History of a patient presenting with a cough

Cough is a reflex action in which the body gets rid of foreign material or sputum in the respiratory tract. It can also be as a result of the irritation of the respiratory pathway and bronchoconstriction. Coughing is a sign of an underlying disease, so proper history taking and examination are required to identify the underlying disease.

John is a patient who presents to the clinic with a cough. He is an alcohol addict. For the history taking, I would like John to tell me the following things: when the cough started, to determine whether the cough is acute, sub-acute or chronic. A cough which lasts less than three weeks is acute, between three to eight weeks is sub-acute and more than eight weeks is chronic according to Brenda, Janice and Kerry, (2009). An acute onset cough could be an acute infection. If the cough is recent, John should explain when it started if it started when he was eating then the cough could be a sign of some foreign body in the respiratory tract and he could be choking.

Find out from John whether cough is productive or non-productive. In a productive cough, sputum or phlegm is expectorated but in a non-productive cough, the cough is dry. A dry nonproductive could be a sign of a viral infection.

In the case the cough is a productive cough, then find out the characteristics of the sputum. Color and amount of the sputum produced should be noted. Copious amount of thick yellow, green or rusty sputum could be an indication of a bacterial infection. Pink tinged sputum suggest lung tumor. Profuse and pink sputum might indicate pulmonary edema according to Brenda et al. (2009). If John reports that the sputum has a foul smell then, it could be an indication of lung abscess. Blood tinged sputum might be an indication of pulmonary and cardiovascular disorders thus it is of essence to ask if he has noticed any blood in the sputum. Production of blood also could be an indication of trauma; thus it is also important to ask John if he had a traumatic experience.

It is important to find out the time that the cough occurs. A cough that occurs mostly at night might indicate an onset of left sided heart failure, in the morning indicates asthma or bronchitis.

I would also like to find out whether there may be other associated signs and symptoms that accompany the cough such as; fever, weight loss,loss of appetite, pain when coughing, chest tightness when coughing, shortness of breath, and heartburn. Fever accompanied with coughing is an indication of infection. If a productive cough is reported that is associated with night sweats and weight loss, then Tuberculosis investigations are required.

Underlying illnesses might also be the cause of the cough, so it is necessary to find out from John whether he has any other illness such as asthma the bronchoconstriction and irritation of the airway by allergens could lead to the coughing more. In the case of asthma, it is important to inquire of any exposure to allergens such as dust, pollen, smoke and any new pets. De Blasio et al. (2007) in gastroesophageal reflux disease, the gastric acid irritates the esophagus thus stimulates the cough receptors.

If he has taken any medication to treat a cough. The time that he began taking the medication and if he has cleared the medication. If he has been taking medication and the cough is worsening, thorough investigations are needed to find out the specific causative microorganism, or any other disease for treatment. If the condition is improving then, one can watch and wait as other investigations are carried out. If the cough clears after taking medication but then recurs after a short period, then further investigations should be carried out.

It is necessary to ask if John is on any other medication. Coughing is a side effect for angiotensin converting enzyme inhibitors. The cough is usually nonproductive according to the research done by Joseph et al. (2011).

One should ask about social habits such as smoking, the duration of smoking and also the number of cigarettes smoked per day. Prolonged and heavy smokers are at a high risk of Congestive and Obstructive Pulmonary Disease (COPD) and chronic bronchitis of which one of the signs is coughing. The occupation could also be a predisposing facto, if he works in a tobacco firm; timber industry could be disposed to sawdust or textile industry.

Find out if there are other members of his family with respiratory of cardiac disorders such as asthma, cystic fibrosis, heart failure. Some of these diseases can be inherited, and the cough could be a symptom.

In conclusion, a thorough history taking of a patient presenting with a cough is crucial. It guides patient’s caretakers on the investigations and diagnosis of the disease. Some of the investigations to be carried out are sputum culture and sensitivity, chest x-rays, Echocardiography and blood tests. Proper history taking also aids in planning care of the patient.

References

Brenda, G., Janice, L., Kerry, H. (2009). Bruner & Suddarths Textbook of Medical Surgical Nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.

De Blasio, F., Johann, C.V., Mario, P., Allesandro, Z., Panagotis, K.B., Gunsley, K., Rosella, B., Gianluca, D.D., Luigi, L. (2011). Cough Management. A Practical Approach, 7(7), 10. Retrieved from http://www.coughjournal.com/content/7/1/7Joseph, J., Benich, M., Peter, J. (2011). American Family Physician. Evaluation of the Patient with Chronic Cough, 84(8), 887-892. Retrieved from http://www.aafp.org/afp/2011/1015/p887.html