SOLVED70

You are working with Dr. Nancy Law in a community clinic. Today she is scheduled to see a new patient, Sunita Patel, with a report of a cough for eight weeks. Dr. Law asks you to do a focused history and physical exam and develop a working differential before presenting Sunita’s story to her. You begin by picking up Sunita’s chart and reviewing the nurse’s intake information: Patient: Patel, Sunita Patient new to practice. Recently moved to area. Old records are being faxed from prior PCP. Age: 6 years Chief concern: Coughing for eight weeks. No improvement and maybe worsening. Mom concerned. Vital signs: Temperature is 37.6 C (99.68 F) Pulse is 92 beats/minute Respiratory rate is 18 breaths/minute Oxygen saturation is 99% Weight is 22 kg (50th percentile) Height is 118 cm (50-75th percentile) Medications: None Allergies: No medication, food, or environmental allergies You continue your history by asking a focused review of systems and learn the following: Constitutional: No fevers associated with the cough. No weight loss. Good appetite. Skin: Patient has mild eczema. No new rashes associated with this cough. Head: No headaches. More nasal congestion since moving here. Had some sneezing during the early autumn. Throat: No sore throat. No change in Sunita’s voice. No history of choking. Respiratory: Cough is sometimes triggered by laughing or crying. No shortness of breath. No wheezing. No chest pain. Cardiac: No palpitations. Gastrointestinal: No stomach aches. No vomiting or diarrhea. Past medical history: Born in India and moved to the U.S. when she was one year old. Born full term without complications. Past history significant for mild eczema and two episodes of otitis media as a toddler. No history of hospitalizations, pneumonia, or wheezing. Normal growth and development. Immunizations up-to-date. No medication allergies. Family History: Asthma (mother and cousins). No other chronic pulmonary conditions or infections. No one with recurrent infections. Social History: In first grade and enjoys school. Family moved to the area about three months ago. They live in a single-family home. There are no smokers in the house. They have one dog. There are carpets in the bedrooms. Sunita lives with her parents, 9-year-old brother, paternal grandmother. Grandmother is from India and moved to the United States three months ago when they moved into the new house. Mrs. Patel notes that there is a lot of tuberculosis in the area of India where the grandmother lived, but the grandmother recently had a negative tuberculin skin test (TST) and has not had a cough. Tuberculosis is an unlikely cause of Sunita’s cough, but placing a TST or ordering an Interferon Gamma Release Assay (IGRA) would be reasonable to consider. As you complete your history and prepare to do a physical exam, you review the information from Sunita’s history and your initial impression. Based on what you know about the patient so far, write a one- to three-sentence summary statement to communicate your understanding of the patient to other providers.
SCIENCE
HEALTH SCIENCE
NURSING

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