7 Proven Strategies for Mastering Clinical Assessment of Cough Successfully | studycreek.com
Learn 7 effective tips to effective clinical assessment of cough.
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Introduction
Cough examination is among the most common and necessary skills of healthcare practice, especially in the nursing and primary care practice. Cough is a symptom with a very broad etiological basis, including simple upper respiratory infections and dangerous cardiopulmonary diseases. Due to the wide range of this difference, the clinical evaluation of cough should be patient-focused, evidence-based, and systematic.
The clinical assesment of cough in clinical education and practice provides the healthcare provider with the ability to distinguish between acute, subacute, and chronic conditions and avoid extraneous diagnostic tests. This paper discusses seven evidence-based practices which can be applied to improve clinical assessment of cough, diagnose more accurately, and promote the best patient outcomes.
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Knowing the Intention of Clinical Assessment of Cough.
The initial objective of the clinical essessment of cough is to determine the root cause in the form of a detailed history and directed physical examination. The very cough is a protective reflex, however, the continued coughing or coughing of a severe nature is often a sign of an underlying pathology that will need additional examination.
A systematic clinical assessment of cough assists the clinicians:
- It should be established whether the cough is acute, subacute, or chronic.
- Early detection of life threatening conditions.
- Less superfluous imaging and lab tests.
- Facilitate proper treatment planning.
Clinical assessment of cough without the systematic approach may result into misdiagnosis, delayed care or wrong use of antibiotics.
Holistic History Taking in Clinical assessment of Cough.
The clinical assessment of cough is made up of history taking. The provider is obliged to obtain specific data concerning the onset, duration, nature, and symptoms related to it.
Key components include:
- Cough (acute vs. chronic) Time.
- Effective coughing and ineffective coughing.
- Fever, dyspnea, or chest pains.
- Exposure to the environment or work place.
- Smoking or vaping history
A useful clinical assessment of cough is a treatment that incorporates the data that the patient reports but also involves clinical judgment in order to reduce the possible possible diagnosis and advance to physical examination.
Concentrated Physical Examination Methods.
Special physical examination is vital to a quality clinical cough evaluation. The examinations must focus on the ears, nose, throat, and respiratory system and to be precise and effective.
The significant examination elements are:
- Examination of nasal mucosa of inflammation or drainage.
- Exudate or erythema of the throat Oropharyngeal examination.
- Life breath sounds in the fields of the lungs to check the presence of wheezes or crackles.
- Monitoring respiratory effort and oxygenation.
The physical examination of cough depends heavily on the ability to correlate physical results with the past in order to define the further management steps.
Distinguishing between Acute and Chronic Causes.
A characteristic of proper clinical assessment of cough is differentiation. Viral infections are usually associated with acute coughs whereas chronic cough is a symptom associated with asthma, gastroesophageal reflux disease, or postnasal drip.
The clinicians who have a clinical assessment of cough should consider:
- Greater than eight weeks period.
- Lack of infectious symptoms
- Coughing of recurrent or nocturnal nature.
This difference will make sure that clinical assessment of cough provides the right referrals and long-term treatment plans.
Diagnostic Tests in Clinical assessment of cough.
Despite the fact that most of the cases do not necessitate testing, diagnostic tools are supportive in clinical assessment of cough in the context of being accompanied by red flags.
The diagnostic tests that are commonly used are:
- Chest x-ray to eliminate pneumonia.
- Asthma Spirometry.
- Pulse oximetry oxygen saturation.
- Tests ordering should never substitute clinical reasoning with an adequate clinical assessment of cough.
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Identifying Red Flags in Clinical Evaluation of Cough.
The clinical assessment of cough is important in the identification of red flags. Some of the symptoms require urgent intervention or referral.
Red flags include:
- Hemoptysis
- Unintentional weight loss
- Night sweats
- Persistent fever
- Hypoxia
Clinical observation of cough is vigilant assessment of cough, where prioritization of patient safety is done by identifying the times when a symptom goes beyond routine management.
Patient Education and follow up Plan.
Educating patients is part and parcel of clinical assessment of cough. Effective communication determines patient comprehension, compliance to the treatment and proper follow up.
Clinical assessment of cough requires effective education to be inclusive of:
- Discussion of probable reasons.
- Education of symptom monitoring.
- Guidance on medication use
- Dangerous symptoms that need critical treatment.
Follow-up plans enhance follow-up care and complement the delivery of positive results upon the initial clinical assessment of cough.
The Evidence-Based Practice Role.
Evidence-based practice enhances the clinical assessment of cough through a combination of up-to-date investigations along with clinical insight and patient preferences. Recommendations are on a conservative approach to uncomplicated cough management and in support of specific testing, where needed.
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Common Mistakes to Avoid
Mistakes during the clinical assessment of cough are usually as a result of incomplete history taking or early diagnostic tests. Common mistakes include:
Overprescribing antibiotics
Disregarding environmental factors.
The inability to re-examine persistent symptoms.
It is necessary to avoid these pitfalls in order to make the clinical evaluation of cough patient-centered and clinically reasonable.
Direction of Future Research on Clinical Assessment of Cough.
There are new technologies affecting clinical assessment of cough, such as digital tools of auscultation and AI-assisted symptom analysis. Although technology is effective, clinical judgment is the basis of effective cough evaluation.
With the changes in healthcare, clinical assessment of cough will continue to be a competency in the endeavors of nurses and advanced practice providers.
