Different Diagnosis

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Differential Diagnoses
1 Chronic Obstructive Pulmonary Disease with Acute Exacerbation J44.1
An acute exacerbation of COPD entails sudden worsening of the patient’s respiratory symptoms. This can be classified into mild, moderate, or severe (Sato et al., 2016). Ko et al. (2016) state that one of the most common causes of an acute exacerbation is the presence of an ongoing infection, which may be bacterial or viral in nature. Its signs and symptoms are worsening respiratory symptoms, especially dyspnea or shortness of breath. This is accompanied by increased sputum production with changes in color and quality, fatigue, and the need to increase the frequency of medications. The condition may progress into acute respiratory failure, which is a life-threatening situation. Some of the risk factors include previous acute exacerbations, which are directly correlated with the risk, cardiovascular diseases such as ischemic heart disease and cardiac failure, history of asthma, long-term oxygen therapy, and significantly decreased partial pressure of arterial oxygen (Crisafulli et al., 2018). The decline in respiratory function may be ascribed to progressive airway inflammation leading to airflow limitation. Furthermore, since COPD tend to have an incomplete symptom resolution, it contributes to aggravating systemic inflammation. Data suggest that an acute exacerbation decreases lung function to approximately twenty-five percent (Hillas et al., 2016).
In this case, the patient was diagnosed with chronic obstructive pulmonary disease in 2013 and asthma in 2015. Both of these are risk factors in having a COPD exacerbation. Moreover, despite having these diseases, the patient failed to discontinue smoking. Other risk factors include a slight decrease in oxygen saturation at 90 to 93% and the presence of cardiovascular disease (cardiac dysrhythmias NOS in 2007 and pernicious anemia in 2019). The risk associated with cardiovascular disease is elevated due to the following signs: reduced peripheral pulses (2+ in radial, femoral, and brachial arteries, 1+ in popliteal, tibial, and dorsalis pedis arteries) and increased jugular venous pressure (3cm above the sternal angle), which indicates an increased atrial pressure. All of these predispose the patient to have exacerbations. The presence of a sore throat may imply an acute upper respiratory infection, which predisposes the patient to an acute exacerbation.
The signs and symptoms present in the patient include dyspnea or shortness of breath, primarily upon exertion, fatigue, and productive cough. The gravity of dyspnea is also evident when the patient says that she frequently sleeps on an elevated headrest. The patient also manifests wheezing, which indicates asthma. Additionally, pulmonary examination reveals ronchi in the RLL.
2 Acute Upper Respiratory Tract Infection (URTI) J06.9
URTIs represent signs and symptoms related to the upper airways (sinuses, nose, laryngopharynx, and the larger airways). Frequently, an infection develops when a pathogen invades the upper airway mucosa. The pathogens can be acquired through inhalation or droplet transmission. The barriers against these pathogens are the hair lining the nasal mucosa, the angle between the nasal passage and pharynx, and cilia in the lower airways that transport the pathogen back to the upper respiratory tract to be excreted outside the body (Thomas & Bomar, 2020).
The risk factors include a previous history of asthma or allergic rhinitis, smoking, contact with individuals who had previous infections, or those who present with symptoms of a URTI, low immunity, and anatomical anomalies. The signs and symptoms include cough, sore throat, runny nose, nasal congestion, headache, low-grade fever, sneezing, malaise, facial pressure, and myalgia (Thomas & Bomar, 2020). Chen et al. (2020) suggest that a URTI is a prerequisite for acute COPD exacerbation. Hence, the patient’s additional signs and symptoms.
The patient is currently present with rhinorrhea or runny nose, productive cough, headache, sore throat, and fatigue. However, the patient does not show fever signs and symptoms (temperature is at 97.4 degrees F). She has the following risk factors: a lifetime smoker, history of asthma, and contact with patients with infection (a relative who had COVID-19).
3 Pneumonia, unspecified organism J18.9
Pneumonia presents with high-grade fever with chills, tachycardia, sweating, productive or nonproductive cough (can be blood-tinged, purulent, or transparent), dyspnea even when doing every day, or light work, pleuritic chest pain, headache, arthralgia, myalgia, and fatigue. Its primary risk factor is exposure to an individual with a history of pneumonia during its active stages (Sattar & Sharma, 2019). Physical examination varies from person-to-person, but one may present high or low temperature, tachycardia or bradycardia, tachypnea or bradypnea, cyanosis, positive egophony, increased tactile fremitus, crackles, ronchi, or rales, and flat to dull sound on percussion (Sattar & Sharma, 2019; Htun et al., 2019).
In our patient, pneumonia must be ruled out because it presents with some of its signs and symptoms. Furthermore, the patient has a moderate risk of incurring the disease, as manifested by exposure to a COVID-19 patient. To rule out pneumonia, the following tests must be done: sputum and blood culture, C-reactive protein, procalcitonin, serology, ESR, and chest x-ray (Htun et al., 2019).
4 Cough R05
Cough can also be a protective reflex initiated by the higher brain centers to remove the pathogen or foreign object that entered the respiratory system. The stimulus is carried to the caudal nucleus of tractus solitarius, and this projects to...