Reference no: EM133551461
Assignment:
The Sullivan's are a family of four who reside in rural Canon City, Colorado. They are interracial, "middle-class", Catholic, and well-respected in the community.
Jack (65-year-old husband and father): Hispanic; owns the local hardware store; smokes; is moderately obese, with heavy red meat and fat intake; enjoys a "few" cocktails in the evening; participates on City Council; does not make regular preventive care visits or adhere to medical instructions.
He has been a patient in your practice for the past 2 years. He is here today for re-evaluation of his COPD. He was diagnosed with COPD 3 years ago based on his clinical symptoms. He currently has an early morning cough, productive of clear/white sputum.
Social history: previously smoked 2 packs of cigarettes daily for 35 years and has now cut down to one pack per day. Married, lives with his wife and 2 (16 & 9 y/o) children. He lives in a ranch-style house because he is unable to climb stairs. He has been losing weight over the past year or so because "It is too hard to eat" he states.
PMH: Last year, hospitalized with pneumonia which required a brief admission to the ICU but he was not intubated, cardiomegaly.
Medications: Albuterol MDI BID and occasionally uses a Flovent inhaler ("when I remember"). He has required antibiotics and prednisone for exacerbation's about three times during the past year. He has not received any immunizations.
Vital signs:
5'9", weight 210#. His weight when he was 30 years old was 180#.
You repeat spirometry testing and find that FEV1 is 39%, < 80% predicted. O2 saturation is 87% at rest and 83% after walking 100'.
PE: A&Ox3, color pink, skin w/d. HRR, Chest scattered rhonchi, extremeties: no edema. pulses intact
1- What are the top 3 differential diagnosis and why? present pertinent positives and negatives
2- Provide a plan for the top differential for this patient including education.