M.C. is a 69-year-old man who presents to the outpatient office with a hacking, raspy cough. Subjective Data 1. What other questions should the nurse ask about the cough? 2. Develop a problems list from the objective and subjective data. 3. What should be included in the plan of care? 4. What risk factors are associated with this age group?

1. When evaluating MC’s cough, the nurse should ask additional questions to gather more information and better understand the nature of the cough. These questions may include the following:

– How long has the cough been present?
– Is the cough dry or productive (producing sputum/phlegm)?
– Is the cough accompanied by any other symptoms, such as fever, chest pain, shortness of breath, or wheezing?
– Does the cough worsen at any specific time (e.g., during the day, at night, after eating, with physical activity)?
– Has MC noticed any triggers or factors that seem to aggravate or alleviate the cough?
– Does MC have a history of any respiratory conditions or allergies?
– Does MC smoke or have a history of exposure to environmental pollutants?

These questions will help the nurse assess the severity, duration, and potential underlying causes of MC’s cough.

2. Based on the objective and subjective data collected, a list of potential problems can be compiled. Some problems that may be identified include:

– Acute bronchitis or respiratory infection: MC’s hacking, raspy cough could be indicative of an acute respiratory infection, such as bronchitis, which may require medical intervention.
– Chronic obstructive pulmonary disease (COPD): If MC has a history of smoking or exposure to environmental pollutants, the cough could be a symptom of COPD, a progressive lung disease that affects airflow and breathing.
– Gastroesophageal reflux disease (GERD): If MC experiences coughing episodes primarily after eating, GERD could be a potential problem, as stomach acid reflux can irritate the airways and cause a cough.
– Allergic or environmental triggers: If MC reports a history of allergies or exposure to certain environmental factors (e.g., dust, pet dander), the cough could be related to an allergic or environmental trigger.
– Postnasal drip: If MC has any nasal congestion, sinus symptoms, or a history of allergies, postnasal drip could be contributing to the cough.
– Medication side effect: If MC recently started taking a new medication, a potential side effect could be causing the cough.

These are just a few examples of problems that could be relevant based on MC’s symptoms and medical history. The nursing diagnosis can be further refined and prioritized after a comprehensive assessment.

3. The plan of care for MC’s cough should address the underlying cause, relieve symptoms, and promote healing. It could include the following components:

– Treat the underlying cause: If the cough is due to a respiratory infection, appropriate antimicrobial therapy may be prescribed. If it’s related to a chronic condition like COPD or asthma, medications to manage symptoms and reduce inflammation may be necessary.
– Symptom relief: Depending on the nature of the cough, symptomatic treatment options may include cough suppressants, expectorants to aid in removing secretions, or bronchodilators to improve airflow.
– Environmental modifications: If the cough is triggered by allergens or irritants, the plan may involve identifying and avoiding these triggers, improving indoor air quality, or implementing strategies to reduce exposure.
– Lifestyle modifications: In some cases, lifestyle changes such as smoking cessation, weight loss, or dietary modifications (e.g., avoiding trigger foods for GERD) may be necessary to alleviate the cough.
– Education and self-management: Providing education to MC about managing their condition is crucial. This may include information about proper inhaler technique, recognizing exacerbation symptoms, and when to seek further medical attention.

4. Several risk factors are associated with this age group, which may contribute to MC’s cough. Some common risk factors include:

– Aging-related changes: As individuals age, the respiratory system undergoes certain physiological changes, such as decreased lung elasticity and weakened immune function. These changes can make older adults more susceptible to respiratory infections and prolong the duration of cough symptoms.
– Chronic conditions: Older adults are more likely to have chronic medical conditions, such as COPD, asthma, or GERD, which can cause or exacerbate coughing.
– Medication use: Older adults often take multiple medications, which can have side effects including cough. For instance, some blood pressure medications (e.g., ACE inhibitors) are known to cause a persistent cough.
– Environmental factors: Older adults may be exposed to environmental pollutants and allergens over an extended period, which can contribute to chronic coughing.
– Weakened immune system: Aging can lead to a weakened immune system, making older adults more susceptible to respiratory infections.

These risk factors should be taken into consideration when evaluating and managing MC’s cough, as they can influence the choice of diagnostic tests, treatment options, and preventive measures.