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Katia Gedeon

Clinical Experience

I had the opportunity of handling adult patients within a clinic this week and I gained a lot of experience handling this group of individuals. However, just like in any new experience I faced a few challenges at the beginning. The most outstanding challenge was handling older adults. Most of them would not communicate straight and were never explaining their situations in detail; especially the ones that looked seriously sick. Therefore, I had to keenly observe their gestures and body language to help understand their complaints better.

There was a case of a 68 old white male who came to the clinic complaining of fever and cough that had lasted for five days. I welcomed the patient and began by introducing myself and then explaining what the session entails while reassuring him that everything discussed would remain confidential. The patient stated that he had developed a harsh and productive cough five days back. He also experienced yellow and thick sputum that had streaks of blood. Further, he developed malaise, chills, fever, and shaking alongside the cough. Besides, two days ago the patient developed a sharp pain in his right chest and the pain intensified with inspiration. Even though the patient had lost about 14lbs over a few months, he claimed he had not lost appetite.

His history showed that the patient had chronic smoker's cough for 5 to 10 years which he described as non-productive, mild, and mostly occurred in the morning. Moreover, the patient has smoked one packet of cigarettes daily for the last 38 years. He had previously been treated for hemorrhoids, mild hypertension, appendicitis, and bronchitis.

I then conducted a physical examination on the patient where I gathered that the patient was an elderly man who looked underweight and haggard with a sallow complexion. He continuously coughed and leaned on his right side holding the right chest while seated in a chair. The vital signs included BP 152/90, regular respiratory rate of 24 per minute, apical heart rate of 112 per minute, height was 160 cm, weight 72 kg, and BMI of 22.22. Neck examination revealed a large and non-tender lymph node within the right supraclavicular fossa while the fingers showed clubbing.

Laboratory: Neutrophils 70%, WBC 17,000/mm3, lymphocytes 15%, bands 15 %.

Differential Diagnoses

Pneumonia

Pneumonia is one of the possible differential diagnoses in this situation. It ranges from self-limited, mild, to even life-threatening conditions. Some of the signs and symptoms include chills, fever, nonproductive cough, and headache among others (Mandell & Niederman, 2019). This patient experienced a number of these symptoms which would be an indication that he could have pneumonia.

Bronchiectasis

This is a rare disease that is mostly secondary to some infectious processes resulting in permanent and abnormal distortion of some of the conducting airways or bronchi (Hill et al., 2019). Some of the signs and symptoms include cough and regular production of sputum that lasts for months or even years. The other symptom is blood-streaked sputum coming from the airways linked with acute infections. These symptoms were present in this patient.

A chest x-ray, latent, and PA view revealed acute pneumonia within the right middle lobe. The patient was eventually treated for ten days as an outpatient with antibiotics. Post-treatment chest x-ray would be conducted and the patient would be advised to quit smoking. One thing I learned is the need to document everything and plan myself before I get to work. I realized that planning and documentation were very vital since it minimizes errors within the clinic.