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In the case study, a 68-year-old male has c/o cough for the last 2 months, frequent urination for the past 4 months, history of hypertension and a smoker for the last 40 years. The patient does not know his family history; however, diagnoses, recommendations and treatment will be based on the information given.
CC: Cough for the past 2 months that will not go away.
COPD: (J44.9)-Is a chronic inflammatory lung disease that cause air flow obstruction to the lungs. The disease is generally caused from long term cigarette smoking as well as exposure to cigarette smoke and other Inhaled irritants (NIH, 2022). Symptoms of COPD includes frequent and ongoing cough that may produce mucus, shortness of breath, wheezing, and chest tightness. Individuals with COPD are likely to experience episodes of exacerbations that can worsen their symptoms and persist for several days.
Lung Carcinoma: (C34.00)- Is a type of cancer that develops in the lungs of individuals who are smoker and nonsmokers. The chance of lung cancer increases with the length of time and number of cigarettes smoked (ACS, 2023). Symptoms of lung cancer develops overtime and patients maybe asymptomatic in the early stage. As the disease progresses individuals may experience shortness of breath, chest pain, weight loss, cough that does not go away, and hoarseness.
GERD: (K21.9)- Is a digestive disorder that occurs when food and fluids are backed up from the stomach and leak back into the esophagus (AGA, 2021). This condition affects people of all ages and is accompanied with symptoms that include trouble swallowing, a cough that does not go away, frequent burping, heart burn, and a feeling of lump in the throat. There are also risk factors for developing GERD such as overweight, smoking, medications, alcohol, and age.
I would do a thorough assessment and work up on the patient before prescribing any medications. My rationale for doing this is that, although, the patient has a cough for the past 2 weeks it is crucial for me to know what I am treating. The following testing would be recommended lung cancer screening with low dose CT scan, chest Xray, and Spirometry to see what is present in the lungs (Dai et al., 2018). For medication it would be a short acting beta-agonist (SABA) Albuterol inhaler every 4-6 hrs (GINA, 2021). The patient will be educated on smoking cessation, and other lifestyle modifications to prevent exacerbations and complications. Depending on imaging results, pt may be referred to a Pulmonologist or Oncologist for further evaluation and treatment.
CC: Frequent urination for the last 4 months.
Benign Prostatic Hyperplasia (N40.1) is a condition that occurs when the prostate is enlarged causing a blockage or slowing in the urinary stream. This condition is seen in men as they aged, the prostate gets bigger and presses against the bladder and compress the urethra, resulting in a slow flow of urine from the bladder. The most common symptoms of BPH include frequent urination, weak urine stream, and dribbling or leaking of urine (AUA, 2021).
Diabetes Mellitus (E11.9) Frequent urination is a common symptom of diabetes. The patient does not have other symptoms such as feeling thirsty or constant hunger. However, he has a history of hypertension that can cause insulin resistance and contribute to diabetes (Petrie et al., 2018).
Interstitial Cystitis (N30.1) is a chronic condition of the urinary bladder that causes pain, pressure, or discomfort in the suprapubic region. The exact cause is unknown, but factors such as defective lining in the bladder wall, allergy, abnormal substance in the urine and autoimmune can precipitate the condition (AUA, 2023). Women is more likely to develop this condition than men. IC in men causes lower urinary tract symptoms of frequency and sudden urges to urinate that lasted for 6 weeks (AUA, 2023). Other symptoms include nocturia, pain when the bladder is filled, and painful urination.
Physical examination of the prostate via rectal exam, UA, PSA levels, CBC, Cystoscopy, Ultrasound and MRI (AUA, 2021). Medication would not be given until testing results are finalized. Some results may take 24 -48 hrs to be resulted. If BPH is the confirming diagnosis- Flomax 0.4 mg daily will be prescribed, and patient will be referred to urologist for further evaluation and management.
American Cancer Society (2023) Lung Cancer. https://www.cancer.org/cancer/lung-cancer/about/what-is.html
American Gastroenterological Association (2021) Gastroesophageal Disease (GERD). https://patient.gastro.org/gastroesophageal-reflux-disease-gerd/
American Urologic Association (2021) Benign Prostatic Hyperplasia (BPH). https://www.urologyhealth.org/urology-a-z-/interstitial-cystitis/
American Urologic Association (2023) Interstitial Cystitis. https://www.urologyhealth.org/urology-a-z-/benign-prostatic-hyperplasia-(bph)
Dai, J., Yang, P., Cox, A., & Jiang, G. (2017). Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective. Oncotarget, 8(11), 18513–18524. https://doi.org/10.18632/oncotarget.14505
Global Initiative for Chronic Obstructive Lung Disease (2021) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. https://goldcopd.org/wp-content/uploads/2022/POCKET-GUIDE-GOLD-2023
National Heart, Lung, and Blood Institute (2022) COPD Symptoms. https://www.nhlbi.nih.gov/health/copd/symptoms
Petrie, J. R., Guzik, T. J., & Touyz, R. M. (2018). Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. The Canadian journal of cardiology, 34(5), 575–584. https://doi.org/10.1016/j.cjca.2017.12.005