COPD Secondary to Metastatic Lung Cancer Assignment

Subjective data

The advanced practice nurse (APN) should obtain a detailed history of the present illness (HPI) and inquire about the onset, duration, and progression of the patient’s dyspnea, fatigue, and decline in lung function. They should explore associated symptoms such as cough, sputum production, weight loss, and pain. The patient’s statement of being “tired of this fight” should be further explored to assess his emotional and psychological well-being. This paper aims to evaluate a patient with a respiratory infection secondary to metastatic lung cancer. COPD Secondary to Metastatic Lung Cancer Assignment

The APN should gather information about the patient’s smoking habits, including the duration of smoking, the number of cigarettes smoked per day, and any previous attempts to quit smoking (Swenson et al., 2022). The APN should review the patient’s medical history, including the diagnosis of metastatic lung cancer and previous treatments. The APN should explore the patient’s social support system, living conditions, and any barriers to accessing healthcare.

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Additional objective data to assess for verification

Measure the patient’s oxygen saturation (SpO2) levels to confirm the low arterial blood oxygen levels reported in the case. Verify the patient’s respiratory rate, as an elevated rate was noted in the initial presentation. The APN would confirm the presence of diminished breath sounds over the affected lung fields and assess for any adventitious sounds, such as wheezing or crackles (Bertrand et al., 2020). Reconfirm the dullness noted on percussion over the right lower and middle lung fields, which suggests consolidation or pleural effusion. Observe for signs of increased work of breathing, such as using accessory muscles in the neck and chest, and assess the patient’s general appearance, level of consciousness, and signs of pallor or cyanosis. COPD Secondary to Metastatic Lung Cancer Assignment

Co-morbid conditions

Assessing for signs of malnutrition, such as weight loss and muscle wasting, would be essential, as the patient mentions a lack of energy to eat. The APN would observe signs of depression or anxiety, as indicated by the patient’s statement of feeling tired of the fight and expressing a desire to die (Rohde, 2021). The APN should perform a thorough cardiovascular examination to evaluate for any signs of cardiac involvement or complications, considering the patient’s history of metastatic lung cancer and the tracheal shift noted on the AP’s chest x-ray.

For this patient, the appropriate national guidelines to consider are the guidelines for diagnosing and managing lung cancer. These guidelines may vary depending on the country, but they generally provide recommendations for evaluating, staging and treating lung cancer.

Diagnostic tests

A chest CT scan can provide detailed imaging of the lung masses and help determine the extent of metastasis. Pulmonary function tests could assess lung function and measure parameters such as forced vital capacity (FVC) which can help evaluate the severity of airflow limitation.   (Kramer & Annema, 2021). In addition, Bronchoscopy, complete blood count, and lung biopsy would be essential. Based on the information provided, the medical diagnosis for the patient is COPD secondary to metastatic lung cancer. COPD Secondary to Metastatic Lung Cancer Assignment

A lung mass, tracheal shift, diminished breath sounds, and dullness on percussion suggest the involvement of the right middle and lower lung fields. However, given the long-standing history of cigarette smoking and the underlying malignancy, a diagnosis of COPD is more likely, particularly chronic bronchitis. The patient’s history of tobacco and accelerated decline in lung function are additional supporting factors (Adeloye et al., 2019). Differential diagnoses could include pneumonia, Tuberculosis, and asthma.

Treatment plan

The patient would be started on supplemental oxygen therapy at 2 liters per minute via nasal cannula to improve oxygenation and relieve dyspnea. Prescribe opioids, such as morphine, at an appropriate dose (e.g., 5 mg immediate-release tablets) to alleviate pain associated with metastatic lung cancer. I would also administer short-acting bronchodilators, such as albuterol, via a metered-dose inhaler (MDI) with a spacer or a nebulizer, as needed, to relieve bronchospasm and improve breathing and refer the patient for a palliative consult (Buttery et al., 2021). Also, I would engage the patient in a conversation about the importance of quitting smoking to improve overall lung health and possibly slow down the disease progression.

Healthy People 2030 goals, in this case, focus primarily on palliative care rather than meeting the disease prevention or health promotion goals outlined in Healthy People 2030. However, there are still opportunities to promote health within this context. Some considerations include psychological support strategies to address the patient’s emotional well-being and mental health, such as providing access to counseling services or support groups for patients with terminal illnesses. COPD Secondary to Metastatic Lung Cancer Assignment

Patient teaching

I would discuss advance care planning, including the importance of documenting preferences for resuscitation, life-sustaining treatments, and palliative care. Providing information about resources for creating advance directives and appointing a healthcare proxy would also be beneficial.

CTP code 99204 represents the comprehensive level of evaluation and management for a new patient with a complex medical condition. ICD-10 code C34.91 for the diagnosis of COPD for follow–up and billing. The initial visit code (99204) requires a higher level of complexity, including a more detailed history, comprehensive examination, and medical decision-making, as the patient’s condition is assessed for the first time (Sivakumaran et al., 2021). The follow-up visit code (99214) represents the ongoing management of an established disease and involves a slightly less detailed examination and medical decision-making.

