Peer Responses: Length: A minimum of 275 words per post, not including reference

Peer Responses:
Length: A minimum of 275 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
In the case of the 68-year-old male presenting to the clinic today complaining of a cough for the last two months that will not go away, frequent urination for the last four months and a past medical history of hypertension there are multiple diagnoses to consider. The first diagnosis differentials that first come to mind are chronic obstructive pulmonary disease (COPD), adverse effects of unspecified drugs, medicaments and biological substances, diabetes, urinary tract infection or overactive bladder. My initial step in creating my diagnosis would be to obtain a more thorough medical history assessment using the acronym OLDCART. I’d ask him to describe his cough, any triggers, allergies, and if he has used any medications to treat it. Regarding his frequent urination I ask him the same questions and more specifically when the urgency occurs more or if it throughout the day, if he has pain while urinating, and assess for costovertebral angle (CVA) tenderness. In addition I’d ask him if he is compliant with his hypertension medications and if he has had any recent illnesses.
Following my history intake, I would perform a physical exam and focus on the ENT, CV, pulmonary, GU and GI systems. Depending on the assessment I would then formulate my plan of care. My leading diagnosis for the cough would be COPD due to his long history of smoking. To confirm I’d order a pulmonary function test, chest x-ray to assess for empyema or possible heart failure and order lab tests as well (Mayo Foundation for Medical Education and Research, 2020). Regarding his frequent urination, if the patient denied dysuria, denied CVA tenderness, and had a negative urinalysis in clinic my leading diagnosis would be overactive bladder. “The sudden urge to urinate, also known as overactive bladder (OAB), may reflect higher sympathetic activity and be associated with higher blood pressure (BP)” (Akbar, 2022). I would order the following labs to also rule out any other diseases that may also be the contributing factors such as CBC, CMP and A1C. Depending on the lab results, urinalysis, pulmonary tests, I would then be able to make a final diagnosis and treat the patient appropriately. In the meantime, I would prescribe the patient a short acting inhaler in case of acute distress such as albuterol, 2 puffs inhaled q4-6h as needed (Epocrates, 2023). If there was no evidence of a urinary tract infection I would prescribe the patient with oxybutynin, 5 mg PO, everyday for his overactive bladder (Epocrates, 2023). I would then schedule a follow up visit in 2 weeks with the patient to discuss the medication and his lab results.
References
Akbar, A., Liu, K., Michos, E. D., Bancks, M. P., Brubaker, L., Markossian, T., Durazo-Arvizu, R., & Kramer, H. (2022). Association of Overactive Bladder With Hypertension and Blood Pressure Control: The Multi-Ethnic Study of Atherosclerosis (MESA). American journal of hypertension, 35(1), 22–30. https://doi.org/10.1093/ajh/hpaa186
Epocrates . (2023). albuterol inhaled. albuterol inhaled: Dosing, contraindications, side effects, and pill pictures – epocrates online. Retrieved March 14, 2023, from https://online.epocrates.com/drugs/3307/albuterol-inhaled#adult-dosing
Epocrates. (2023). oxybutynin. oxybutynin: Dosing, contraindications, side effects, and pill pictures – epocrates online. Retrieved March 14, 2023, from https://online.epocrates.com/drugs/58/oxybutynin
Mayo Foundation for Medical Education and Research. (2020, April 15). COPD. Mayo Clinic. Retrieved March 14, 2023, from https://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/drc-20353685