Physical Assessment of Respiratory System

Case Study 1
Primary Diagnosis: Viral Pneumonia
Pneumonia, in basic terms, leads to the inflammation of the lung’s air sacs. It could be caused by a wide range of organisms such as fungi, viruses, as well as bacteria. Some key symptoms of pneumonia, according to the American Lung Association (2018), include but they are not limited to: “cough, which may produce greenish, yellow or even bloody mucus; fever, sweating and shaking chills, shortness of breath; rapid, shallow breathing; sharp or stabbing chest pain; loss of appetite, low energy, and fatigue; nausea and vomiting; confusion.” The symptoms Patient X (a 35-year-old Asian male) presents are consistent with the early symptoms of viral pneumonia. This is more so the case in reference to the mild intermittent fever, productive cough, and occasional nausea and muscle pain. It is also important to note that during examination, one is likely to identify rales and rhonchi amongst patients with pneumonia. The patient in this case presented scattered rhonchi. The scattered rhonchi are due to the presence of mucus in the airways. The symptoms would have gotten worse over time, i.e. with the fever being as high as 105 degrees.
Differential Diagnosis
In essence, the differential diagnosis for viral pneumonia could be rather broad. Below are four differential diagnoses for Patient X:
Influenza
This is a respiratory infection that in some instances does not require any medical intervention. It should, however, be noted that in some instances, it could result in fatal complications (Myint and Robinson, 2012). Some of the symptoms of influenza include: fever, sore throat, nasal congestion, weakness and fatigue, persistent cough (mostly dry), headaches, myalgia, and fever (Myint and Robinson, 2012). In the case of Patient X, influenza could be ruled out as the patient does not present sore throat, dry and persistent cough, and headache. Also, Patient X presents low grade fever (99 degrees) whereas in the case of influenza, fever over 100 degrees would have been more likely.
Asthma
Asthma results from the narrowing as well as swelling of the airways and the production of additional mucus. As a result, the person suffering from the same could experience difficulty in breathing as well as shortness of breath which could be accompanied by wheezing and coughing. Thus, some of the main symptoms of asthma are: wheezing, breath shortness, chest tightness, breathing difficulties, and cough attacks (Myint and Robinson, 2012). It should be noted that breathing sounds in the case of asthma tend to be different from those of pneumonia. When it comes to asthma, one is likely to hear wheezing when listening with the stethoscope. Patient X presented scattered rhonchi and mild wheezing. Asthma was ruled out. Further, the patient does not report any chest discomfort.
Pleural Effusion
In essence, this is an unusual fluid amount around the lung. The said fluid buildup could be as a consequence of a wide range of factors. These include, but they are not limited to, an infection (such as tuberculosis and pneumonia), cancer (particularly lung cancer), and a leak from other body organs (which effectively results in the buildup of fluid in the pleural space). Symptoms could in this case be inclusive of a persistent cough, fever, chest discomfort and/or pain, and shortness of breath (Myint and Robinson, 2012). In our case, Patient X presents only one of these symptoms, i.e. shortness of breath. For this reason, pleural effusion was ruled out. It should, however, be noted that pneumonia remains one of the causes of pleural effusion and this could result in an overlap of symptoms.
Acute Bronchitis
It is important to note that as the American Lung Association (2018) points out, “acute bronchitis is sometimes diagnosed as pneumonia.” Symptoms of acute bronchitis that happen to be most common include, but they are not limited to, a productive cough, a whistling/wheezing sound when breathing, low grade fever, tiredness, stuffy/runny nose, and malaise (Myint and Robinson, 2012). Patient X presented some of the symptoms that have been identified above. In this case, pneumonia was ruled out because the patient did not exhibit a stuffy/runny nose and did not report sore ribs (which often result from prolonged coughing periods). It should, however, be noted that a chest x-ray could help draw a distinction between acute bronchitis and pneumonia.
Role of Patient History and Physical Exam in Diagnosis
In this case, Patient X’s x-ray exam returned patchy consolidation in the patient’s right lower lobe. In essence, this is an indication of a respiratory tract infection. It has been indicated that the patient works as a law clerk. For this reason, it would be expected that he attends packed court sessions on a regular basis. The viruses that cause viral pneumonia could be spread through tiny fluid droplets that accompany a sneeze or cough and travel through the air. It is not difficult to see how Patient X could have contracted pneumonia in a packed courtroom.
Treatment
Overall Treatment Goal:
The treatment of viral pneumonia would in this case be supportive – i.e. designed to make Patient X feel batter.
Medication:
· Antiviral Medication: In seeking to minimize viral activity, I will recommend Ribavirin.
· Cough Medication: In seeking to reduce coughing, I will recommend Guaifenesin.
· Fever and Pain Medication: For pain relief and to rein in fever, I will recommend Acetaminophen.
Treatment Plan beyond Medications:
It should be noted that full recovery could take a couple of weeks. For instance, until all sputum is cleared, the patient may continue coughing for some time. The patient will be advised to:
· Drink a lot of fluids (so as to thin mucus and enhance the likelihood of coughing it up).
· Get plenty of rest.












References
American Lung Association (2018). Pneumonia Symptoms and Diagnosis. Retrieved from https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/pneumonia/symptoms-and-diagnosis.html
American Lung Association (2018). Acute Bronchitis Symptoms, Causes and Risk Factors. Retrieved from https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/acute-bronchitis/symptoms-causes-risk-factors.html
Myint, S. & Robinson, D.T. (Eds.). (2012). Viral and Other Infections of the Human Respiratory Tract. New York, NY: Springer Science & Business Media.