Discuss the Mr. Barley history that would be pertinent to his respiratory problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

Mr. Barley’s History That Would be Pertinent

The patient comes to the clinic experiencing breath shortness and a worsening cough in the last month. The worsening of the cough is more pronounced in the morning, and the cough comes with whitish phlegm. The current systems are the same as the ones he had around one year ago.

The patient has a history of forty pact year smoking. Even though he is a farmer and is close to chemicals, he usually has the protective gear. The patient reports no recent travels and has not had tuberculosis exposure.

The patient has no orthopnea, paroxysmal nocturnal dyspnea, or swelling of the leg. While the patient has hypertension and stroke as part of the family history, there are no other major illnesses in this family history.

Physical Exams and Diagnostic Tools

Physical exams is essential in diagnosis. The exams revealed that end-expiratory wheezing, some crackles located at the bottom area of the lungs, and a bigger AP diameter. Besides, a murmur was located at the right upper sternal border and some radiation to the sterna border (lower left area).

A pulmonary function test was also given for COPD diagnosis (Wang & Zeng, 2020), while a chest x-ray was applied to help in ruling out other dyspnea causes. A spirometry test was also given. I believe that the tests were comprehensive, and I would not recommend any additional tests.

Plan of Care

The main primary care plan for the patient is smoking cessation. A smoking cessation plan should be comprehensive and patient-centered if it has to be successful; therefore, offering education and information about smoking cessation can be key in helping the patient quit smoking.

The education sessions should be combined with pharmacological interventions such as the use of a bronchodilator as the need arises. The use of bronchodilators can be helpful in relieving symptoms connected to COPD (Janson et al., 2019). Besides, the patient should be taught the side effects of bronchodilators. The patient should come for a follow-up in two weeks’ time.

References

• Janson, C., Malinovschi, A., Amaral, A. F., Accordini, S., Bousquet, J., Buist, A. S., … & Jarvis, D. (2019). Bronchodilator reversibility in asthma and COPD findings from three large population studies. European Respiratory Journal, 54(3). DOI 10.1183/13993003.00561-2019
• Wang, K., & Zeng, R. (2020). Pulmonary function test. In Handbook of Clinical Diagnostics (pp. 337-342). Springer, Singapore.