As a nurse practicing within a family practice, you are interviewing a 55-year-old woman who is an executive assistant at a local law firm, where she has worked for 9 years. She has a 7-year history of respiratory illness, which occurs several times throughout the year, not seemingly connected to the changes in season. She does not use tobacco products in any form. During your questions regarding her home and work environments, she reports that she enjoys working adjacent to the courthouse in a building over 100 years old because it is such a contrast to her brand-new home on a local golf course. When describing the health of her coworkers, she indicates, “We all share illnesses, which seem to affect everyone else during the year; we just seem to be sicker more often!”
- What information is pertinent to your client’s case?.
- How would you assess your client’s risk?.
- What would be an exposure pathway for your client?.
Your document should be 1-2 pages in length, in APA format, typed in Times New Roman with 12-point font, double-spaced with 1” margins, and include at least two citations using references less than five years old.
Clinical History of a Respiratory Illness
A 55-year old woman presents with a 7-year history of a respiratory illness that does not seem to worsen or improve with a particular season of the year. She does not use any tobacco products but she reports observing a similar illness amongst her coworkers. It would be pertinent to establish symptoms that she experiences. For example, if she coughs, is it productive or non-productive? This is crucial because an infection would give a productive cough with certain colour changes in the mucus or sputum. The presence of blood or pus should also be enquired in the case of a productive cough. It would be important to enquire about the duration of the cough. Has it existed over the entire period of the illness or did it just start recently? A chronic cough is suggestive of a progressive destructive process.
Chest pains is also an important symptom to enquire about. These could be occurring during coughs or when the patient is at rest. Chest pains are a distinctive feature of pulmonary tuberculosis. These may be accompanied by breathlessness or chest tightness as a result of accumulation of respiratory secretions such as mucus.
It is crucial to assess the presence of fever. Elevations of body temperature is indicative of a viral, bacterial or parasitic infection and less likely to be a malignancy. This may be observed as night sweats which is a common feature of patients with TB. This may be accompanied by decline in body temperatures in the morning. The patient may complain of chills when they wake up. Besides these, the presence of systemic manifestations of disease should be enquired about, for example, muscle pains, joint pains, loss of appetite and significant weight loss.
The occurrence of other diseases is also important in the pathogenesis of respiratory diseases. Eliciting illnesses such as HIV/AIDS, diabetes mellitus or a malignant condition points towards weakening of the immune system that contributes to further invasion by infective organisms. (Gellete, Kebede, & Berhane, 2017)
In assessing the patient’s risk, I would carry out a chest x-ray. From this, it would be easier to tell the extent of damage to the lungs, trachea or bronchi. It is also possible to elicit fluid accumulations in the chest cavity. Measurement of weight and comparing it with her weight from the previous years would be important to notice the trend in her weight assuming that she is on a normal and healthy diet. A microbiological analysis of a respiratory lavage would effectively point out the extent of invasion by microorganisms. Other tests include a full hemogram, serum analysis and bone marrow examination to determine whether the disease has disseminated.
From the patient’s clinical history, she was possibly exposed to an infected patient most likely in her place of work about a decade ago. She inhaled respiratory droplets after the first case coughed or sneezed. Microorganisms in these droplets then accumulated and multiplied in her lungs causing a latent infection which has been advancing over the years. This would probably be due to compromise of the immune system (Orme, 2014)