Question Answered step-by-step Jose is a 60-year-old retired states trooper who presents to the… Jose is a 60-year-old retired states trooper who presents to the clinic with shortness of breath (SOB). The SOB has been going on for several weeks, but it has gotten progressively more frequent over the past week. In the past, it occurred only with strenuous activity, which he has limited. Now, it occurs with minor exertion, such as walking from the front door to his mailbox. The SOB improved with rest, but over the past week, he has had to rest more often. He has a cough productive of yellow mucoid sputum. He denies chest pain, orthopnea, paroxysmal nocturnal dyspnea, and palpations. He denies nasal congestion, ear pain, sinus pain, sore throat, neck pain, or stiffness, and fever. He has lost 25 pounds over the past 3 months and notes that his appetite is decreased. He denies night sweats. He does not have headaches, ear pain, facial pain, sore throat, nasal congestion, or neck pain or stiffness. He denies swelling in his legs. He does have some pain with exertion, but this goes away if he sits down and rests for a few minutes. He denies muscle or joint pain. He had mumps and chickenpox as a child. He has high blood pressure, for which he takes two medications. He has high cholesterol and takes one medication for it. He had an appendectomy at age 10, a hernia repair at age 18, and an arthroscopy at age 35. He lives with his wife of 36 years. They have four children. He smokes three packs of cigarettes daily and started smoking at age 15. He drinks a six-pack of beer every weekend. He has never tried illicit drugs. He completed an associate degree in criminal justice. He used to go jogging but has not had the energy continue for several months. His father died of lung cancer at the age of 63. His mother is alive and has high blood pressure; she had a stroke last year and is currently living in a long-term care facility. Using the information in the scenario and the actual findings below, What are three (3) differential diagnoses? Include why you chose each diagnosis based on the information and identify the most likely diagnosis (by listing the most likely first). Give proper citation. Actual Findings: General Survey: The patient is an alert older male, sitting in a chair with his arms at his side and leaning forward slightly Vital Signs: BP 135/78mm Hg; HR 75 bpm/regular; respiratory rate 28 breaths/min; temperature 97.5F HEENT: Normocephalic, atraumatic; Sclera white, conjunctivae clear; External ear canals pink; tympanic membrane pearly gray with a good cone of light; Nose patent with pink mucosa; Oropharynx pink and moist; Neck supple without adenopathy Cardiovascular: JVP 8 cm above the right atrium; carotid upstrokes brisk without bruits; good S1, S2; no S3, S4: no murmurs or extra sounds; PMI 9 cm lateral to the midsternal line. Thorax and Lungs: Thorax with increased A-P diameter; hyper resonance to percussion; Lungs with decreased breath sounds and end-expiratory wheezes; no rales or rhonchi; Decreased respiratory excursion; diaphragms descend 2 cm bilaterally Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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