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Nursing

Differential Diagnosis

            The patient in question, a 15 year-old with a persistent dry cough, should be examined thoroughly to determine the nature of the cough and any underlying or accompanying symptoms. Upon review of the patient’s prior medical history, the problem has been intermittent for approximately one year, but the symptoms are consistent and have not worsened. Performing a detailed assessment is required to determine the extent and cause of the dry cough and to determine if any specific factors might be at work. The patient does not experience wheezing to accompany coughing episodes. Evaluation of the patient must include an examination of lungs, airway, breathing, and overall appearance.

            The patient should undergo a chest x-ray to determine if any physical findings are present in relation to the cough that are significant in nature. In this case, the chest x-ray is the most natural approach because it conveys the importance of any findings that might require additional evaluation and possible treatment. In addition, if the x-ray does not present any significant findings, testing such as examination of the sinus cavities through nasoendoscopy and bronchoscopy might be necessary in this case. Finally, an exploration of iron deficiency through iron testing could be an indicator of coughing symptoms.

            The possible differential diagnoses for this patient include the following: 1) Asthma; 2) Non-Asthmatic Eosinophilic Bronchitis (NAEB); and 3) Gastro-oesophageal reflux disease (GORD). Each of these diagnoses requires its own set of tests to determine if the presenting symptoms correspond with the diagnosis. For example, a diagnosis of Asthma requires physical assessment to determine if wheezing is present. Testing includes spirometry with the use of the bronchodilator to determine if Asthma is the appropriate diagnosis. In this case, since the patient does not present with wheezing to begin with, the diagnosis of Asthma is unlikely.

            Non-Asthmatic Eosinophilic Bronchitis (NAEB) is also a possibility when the patient does not present with any significant symptoms other than a random non-productive cough that is not associated with wheezing episodes or other factors that could indicate the possibility of Asthma. The most common test to determine this condition is the sputum/broncho-alveolar lavage differential count. In addition, testing to evaluate exhaled nitric oxide is a possibility in this case.

            Finally, Gastro-oesophageal Reflex Disease (GORD) is a possibility when there are presenting symptoms of heartburn, acid regurgitation, and associated postural changes in these conditions, accompanied by a random cough without any wheezing symptoms. In this case, the first line of defense and testing is to prescribe proton-pump inhibitors for a period of at least eight weeks to determine their effectiveness in reducing coughing symptoms. In this case, it is likely that since the patient has not complained of a history of heartburn or acid reflux symptoms, this diagnosis is not likely.

            Based upon the information that has been provided through the patient’s medical history and current assessment, it is likely that the patient is suffering from Non-Asthmatic Eosinophilic Bronchitis (NAEB). Her symptoms indicate a dry cough without accompanying wheezing, along with increased physical activity over the past week due to swim training. Therefore, it is important to begin treatment for the patient to alleviate her persistent dry coughing symptoms, including the use of inhaled corticosteroids to produce antinflammatory properties. The use of an inhaled corticosteroid, particularly after periods of heavier physical activity, such as swim training, serves as an important means of alleviating possible symptoms over a period of time and in ensuring that the patient’s condition does not worsen beyond the current dry cough, particularly at the time of increased physical activity.