(Answered) NR601 Week 2: COPD Case Study Part 1

Case Study – Part 1

Date of visit: November 20,2019 

62 year-old Caucasian male presents to the office with persistent cough and recent onset of shortness of breath. Upon further questioning you discover the following subjective information regarding the chief complaint. 

History of Present Illness 
Onset  6 months 
Location  Chest 
Duration  Cough is intermittent but frequent, worse in the AM 
Characteristics  Productive; whitish-yellow phlegm 
Aggravating factors  Activity 
Relieving factors  Rest 
Treatments  Tried Robitussin DM without relief of symptoms 


Severity  Unable to walk > 20ft without stopping to catch his breath. Last year at this time he routinely walked 1 mile per day without difficulty 
Review of Systems (ROS) 
Constitutional  Denies fever, chills, or weight loss 
Ears  Denies otalgia and otorrhea 
Nose  Denies rhinorrheanasal congestion, sneezing or post nasal drip.  
Throat  Denies ST and redness 
Neck  Denies lymph node tenderness or swelling 
Chest  Describes a persistent productive cough upon wakening for the last 6 months. Color of phlegm is usually white-yellowishShortness of breath with activity. 
Cardiovascular  Denies chest pain and lower extremity edema 


Medications  Metoprolol succinate ER (Toprol-XL) 50mg daily for hypertension; Multivitamin daily 
PMH  Primary hypertension 
PSH  Cholecystectomy, appendectomy 
Allergies  Penicillin (hives) 
Social  Married, 3 children 

Senior accountant at a risk management firm 

Habits  Former smoker (20 pack-year), quit “cold turkey” when father died; Denies alcohol or illicit drug use. 
FH  Father died of MI & CHF at age 59 years (diabetes, hypertension, smoker) 

Mother is alive (osteoporosis)  

Healthy siblings 


Physical exam reveals the following: 

Physical Exam 
Constitutional  Adult male in NAD, alert and oriented, able to speak in full sentences  
VS  Temp-98.1, P-66, RR-20, BP 156/94, Height 68.9in, Weight 258 pounds, O2sat 94% on RA 
Head  Normocephalic 
Ears  Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. 
Nose  Nares patent. Nasal turbinates clear without redness or edema. Nasal drainage is clear. 
Throat  Oropharynx moist, no lesions or exudate. Tonsils ¼ bilaterally. Teeth in good repair, no cavities noted. 
Neck  Neck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. No JVD 
Cardiopulmonary  Heart S1 and S2 with no murmurs, noted. Lungs clear to auscultation bilaterally with faint forced expiratory wheezes in bilateral bases. Respirations unlabored. Legs without edema. 
Abdomen  Soft, non-tender. No organomegaly 



  1. Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. May use approved medical abbreviations. Avoid redundancy and irrelevant information.
  2. Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement (2-3 sentences) of pathophysiology for each.
  3. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.
  4. Rank the differential in order of most likely to least likely.
  5. Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based practice (EBP) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBP evidence.


History and physical (H&P) findings

The patient is a 62-year old Caucasian male, who present to the primary care with a cough that started 6 months ago. He reports intermittent cough, productive with white-yellowish sputum. A factor that aggravates the cough is the activity, and cannot manage more than 20ft walking before he stops to catch a breath. This is a drastic change from last year as he could easily manage one mile without difficulty. The cough is worse in the morning and is relived with only rest and has tried using Robitussin DM to manage the symptoms.  He has a height of 68.9in of  weight 258 pounds, O2sat 94% on RA ….To access the solution  click the icon below to purchase at $10