coursework-banner

NU-664B Week 3 Discussion 1: Hispanic / Nondocumented Patient with Acute Illness

NU 664B Week 3 Discussion 1 Hispanic  Nondocumented Patient with Acute Illness

Top 4 Differential Diagnoses:

Influenza: Influenza is likely the condition that this patient is presenting according to her symptoms. Influenza typically presents with symptoms such as a fever, sore throat, chills, fatigue, and a non-productive cough (Dolin, Hirsch, & Baron, 2022; Han et al., 2019). The patient’s age, location, presence of any co-morbid conditions, and sudden onset of symptoms typically present as either Influenza A or B, in addition to other symptoms like rhinorrhea, congestion, and myalgias (Dolin, Hirsch, & Baron, 2022; Han et al., 2019). This patient also did not receive a flu shot, which could precipitate this patient to likely have Influenza versus another type of infection (Dolin, Hirsch, & Baron, 2022; Han et al., 2019). Influenza testing through PCR or rapid is needed for a formal diagnosis (Dolin, Hirsch, & Baron, 2022; Han et al., 2019).

SARS-COV-2 (Coronavirus Disease 2019 (COVID-19)): COVID-19 is another diagnosis to rule out for this patient due to her symptoms of a fever, chills, myalgia, loss of taste and smell, and dyspnea (Serener & Serte, 2020). COVID-19 can also present with sudden onset of symptoms, like Influenza, and it is uncertain whether this patient has ever received a COVID-19 vaccination (Serener & Serte, 2020). Imaging is strongly needed to determine COVID-19 versus other types of pneumonia, testing through PCR (Serener & Serte, 2020). Sore throat is not a common presentation in patients with COVID-19 (only 5-10% of studied cases), leaving COVID-19 a more unlikely diagnosis (Curtis, 2022).

Community Acquired Pneumonia (CAP): CAP is likely another diagnosis that could be present in this patient. Many of the typical symptoms of CAP include a cough and fever, but it typically can present after another illness like Influenza; especially if it is viral in origin (Han et al., 2019). In a study by Han et al. (2019), there was a great chance that patients who had respiratory symptoms likely had Klebsiella Pneumoniae or Pseudomonas Aeruginosa. This diagnosis is also likely due to her age and co-morbid conditions, although it is uncertain she has it without confirming her receipt of a pneumonia vaccination and obtaining a more thorough assessment into her symptoms (Han et al., 2019). Also, a thorough history as to the onset, duration, and other symptoms would be important to obtain from this patient to be certain about a CAP diagnosis over an Influenza type diagnosis (Dains, Baumann, & Schiebel, 2018; Dunphy et al., 2020).

Tuberculosis (TB): Although less likely to occur, the patient will need to be ruled out for TB if more common illnesses are negative. Tuberculosis can present with respiratory symptoms, such as cough, chest pain fevers, fatigue, chills, and loss of appetite. The most distinguishing symptom is coughing up blood, which would be an important characteristic when diagnosing this patient (Mayo Clinic, 2023). Travel to Latin American countries is also a known risk factor to acquiring TB, so a thorough history of travel and family members who have been traveling recently is important information to collect (Mayo Clinic, 2023).

Plan:

Primary Differential Diagnosis: Influenza

Pharmacology

Some of the pharmacologic treatments for Influenza include Tamiflu (oseltamivir phosphate) within the first 48 hours of having symptoms, alternating between Tylenol 650mg PO Q4-6 hours as needed) and Ibuprofen (200-400mg PO daily as needed) to manage fevers and pain (Dolin, Hirsch, & Baron, 2022; Woo & Robinson, 2020).

Non-Pharmacology

Some of the non-pharmacologic treatments for Influenza include the use of a Nedipot steam to loosen secretions (Woo & Robinson, 2020); Nasal saline lavage (Woo & Robinson, 2020); Increasing hydration to manage her current symptoms of dehydration (Woo & Robinson, 2020); and using a humidifier to help moisten secretions (Woo & Robinson, 2020) could be helpful to this patient.

Labs/Diagnostics

Some of the labs that I would order include a Complete Blood Count (CBC) (a decreased PLT count is strongly associated with Influenza infection (Han et al., 2019)), an Influenza nasal PCR test to confirm the presence of Influenza A or B (Dolin, Hirsch, & Baron, 2022; Patel & Hwang, 2022), a chest X-ray if symptoms (upon further assessment) include shortness of breath (Dolin, Hirsch, & Baron, 2022; Serener & Serte, 2020), or, a chest CT and QuantiFERON Gold Test if the patient has presence of blood in the sputum (Mayo Clinic, 2023). These tests help rule out the other types of respiratory infections that this patient may be experiencing at this time.

Referrals/Interprofessional Communications

For Influenza, there are no referrals or interprofessional communications necessary, unless there is a severe case where hospitalization is needed (Dolin, Hirsch, & Baron, 2022; Han et al., 2019).

