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

Posted: April 4th, 2019

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.
_______________
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.

Introduction:

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.

Questions:

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

Discussion:

What questions would have been asked as part of the medical history?

The following questions would have been asked as part of the medical history:

When did the cough start?
How often does the cough occur?
What does the cough sound like?
Is there any sputum produced with the cough?
Are there any other symptoms associated with the cough, such as fever, shortness of breath, or chest pain?
What medications is the patient taking?
Does the patient have any allergies?
Does the patient smoke?
Does the patient have any other medical conditions?

What physical aspects would have been completed as part of the physical exam?

The following physical aspects would have been completed as part of the physical exam:

Vital signs, including temperature, blood pressure, pulse, and respiratory rate.
Auscultation of the lungs.
Palpation of the lymph nodes.
Examination of the throat.

Based on the medical history and physical exam, what is the most likely cause of his cough?

The most likely cause of his cough is angiotensin-converting enzyme (ACE) inhibitor-induced cough. ACE inhibitors are a class of medications that are used to treat hypertension and heart failure. They work by blocking the action of angiotensin-converting enzyme, which causes the blood vessels to dilate. This can lead to a dry, hacking cough that is often worse at night.

What other possible diagnoses should be considered?

Other possible diagnoses that should be considered include:

Upper respiratory tract infection
Asthma
Chronic obstructive pulmonary disease (COPD)
Gastroesophageal reflux disease (GERD)
Lung cancer

Are there any other tests that should be completed before producing a diagnosis? Why or why not?

No other tests are necessary before producing a diagnosis. The diagnosis of ACE inhibitor-induced cough is based on the patient’s history and physical exam.

What is the treatment for this patient, including education?

The treatment for this patient includes:

Discontinuing the ACE inhibitor.
Starting a different class of medication to treat hypertension and heart failure.
Using over-the-counter cough suppressants and expectorants.
Drinking plenty of fluids.
Avoiding smoking and secondhand smoke.

Conclusion:

In conclusion, the most likely cause of this patient’s cough is ACE inhibitor-induced cough. Other possible diagnoses that should be considered include upper respiratory tract infection, asthma, COPD, GERD, and lung cancer. No other tests are necessary before producing a diagnosis. The treatment for this patient includes discontinuing the ACE inhibitor, starting a different class of medication to treat hypertension and heart failure, using over-the-counter cough suppressants and expectorants, drinking plenty of fluids, and avoiding smoking and secondhand smoke.

References:

[Angiotensin-converting enzyme inhibitor-induced cough