. Extrapulmonary Tb requires same treatment regimen as pulmonary Tb, but the during is up to 12 months. Talent Tb treatment is only recommended for people under 35 years and those with HIV regardless of age. Treatment at this stage may require the use of chemotherapies and corticosteroids that may suppress the working of the immune system
WHAT WOULD BE AN APPROPRIATE NEXT STEP BEFORE PRESCRIBING THERAPY FOR JANE’S COPD?
Before prescription of the drugs, the patients’ history of the type of drugs they allergic to should be known, to avoid complications during treatment. For instance, some patients do not cope well with anticholinergics like people with glaucoma. Different levels of COPDs require various forms of treatments, long- acting beta two agonists is efficient in treating stages two and four. Patient with a history of skin problems can be identified and be given less reactive antibiotics that function equally as tetracycline. Tetracycline increase skin’s sensitivity to the sunlight.
WHAT CAN BE DONE TO REDUCE JANE’S RISK OF COPD EXACERBATION?
Since this is a chronic condition where exhalation is obstructed, restoring airflow along the respiratory system is vital. Smoking cigarette is the primary cause of COPDs and cessation can help reduce risk factors. In cases of the withdrawal syndrome, nicotine replacement can be used to manage the case Kitzinger, (2015). COPDs narrows the always channels and with deposits like tar it becomes inelastic. Bronchodilators can be used to relax the airways and the smooth muscles. Drugs can manage dyspnea like anticholinergic that include ipratropium bromide.
Patients who engage in physical exercises promotes better blood flow and physical wellness. This can help slow the progression of the COPD, diet can be a good booster to nourish the body. The use of antibiotics can help remove any bacterial development along the airways that may cause inflammation Kitzinger, (2015). Behavioral therapy is required for those suffering from dyspnea, education and behavioral intervention contributes to control the urge for smoking and other risk factors like alcoholism. However during COPDs treatment, comorbidity is a concept that defines conditions that arise as side effects of COPD drug therapies. Comorbidity should be monitored to ensure a quality life, for example, osteoporosis may occur Campbell et al. (2014).
Wibberley, S., Ochiai, Y., Pitt, R., & Mathieson. “IPF–The patients’ differential diagnosis of COPD.”European Respiratory Journal 44.Suppl 58 (2014): 1887.
Campbell, Ross T., and John JV McMurray. “Comorbidities and differential diagnosis in heart failure with preserved ejection fraction.” Heart failure clinics10.3 (2014): 481-501.
Kitzinger, Sheila. “Towards better management of COPD.” The Lancet385.9979 (2015): 1697-1802.