Conclusion
Clinical assessment of cough is a critical clinical skill, which involves taking a comprehensive history, performing a careful physical examination, carrying out selective diagnostic tests and educating the patient. Through systematic measures, the healthcare providers are able to diagnose causes precisely, eliminate unwarranted interventions and enhance patient outcomes.
Regardless of being a student or a practicing clinician, improving your style of clinical assessment of cough will improve diagnostic confidence and professional competence. Academic and clinical writing
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SAMPLE QUESTION
Review this week’s Learning Resources and consider the insights they provide related to ears, nose, and throat.
- Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation within the Shadow Health platform. Review the examples also provided.
- Review the DCE (Shadow Health) Documentation Template for Focused Exam: Cough found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Review the Week 5 Focused Exam: Cough Rubric provided in the Assignment submission area for details on completing tReview the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation within the Shadow Health platform. Review the examples also provided.
Review the DCE (Shadow Health) Documentation Template for Focused Exam: Cough found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
ANSWER
Focused Assessment: Cough
This is the minimum of a week 5 Shadow Health Documentation.
Introduction
Cough is a frequent manifestation both in the primary and acute care facilities, and can have an upper or lower respiratory tract basis, a gastrointestinal etiology, or an environmental etiology. An attentive ear, nose, and throat (ENT) examination, coupled with a respiratory assessment is also a critical part in uncovering the etiology behind cough and applying suitable clinical care. The present paper is a selective subjective and objective evaluation of a patient whose chief complaint is that of cough and thereafter, an explanation of pertinent physical examination and diagnostic tests that were applied to assist in clinical diagnosis.
Subjective Assessment
Chief Complaint
The patient complains of having a chronic cough.
History of Present Illness
The patient is an adult and reports about the cough that has been lasting several days. The description of the cough is non-productive and intermittent. The patient denies fever, chills, chest pain, hemoptysis, or dyspnea at rest but reports the related symptoms of nasal congestion and irritation of the throat. Cough is aggravated by night and prolonged talking. The patient states that she feels partially relieved when taking more fluid and using over-the-counter cough medication. No recent history of travelling or known contacts with respiratory infections.
Past Medical History
The patient denies having any chronic respiratory diseases like asthma or chronic obstructive pulmonary disease. No history of gastroesophageal reflux disease or frequent sinus infection.
Medications
The patient denies the use of over-the-counter cough suppressants occasionally. No reported prescribed drugs.
Allergies
The patient denies any drug allergies.
Social History
The patient denies tobacco, vaping or illicit drug use. Alcohol is said to be used intermittently. Occupational or environmental exposures that might cause irritation of the respiratory tract remain unknown.
Review of Systems
Constitutional: Denies fevers, chills, or weight loss.
ENT: Says that she has nasal congestion and throat irritation but denies ear pain or sinus pressure.
Pulmonary: Denies dyspnea or wheezing at rest; complains of cough.
Cardiovascular: Denies heart pain or palpitations.
Gastrointestinal: Denies reflux, vomiting, or nausea.
Objective Assessment
Vital Signs
Vital signs are normal, and oxygen saturation on room air.
Physical Examination
General Appearance:
The patient is not in acute distress, oriented, and alert.
Head, Eyes, Ears, Nose and Throat:
The head is normocephalic and without trauma. Nares is a mild erythema drainage. There are no tonsillar exudates as there is mild erythema of the oropharynx. Middle ear drums are clear and without signs of infection.
Neck:
Cervical lymphadenopathy is absent. The trachea is midline.
Respiratory:
The expansion of the chest is symmetrical. Breath sounds: clear bilaterally, with no wheezes, crackles, or rhonchi. No involvement of accessory muscles is witnessed.
Cardiovascular:
The heart sounds are normal with normal rate and rhythm. None of the murmurs, rubs or gallops.
Assessment
It can be concluded that the most possible diagnosis is an acute upper respiratory infection with related cough, which can be caused by the postnasal drip, based on the patient history and the physical examination results. There is no fever, abnormal lung sounds and other systemic symptoms that decrease the risk of pneumonia or other lower respiratory tract infections.
Diagnostic Considerations
Even though diagnostic testing is not recommended in this instance, the tests below can be considered in case of the persistence of the symptoms or further deterioration:
Radiography of the chest to exclude pneumonia in case there are abnormal changes in the lungs or fever.
Pulse oximetry to detect oxygen-saturation level.
Spirometry in case of the suspicion of asthma or reactive airway disease.
Viruses testing when it is presumed that there is an infectious etiology systemically.
The findings of such diagnostic tests would help to either confirm or rule the differential diagnoses and make subsequent treatment decisions.
Plan and Patient Education
The patient should be informed that she should take more oral fluids, keep using over-the-counter cough medicines, and prevent environmental allergens. Education is done on symptom monitoring and red flags that require urgent medical care such as cough that gets worse, fever, dyspnea, and chest pains. The patient will be encouraged to have a follow up in case the symptoms are not improved in two or three weeks.
Conclusion
An attentive ENT as well as respiratory evaluation is important when analyzing patients presenting with cough. The etiology of the benign upper respiratory is backed up in this case by both subjective and objective results. Prudent clinical assessment with judicious utilization of diagnostic testing will result in proper diagnosis without resulting in unnecessary interventions. The strategy encourages effective service, patient-centered and safe care.
