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COPD Exacerbation
differential diagnoses for Jane may be congestive heart failure (CHF), which could account for her dyspnea and be associated with her lifelong habit of smoking, exacerbated by a glass of wine in the evenings; it could possibly be treated by surgery, with the addition of eliminating smoking and alcohol. Peak expiratory flow can be measured to distinguish COPD from CHF. A second differential may be Alpha1-Antitrypsin deficiency (AATD), which could be indicated by the sputum, wheezing, and smoking. This is an inherited genetic condition and can be treated similarly to treating COPD (Stoller, Aboussouan, 2012). Bronchiectasis could be a third differential, but the absence of crackles could rule this out, though voluminous purulent sputum could signify it as a possibility; nonsteroidal anti-inflammatory drugs would be recommended for treatment. Pulmonary emboli may be a fourth diagnosis, and anticoagulation measures would need to be adopted to treat (Guyatt et al., 2012). Nicotine addiction evidenced by the large and long-standing dependency on cigarettes could be a fifth diagnosis, treated by nicotine replacement therapy. Performing a chest X-ray would help with the diagnosis by ruling out pneumonia, and a sputum culture could be performed as well.
An appropriate next step before prescribing therapy for Jane's COPD would be to ensure that a proper diagnosis is made. The criteria for
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If the diagnosis has already been made, the next step to perform prior to giving therapy would be to assess whether the patient is allergic to medications or resistant to types of therapy, such as nicotine replacement therapy. The use of an inhaler (a bronchodilator) could be something that is discussed with the patient asked if she is allergic to the agonists available; likewise, antibiotics could be an option that is available, but again it depends upon the patient's disposition. A care plan should be provided nonetheless so as to guard against future recurrences.
The care plan would be used to help Jane reduce her risk of future COPD exacerbation. The care plan could explain exactly which steps Jane should take to prevent the situation from worsening or coming back. Quitting her smoking and drinking habit would be essential first steps. Likewise,…
References
Guyatt, G. et al. (2012). Antithrombic therapy and prevention of thrombosis. Chest,
141(2): 7-47.
Stoller, J., Aboussouan, L. (2012). A review of a1-antitrypsin deficiency. American
Journal of Respiratory Critical Care Medicine, 185(3): 246-259.
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