Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.
Coughs are the body’s way of clearing airways via forceful expiration. Inflammation, inhaled particles, accumulated mucus, or foreign bodies stimulate a cough reflex by irritant receptor stimulation in the airway. An acute cough is classified as lasting 2-3 weeks, and chronic cough is greater than three weeks in a non-smoker. Frequent cough causes are allergic rhinitis, upper respiratory infections, pneumonia, aspiration, pulmonary embolus, and congestive heart failure. Due to the above-listed scenario, this cough would be diagnosed as acute cough due to timeframe, cough characteristics, and patient history (Huether & McCance, 2019).
Sputum contains immune cells and white blood cells from the lower respiratory tract that protect the airway from infections. Sputum can be clear or colored. Color sputum may be yellow, white, green, red or blood-tinged, or pink. Neutrophils are white blood cells that can take on a green color. This color sputum can be indicative of bacterial infections of the lower respiratory tract. Pneumonia and cystic fibrosis can produce this color sputum. To indeed rule out something benign, a sputum culture would need to be obtained and tested (Verywell Health, 2019). At three weeks in, it would likely be premature to order cultures with limited symptoms.
Due to the timeframe of cough and only accompanying symptom being green sputum, as a practitioner, I would prescribe an expectorant and schedule a follow up if symptoms persist or worsen. Teaching should include that adverse effects of expectorants might be GI upset, headache, drowsiness, and dizziness. Advise patient that expectorants are designed to be short-term (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Additional home treat to loosen secretions would be a humidifier, staying adequately hydrated and warm salt water gargles if sore throat should appear (Barkley, 2018).
Patient Factors- Behavior and Age
Maria is an otherwise, healthy 36-year-old female. Due to her age and symptom status, Maria would be treated conservatively. Maria is a non-smoker and takes no prescribed medications. Further investigation would be required if she was a smoker, currently on prescriptions medications, had current disease processes that may factor into the treatment plan.
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Barkley, T. (2018). Adult-gerontology primary care nurse practitioner. West Hollywood, CA: Barkley & Associates.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Verywell Health. (2019). What causes the amount of sputum to increase? Retrieved from https://www.verywellhealth.com/what-is-sputum-2249192