During the next office visit, which should be within days, the physician would assess the patient’s respiratory status, including lung function tests, oxygen saturation levels, and physical examination findings. The treatment plan may be revised based on this assessment, including adjusting medications for symptom relief, considering oxygen therapy, referring to palliative care services, and discussing the patient’s desire for end-of-life care. COPD Secondary to Metastatic Lung Cancer Assignment

References

Adeloye, D., Song, P., Zhu, Y., Campbell, H., Sheikh, A., Rudan, I., & NIHR RESPIRE Global Respiratory Health Unit (2022). Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modeling analysis. The Lancet. Respiratory medicine, 10(5), 447–458. https://doi.org/10.1016/S2213-2600(21)00511-7

Buttery, S. C., Zysman, M., Vikjord, S. A. A., Hopkinson, N. S., Jenkins, C., & Vanfleteren, L. E. G. W. (2021). Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity. Respirology (Carlton, Vic.), 26(5), 419–441. https://doi.org/10.1111/resp.14032

Grünewaldt, A., Stützle, S., Lehn, A., & Rohde, G. (2021). Dyspnoe und Komorbidität beim Lungenkarzinom: Warum die Anamnese so wichtig ist [Dyspnoea and Comorbidity in Lung Cancer-Patients: The Therapy Starts with Taking the Patients History]. Pneumologie (Stuttgart, Germany), 75(5), 353–359. https://doi.org/10.1055/a-1340-5609

Kramer, T., & Annema, J. T. (2021). Advanced bronchoscopic techniques for the diagnosis and treatment of peripheral lung cancer. Lung cancer (Amsterdam, Netherlands), 161, 152–162. https://doi.org/10.1016/j.lungcan.2021.09.015

Sivakumaran, S., Alsallakh, M. A., Lyons, R. A., Quint, J. K., & Davies, G. A. (2021). Identifying COPD in routinely collected electronic health records: a systematic scoping review. ERJ open research, 7(3), 00167-2021. https://doi.org/10.1183/23120541.00167-2021

Swenson, T. L., & Tran, R. T. (2022). What we learn by taking a social history. Journal of the American Geriatrics Society, 70(9), 2710–2711. https://doi.or COPD Secondary to Metastatic Lung Cancer Assignment

A 6o-year-old white man presents with an accelerated decline in lung function. Last year he was diagnosed with metastatic ling cancer. Today he is dyspneic,

pale, and seems almost listless. He continues to smoke and his pack-year history is 40 years. He says “I am tired of this fight”.

CC: “I have to sleep in my recliner because I can’t lie in bed, and I have no energy to do anything—I don’t even have energy to eat, I just want to die.”

Physical exam: Blood pressure, 120/74; pulse rate, 120 beats/min; respiration rate, 36/min

Height, 5΄9΄΄; weight, 130 lbs.

AP to lateral diameter: 1:1

Cough with clear mucoid sputum

Diminished breath sounds

Dullness overright lower and middle lung fields on percussion and use of accessory muscles during respiration

Chest x-ray film: Mass noted RML and RLL, tracheal shift to left, no cardiomegaly

Arterial blood gases: pH 7.2, PaO2 55, pCO2 60, HCO3 26

Questions:

1. Subjective data: What subjective data should the APN obtain? How is the complaint investigated ie HPI?

This area should discuss history, ROS, and HPI format.

2. You will reassess to verify the presented information. For what additional objective data will you assess and why? COPD Secondary to Metastatic Lung Cancer Assignment

3. What co-morbid conditions should be investigated through the physical exam, how and why?

4. What National Guidelines are appropriate to this case? What do the guidelines state?

What level of evidence supports these guidelines?

5. What diagnostic tests will you order? Why do they apply to this case? What is the sensitivity and specificity? When it is positive or negative what does that mean?

6. What is your medical diagnosis? What are the differential diagnoses?

7. Treatment plan should clearly state what exact orders you are ordering. All medications must have a name, a dose, a route, and a frequency. The diet must be specific. The diagnostics must be specific. Do not say XRAY say type of Xray ie AP/Lat chest Xray

8. Are there any Healthy People 2030 goals that you should consider? How will you promote health with this case? How does it meet the 2030

9. What specific patient teaching is needed? Do not say “how to use an inhaler” state exactly what you will teach COPD Secondary to Metastatic Lung Cancer Assignment

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10. What billing codes would you recommend? This must include the CPT code for outpatient office visits. ICD classify diagnoses ie HTN i10, CPT codes are 992–, Describe the difference between the first visit billing code and follow up billing code.
11. Follow up and evaluation. When will the next office visit occur? What will you assess? How will you revise the plan based upon this assessment? For instance, if you are assessing the HgbA1c and it is 9, what will you order? If it is 6.5 what will you do? COPD Secondary to Metastatic Lung Cancer Assignment