Chief complaint

            The client is aged 60 years. She worked in the bakery shop. However, she would retire soon. The patient came up with severe complains of shortness of breath as well as nonproductive coughing in the last few days of the visit. She was suffering from this condition for almost one month or so. As a result, she also said that her efficiency was not at par with the past records. It was more because of excessive tiredness that she underwent through. At times, the patient was unable to breathe so much that she spent many nights on the recliner, in order to breathe properly. During the interrogation rounds and check-ups, she hardly complained about any type of pain in her chest along with sweating and nausea. It was furthermore, crucial to go through her earlier reports on coronary artery disease and blood pressure. They both were instrumental in providing an idea of her condition and its root-causes. When the client was 40 years old, she had heavy bleeding in vagina, which ultimately led to hysterectomy. She was about to take retirement from the bakery industry. Her status was married. In case of substance abuse, she was far from the same. Hence, she was reluctant to agree regarding her consumption of drugs, alcohol or tobacco. It was also noted that the client did not have any type of upper respiratory illness, at least in the recent past. There was no such distress that was acute. The pulse rate was around 100, while her blood pressure was accounted as 160 by 100. 

Differential diagnosis

The family history of this patient also vital for understanding the diseases that were studded in her genes. For instance, her father’s death was caused by nothing but the fatal prostate cancer. Alternatively, her mother largely died out of cardiac arrest. The diagnoses depicted that the S3 could be heard from top, while S2 and 1 were distant.

The four most chest diseases that are subject of differential diagnosis include the right-sided heart failure, cardiac tamponade, COPD i.e., chronic obstructive pulmonary ailment, and left-sided heart problem.

It is quite noteworthy that the S3 sound is produced by the surge in fluid states inside the heart. Thus, it can be said the symptoms indicate more of left-sided failure in heart (Gustafsson & Rogers, 2017). On the other hand, the heart’s fluid may start moving towards the lungs as insufficient space is available in the former to retain the excess fluid. Therefore, the lower lobes’ bases cause the crackle sounds, once the fluid is collected on various dependent areas (Guazzi & Borlaug, 2012). It is also understandable from the patient’s urge to sit at nights, for comfortable breathing. There are two primary reasons due to which the above-mentioned symptoms can come to the forefront, such as the coronary heart ailment and surged BP, ultimately manifesting in the form of reduced heart contractility and myocardial ischemia.

Treatment plan suggestion

            It would be best to follow a holistic treatment plan than anything else. Thus, the lifestyle and eating habits should be modified to a large extent. The patient was definitely over-active. As a result, it is important to ensure that more amount of rest is taken by her. Now that she is retiring, enough time can be availed for resting. Another important aspect is diet. Her diet has to be fat-free and low sodium formulation (Aranceta & Pérez-Rodrigo, 2012). Moreover, instead of higher portion per meal, it would be better to opt for smaller portions and ease the metabolic system, all together. Conversely, vitamin rich foods along with better supplements can give her the required energy. Additionally, meditation and weight-loss exercises are also suggested for faster recovery. The fluid retention must be controlled at any cost (Ross, Caballero, Cousins, Tucker & Ziegler, 2014). Some of the medicines that can be prescribed are Diamox, Lasix, Torsemide, Enduron, Zide-50 and others. If all these things fail to work then either a pacemaker has to be planted or heart repair transplant should be done, such as surgery for inserting artificial heart valve.