Examining Chest X-Rays
Chest x-rays are an invaluable diagnostic tool as they can help identify common respiratory disorders such as pneumonia, pleural effusion, and tumors, as well as cardiovascular disorders such as an enlarged heart and heart failure. As an advanced practice nurse, it is important that you are able to differentiate a normal x-ray from an abnormal x-ray in order to identify these disorders. The ability to articulate the results of a chest x-ray with the physician, radiologist, and patient is an essential skill when facilitating care in a clinical setting. In this Discussion, you practice your interprofessional collaboration skills as you interpret chest x-rays and exchange feedback with your colleagues.
Consider the three patient case studies and x-rays
Case Study 1
35-year–old Asian male presents to your clinic complaining of productive cough for two weeks. Stated he has had mild intermittent fever with myalgia, malaise and occasional nausea.
- SH: works as a law clerk
- PE: NP noted low grade fever (99 degrees), with very mild wheezing and scattered rhonchi.
Case Study 2
This is a 44-year–old Caucasian male being seen at your clinics with complaints of complaints of cough for 4 days and worsening. Stated he has had high grade fever. States he feels weak and has been in bed most of the last two days. Complains of exertional dyspnea, followed by dyspnea at rest, non-productive cough and pleuritic chest pain
- MEDS: Zovirax, Diflucan, magic mouth wash, Zofran, mycostatin, filgrastin
PMH: HTN, Hep C, HIV/AIDS, thrush
SH: Past IV Drug abuse; lives in a group home;
PE: VS: Ht: 5’7, Wt: 150#, BMI 23,
Anorexic male, febrile, tachypneic, tachycardic, with rales and rhonchi. You note decreased in breath sounds, dullness, and egophony
Case Study 3
A 50 year old Caucasian female presents to the clinic with complaints of cough for almost 2 weeks. Positive productive green sputum with associated chills, sweating, and fever up to 101.5. She manages a daycare and states that many of the children have had upper respiratory symptoms in the last two weeks. PMH: DM diagnosed 7 years ago, controlled on medications.
- MEDS: Glyburide 10mg qd
- PE: She looks ill with continuous coughing and chills.
- BP 100/80, T: 102, HR: 110; O2Sat 97% on RA.
- Lungs: +Crackles, increased fremitus
- Labs: CBC 17,000 cells/mm3 , blood sugar is 120
To prepare:
- Review Part 10 of the Buttaro et al. text in this week’s Resources, as well as the provided x-rays.
- Reflect on what you see in the x-ray assigned to you by the Course Instructor.
- Consider whether the patient in your assigned x-ray has an enlarged heart, enlarged blood vessels, fluid in the lungs, and/or pneumonia in the lungs.
Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study you were selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.
Expert Answer and Explanation
Examining Chest X-Rays
The Primary Diagnosis
The primary diagnosis for this case is pneumonia. Pneumonia is either a bacterial or viral infection that affects one or all parts of the lungs. According to Zhu et al. (2020), pneumonia infection is often spread through droplets from an infected person. This disease has been selected as the primary diagnosis because the patient reports that she has bee interacting with children showing upper respiratory signs for the last two weeks. Some of the signs of pneumonia include fever, chills, a cough that produces mucus, and shortness of breath. The patient has reported almost all the signs highlighted above. The X-ray test showed that the patient has fluids in the alveoli, and according to Lapinsky, Leen, Mak, and Shafiee (2019), this is a sign of pneumonia.
Differential Diagnosis
- Asthma
According to Chahin & Opal (2017), asthma is a chronic respiratory condition that causes a person’s airways to be inflamed, swollen, and narrow, making the individual experience difficulty breathing. Some of the symptoms of the disease include coughing that worsens, difficulty breathing, ad chest pain. This disease has been included in the diagnosis because it causes a cough that produces a lot of mucus as experienced by the patient.
- Chronic Obstructive pulmonary disease
COPD is a group of medical conditions that block a person’s breathing system and thus make it hard for the individual to breathe. Some of the diseases’ signs include lack of energy that can cause fainting, frequent respiratory infections, swelling of legs and ankles, and a cough that produces mucus (Zhou et al., 2020). This disease has been included in the diagnosis because one of its signs is a cough that produces mucus like the one reported by the patient.
- Lung cancer
Lung cancer is the growth of abnormal cells in the lung region. The disease symptoms include a new cough that does not fade, hoarseness, shortness of breath, bone pain, and losing weight (Yoon, Kim, Yang, & Ham, 2028). The disease has been included in the diagnosis because one of its symptoms is a prolonged cough, like the one experienced by the patient for two weeks.
Role of Patient History in the Diagnosis
The personal and medical history provided by the patient was so helpful when diagnosis the individual. The history was used to determine the causes of the ailment. Most of the respiratory problems are often caused by allergies. Therefore, information about allergies could help the medical doctor determine whether the patient’s condition is an allergic reaction (Zhou et al., 2020). By stating where she works, it was concluded that she contracted the disease from the children or the one who infected the kids. Another important history in the diagnosis is that it helped the medical professional risk factors that could have increased the patient’s chances of being infected by the germ. Patient history also provided the medical professional with information about the diagnostic tests the patient can afford.
Potential Treatment Options
The treatment of the patient will depend on the type of pneumonia the individual has. If the patient has bacterial pneumonia, she should be prescribed antibiotics. However, if the condition is caused by a viral infection, the patient should be prescribed an antiviral medication to fight the virus. Fever can be relieved using medications, such as Tylenol, Motrin, and aspirin (Yoon et al., 2018).
References
Chahin, A., & Opal, S. M. (2017). Severe pneumonia caused by Legionella pneumophila: Differential diagnosis and therapeutic considerations. Infectious disease clinics of North America, 31(1), 111. https://doi.org/10.1097/PCC.0000000000001092
Lapinsky, S., Leen, J., Mak, J., & Shafiee, M. A. (2019). A Challenging Case of Non-resolving Pneumonia: Keeping Antisynthetase Syndrome In the Differential Diagnosis. Canadian Journal of General Internal Medicine, 14(1), 25-28. https://www.cjgim.ca/index.php/csim/article/view/278
Yoon, Y. K., Kim, M. J., Yang, K. S., & Ham, S. Y. (2018). The role of serum procalcitonin in the differential diagnosis of pneumonia from pulmonary edema among the patients with pulmonary infiltrates on chest radiography. Medicine, 97(47). doi: 10.1097/MD.0000000000013348
Zhou, M., Chen, Y., Yang, D., Xu, Y., Yao, W., Huang, J., … & Zou, L. (2020). A Deep Learning Pipeline for Accurate Differential Diagnosis between Novel Coronavirus Pneumonia and Influenza Pneumonia. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3539663
Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., … & Niu, P. (2020). A novel coronavirus from patients with pneumonia in China, 2019. New England Journal of Medicine. DOI: 10.1056/NEJMoa2001017
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