Patient education (10-15)

NU 664B Week 3 Discussion 1 Hispanic  Nondocumented Patient with Acute Illness
NU 664B Week 3 Discussion 1 Hispanic  Nondocumented Patient with Acute Illness

The patient should be educated on the following:

Follow up with your PCP if there is no improvement in 3-4 days (Woo & Robinson, 2020); Take all medication as prescribed (Woo & Robinson, 2020); Finish the entire course of antiviral treatment (e.g., Tamiflu)(Woo & Robinson, 2020); Use saline washes if there is presence of congestion (Woo & Robinson, 2020); When using nasal steams, take caution against sustaining a burn (Woo & Robinson, 2020); Follow up with consultations if recommended (Woo & Robinson, 2020); avoid cigarette smoke (Mayo Clinic, 2022), cover your mouth with your arm when symptomatic with coughing or sneezing (Woo & Robinson, 2020); monitor respiratory symptoms, especially with the history of Asthma (Woo & Robinson, 2020); and, if you have any worsening symptoms over the next week follow up with your doctor (Woo & Robinson, 2020). Ensure to have all vaccinations up to date, particularly the Influenza, COVID-19, and Pneumonia vaccines as soon as symptoms resolve (Woo & Robinson, 2020).

Follow up:

It would just be important to have the patient follow up with the PCP if the respiratory symptoms worsen, sudden shortness of breath occurs, or the patient is routinely not able to eat or drink at home (Dolin, Hirsch, & Baron, 2022; Woo & Robinson, 2020).

Health maintenance (primary prevention): Be sure to wash hands frequently to prevent the spread of Influenza to others, especially those who are elderly or are young children as having Influenza can be fatal (Mayo Clinic, 2023; Woo & Robinson, 2020). Avoid being in contact with those who are ill or engaging in high-risk settings to acquire an infection, such as a healthcare setting (Mayo Clinic, 2023; Woo & Robinson, 2020). Be sure to cover any coughs or sneezes with either a tissue or in the crux of the arm (Woo & Robinson, 2020).

Social determinants of health/how to overcome this obstacle to healthcare

Some of the social determinants of health for this patient would include the patient being undocumented, her inability to fully articulate her symptoms, and she is a known English Language Learner (Al Shamsi et al., 2020). These factors may cause barriers in the patient’s ability to disclose her symptoms, seek treatment, and pay for some of the services needed to be well (Al Shamsi et al., 2020). It can also negatively produce healthcare outcomes as disparities arise in those who are of a minority race (Al Shamsi et al., 2020). Therefore, it is important to have translation services assist this patient, reassure the patient about her undocumented status and her ability to freely speak about her healthcare needs, and that she receives the patient teaching she needs to prevent the spread of Influenza to others (Al Shamsi et al., 2020).

References

Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. (2020). Implications of language barriers for healthcare: A systematic review. Oman Medical Journal, 35(2), e122. https://doi.org/10.5001/omj.2020.40

Curtis, B. (2022). Is my sore throat COVID-19 or not. OSF Healthcare. https://www.osfhealthcare.org/blog/is-my-sore-throat-covid-19-or-not/#:~:text=But%2C%20Dr.%20Curtis%20said%2C,and%20smell%20and%20difficulty%20breathing.%E2%80%9D

Dains, J. E., Baumann, L. C., & Scheibel, P. (2018). Advanced health assessment and clinical diagnosis in primary care (6th ed.). Elsevier.

Dolin, R., Hirsch, M. S., & Baron, E. L. (2022). Seasonal influenza in adults: Clinical manifestations and diagnosis. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/seasonal-influenza-in-adults-clinical-manifestations-and-diagnosis?search=influenza&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3

Dunphy, L. M. (2019). Primary care: Art and science of advanced practice nursing- An interprofessional approach (5th ed.). F. A. Davis.

Han, L., Ran, J., Mak, Y. W., Suen, L. K. P., Lee, P. H., Peiris, J. S. M., & Yang, L. (2019). Smoking and influenza-associated morbidity and mortality: a systematic review and meta-analysis. Epidemiology30(3), 405-417. DOI: 10.1097/EDE.0000000000000984

Keilman, L. J. (2019). Seasonal influenza (flu). Nursing Clinics54(2), 227-243. DOI:10.1016/j.cnur.2019.02.009

Mayo Clinic. (2023). Tuberculosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250

Patel, Z., & Hwang, P. (2022). Acute sinusitis and rhinosinusitis in adults: Clinical manifestations and diagnosis. UpToDate. https://www.medilib.ir/uptodate/show/6871

Serener, A., & Serte, S. (2020, November). Deep learning to distinguish covid-19 from other lung infections, pleural diseases, and lung tumors. In: 2020 Medical Technologies Congress (TIPTEKNO) (pp. 1-4). IEEE.

Woo, T. M., & Robinson, M. V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.). F.A. Davis.