Dianne Steinberg is a 69-year-old female whose past medical history includes chronic obstructive pulmonary disease (COPD) and hypertension. The patient’s complaints are productive cough, fever, and breathing difficulties, which are known as dyspnea. It is essential to provide the list of differential diagnoses for the patient, determine the final diagnosis, and discuss specific findings regarding the lungs’ normal and abnormal state.
Appropriate Differential Diagnoses and Reasons
For Dianne, the list of differential diagnoses includes community-acquired pneumonia, influenza, tuberculosis, and bronchitis. The symptoms of community-acquired pneumonia include cough with yellowish mucous, fever, and dyspnea. The symptoms of the flu also include cough and fever. However, cough is usually non-productive. Tuberculosis is characterized by a cough, which can be observed for several days and even weeks. Fever is also one of the symptoms typical of acute forms of the disease (Musher & Thorner, 2014; Prina, Ranzani, & Torres, 2015). Bronchitis is one more possible diagnosis that is appropriate for the case because its symptoms include a cough that can last several days or weeks. This cough is usually productive (Musher & Thorner, 2014). This disease is also associated with a high temperature or fever.
The final diagnosis for the discussed case is community-acquired pneumonia. In spite of the fact that the described symptoms and the patient’s complaints can be associated with many different diseases observed in persons with a past medical history of COPD, the assessment data indicate that the final diagnosis is community-acquired pneumonia. The following assessment findings are observed: the patient’s temperature is 100.1 F (oral), which is typical of fever; the respiratory rate is 22 beats per minute that is high for adults and typical of tachypnea; there is an increased tactile fremitus. Furthermore, there is crackling in the patient’s right lung, and rhonchi are heard in the left lung. Moreover, the left shift for leukocytosis is characteristic of infectious pneumonia. Finally, the diagnosis is supported by the results of the chest X-ray test, which indicates the pulmonary infiltrate in the patient’s lungs.
Findings Regarding the Lungs
While speaking about normal and abnormal findings associated with the auscultation assessment for the lungs, it is essential to note that normal sounds include bronchial and vesicular breath sounds. Strange sounds include wheezes and crackles (Wunderink & Waterer, 2014). In this case, the auscultation assessment indicates wheezes in the left lung and crackles in the right lung. Palpation shows the typical findings for the thorax. Thus, the patient is non-tender to the palpation of the thorax (Prina et al., 2015; Wunderink & Waterer, 2014). However, the abnormal findings related to the palpation assessment of the patient include the increased tactile fremitus while repeating the phrase “ninety-nine.” The areas with the increased fremitus indicate the areas with the higher tissue density typical of pneumonia. The percussion technique helps determine the areas where the lungs are well-aerated, and they are resonant (standard), as well as the areas where dullness can be observed (abnormal) (Musher & Thorner, 2014). In this case, dullness to percussion is heard in the right middle and lower parts of the hemithorax.
The assessment of the patient provides the reasons to state that the final diagnosis is community-acquired pneumonia. The conclusion is based on the laboratory results. Much attention is also paid to the assessment of the patient with the help of auscultation, palpation, and percussion techniques.
Musher, D. M., & Thorner, A. R. (2014). Community-acquired pneumonia. New England Journal of Medicine, 371(17), 1619-1628.
Prina, E., Ranzani, O. T., & Torres, A. (2015). Community-acquired pneumonia. The Lancet, 386(9998), 1097-1108.
Wunderink, R. G., & Waterer, G. W. (2014). Community-acquired pneumonia. New England Journal of Medicine, 370(6), 543-551.