Posted: May 13th, 2023

A 75-year-old man with a history of hypertension

A 75-year-old man with a history of hypertension, diabetes, environmental allergies, and colon polyps presents to the office with a complaint of persistent dry hacking cough that does not improve with over-the-counter treatment with antitussives and allergy medications. The man reports that he has had the cough for 3 months and is tired of the coughing spells he experiences. His medical history reveals that he started taking lisinopril 6 months before this appointment, has taken an over-the-counter allergy medication for several years, had his last colon polyps removed 6 years ago, and his blood pressure today is 145/70. Other medications include metformin XR 500 mg daily, aspirin 81 mg once daily, and loratadine 10 mg daily. The physical exam is negative for any issues other than his mild neuropathy from long-term diabetes. The cough is noted to be dry and hacking as the patient has described. The man is not in acute distress.

1. What questions would have been asked as part of the medical history?
2. What physical aspects would have been completed as part of the physical exam?
3. Based on the medical history and physical exam, what is the most likely cause of his cough?
4. What other possible diagnoses should be considered?
5. Are there any other tests that should be completed before producing a diagnosis? Why or why not?
6. What is the treatment for this patient, including education?

Research: (APA Assignment), Title Page, Introduction, Headings. Citation and reference page is required.
Length: A minimum of 750 words, not including references
Citations: At least two high-level scholarly references in APA from within the last 5 years.
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Persistent Dry Hacking Cough in a 75-Year-Old Man with Hypertension, Diabetes, Environmental Allergies, and Colon Polyps

Introduction:

Coughing is a common symptom experienced by many individuals and can be caused by a variety of conditions such as infections, allergies, and underlying medical conditions. However, when a cough persists for more than eight weeks, it is classified as a chronic cough, and an extensive evaluation is required to determine the underlying cause. In this case study, a 75-year-old man with a history of hypertension, diabetes, environmental allergies, and colon polyps presents with a complaint of persistent dry hacking cough for three months. The aim of this paper is to explore the medical history, physical examination, and possible diagnoses of this patient, as well as provide appropriate treatment options.

Medical History Questions:

As part of the medical history, the following questions would have been asked:

What is the duration of the cough?
Is the cough productive or non-productive?
What time of day is the cough most prominent?
Have you noticed any triggers for the cough, such as exercise, allergies, or certain foods?
Have you experienced any other symptoms such as shortness of breath, chest pain, or fever?
Do you smoke or have a history of smoking?
What medications are you currently taking?
Have you recently started taking any new medications?
Have you recently traveled to any foreign countries?
Do you have a history of any medical conditions, such as asthma, COPD, or lung cancer?
Physical Examination Aspects:

As part of the physical exam, the following aspects would have been completed:

Auscultation of the lungs to assess for any abnormal breath sounds such as wheezing, crackles, or rhonchi.
Inspection of the throat and pharynx for any signs of post-nasal drip, redness, or inflammation.
Palpation of the neck to assess for any enlarged lymph nodes or thyroid abnormalities.
Assessment of vital signs, including blood pressure, pulse, respiratory rate, and temperature.
Examination of the abdomen to assess for any signs of liver or spleen enlargement.
Possible Diagnoses:

Based on the medical history and physical examination, the most likely cause of the patient’s cough is a side effect of lis Based on the medical history and physical examination, the most likely cause of the patient’s cough is a side effect of lisinopril, a medication commonly used to treat hypertension. Lisinopril is known to cause a dry, persistent cough in a small percentage of patients. The cough typically develops within the first few months of starting the medication and resolves within days to weeks of discontinuing the medication.

Other Possible Diagnoses:

Other possible diagnoses that should be considered include:

Gastroesophageal reflux disease (GERD): Chronic cough is a common symptom of GERD, and it is thought to be caused by the irritation of the esophagus from acid reflux.
Postnasal drip: Allergies can cause postnasal drip, which can lead to a chronic cough.
Chronic obstructive pulmonary disease (COPD): Patients with COPD often present with chronic cough and shortness of breath.
Lung cancer: While less common, lung cancer can cause a persistent cough, especially in older adults with a history of smoking.
Additional Tests:

Before producing a diagnosis, further tests should be completed to confirm or rule out the suspected diagnoses. A chest X-ray may be ordered to evaluate the lungs for any abnormalities. A pulmonary function test may also be completed to evaluate lung function and diagnose COPD. A computed tomography (CT) scan may be ordered to evaluate the lungs and rule out lung cancer.

Treatment and Education:

The treatment for this patient would be to discontinue lisinopril and switch to an alternative medication to manage hypertension. The patient should be advised to follow up with their primary care physician for further evaluation and management of their hypertension. The patient can also be prescribed proton pump inhibitors to manage any acid reflux associated with GERD.

Education on lifestyle modifications should also be provided to the patient. This includes smoking cessation, weight loss, and avoiding triggers that exacerbate their allergies. The patient should be advised to stay hydrated and use a humidifier to help ease their cough. The patient should also be advised to monitor their blood pressure at home regularly and attend regular follow-up appointments with their primary care physician.

Conclusion:

In conclusion, a persistent dry hacking cough is a common complaint in clinical practice and can be caused by a variety of conditions. A thorough medical history, physical examination, and appropriate diagnostic tests are necessary to determine the underlying cause. In this case, the most likely cause of the patient’s cough is a side effect of lisinopril, and alternative medications should be prescribed to manage hypertension. Lifestyle modifications and appropriate education should also be provided to the patient.