Meet the Wanamaker Family

Family Presentation

Jerry and Stan Wanamaker have been in a committed relationship for 15 years and have been married for the last three years. Stan works as a successful stock broker while Jerry, a former teacher, is retired and on disability due to chronic heart disease. They live in a comfortable apartment on Long Island, New York. Jerry’s mother, Esma, lives nearby in an assisted living facility. Kaylah, Stan’s daughter, attends New York University and lives with a roommate on-campus. They are a close family, frequently getting together for holidays and special events.

Family health history

Jerry was successfully treated for acute promyelocytic anemia 15 years ago, however he developed heart failure as a side effect of the chemotherapy used. Jerry’s father had COPD and dementia. He passed away from pneumonia 2 years ago. Stan is healthy, but suffers frequent migraines. His parents have both passed away. His mother had a history of rheumatoid arthritis and kidney stones. His father had a history of hyperlipidemia and type II diabetes. His father passed away from renal failure, while his mother passed away last year after suffering a fall and hip fracture. Esma is an active senior, who experienced a CVA 10 years ago with no apparent residual effects. Since that time, she has been on a statin and has had no further cerebrovascular events. Kaylah is a healthy college student who, aside from the occasional cold, has no medical issues.

Meet the Family Members

Jerry Wanamaker: 44 years old, healthy. Suffers from chronic heart failure. History of acute promyelocytic leukemia 15 years ago. Lactose intolerant. Smoked cigarettes for 10 years, approximately 1/2 pack per day. Quit smoking in his early 30s.

Stan Wanamaker: 47 years old, with a history of migraines and irritable bowel syndrome.

Esma Stein: 80 years old, history of osteoporosis, hypertension, chronic back pain, cataracts, and CVA with no residual deficits.

Kaylah Wanamaker: 21 years old, healthy with no significant medical history.

Respiratory Case Study- Kaylah Wanamaker History of Current Problem

Kaylah presents at the University’s clinic with complaints of a dry, hacking cough that has persisted for 5 days. It began with a cold, which came on after an intense week of classes and social activities, during which Kaylah had been sleeping an average of 4 hours per night. She had the cold for about a week, during which she also had a slight fever and sore throat. This was followed by a period of watery nasal discharge, which became deep yellow and thick. Kaylah has been coughing so much that her chest hurts, particularly when deep breathing or coughing. She has not been able to get much rest the last few nights.

Additional Past Medical History

Remember to review the family’s medical history in the introductory presentation. Kaylah is a healthy young woman, who exercises daily and follows a vegetarian diet. She has an active social life and maintains a 4.0 grade average. She is not currently taking any medications. She states that she is not sexually active and denies the use of birth control. While she does not smoke, she admits that she has recently experimented with vaping.

Objective Exam

System Findings

General Kaylah is alert, well-hydrated, well-groomed, although she appears tired.

Vitals Temp: 37.1 C, Pulse 80, RR 16 per minute, BP 106/70. O2 sat. is 98%. Weight is 56 kg.

Skin Warm, dry, and intact. No rashes or lesions.

HEENT Normocephalic. Eyes show no discharge or drainage, although she does have dark circles under each eye. Nose exhibits slight rhinnorhea. Turbinates are pink and no nasal polyps are noted. No redness or erythema of the throat noted.

Respiratory Scattered and bilateral rhonchi noted. No use of accessory muscles noted. Periodic spasmodic coughing.

Cardiovascular No murmurs noted. S1/S2 auscultated. RRR. No clubbing, cyanosis, or edema noted. 3+ femoral and brachial pulses bilaterally

Lymphatic Negative for lymphadenopathy

Abdomen Soft, nontender and non-distended. + bowel sounds. No hepatosplenomegaly noted during palpation

Genitourinary No abnormal findings

Neurological No abnormal findings

Diagnostic testing:

 None ordered

Based upon these findings, the NP you are working with arrives at the following differential diagnosis:

 Acute bronchitis

QUESTION

Bridge to Assessment: Discuss how the pathophysiologic processes occurring in acute bronchitis contribute to Kaylah’s clinical presentation. Link the pathophysiology to the assessment findings. What other findings are commonly observed in acute bronchtis and what causes them?