NRNP 6540 Week 5 Case Assignment
Case Title: A 67-year-old With Tachycardia and Coughing
Ms. Baker is a 68-year-old female who is brought to your office today by her daughter Rebecca. Ms. Baker lives with her daughter and is able to perform all activities of daily living (ADLs) independently. Her daughter reports that her mother’s heart rate has been quite elevated, and she has been coughing a lot over the last 2 days. Ms. Baker has a 30-pack per year history of smoking cigarettes but quit smoking 3 years ago. Other known history includes chronic obstructive pulmonary disease (COPD), hypertension, vitamin D deficiency, and hyperlipidemia. She also reports some complaints of intermittent pain/cramping in her bilateral lower extremities when walking and has to stop walking at times for the pain to subside. She also reports some pain to the left side of her back, and some pain with aspiration.
Ms. Baker reports she has been coughing a lot lately, and notices some thick, brown-tinged sputum. She states she has COPD and has been using her albuterol inhaler more than usual. She says it helps her “get the cold up.” Her legs feel tired but denies any worsening shortness of breath. She admits that she has some weakness and fatigue but is still able to carry out her daily routine.
Vital Signs: 99.2, 126/78, 90, RR 22
Labs: Complete Metabolic Panel and CBC done and were within normal limits
CMP
Component
Value
CBC
Component
Value
Glucose,
Serum
86
mg/dL
White
blood cell count
5.0 x
10E3/uL
BUN
17
mg/dL
RBC
4.71
x10E6/uL
Creatinine,
Serum
0.63
mg/dL
Hemoglobin
10.9
g/dL
EGFR
120
mL/min
Hematocrit
36.4%
Sodium,
Serum
141
mmol/L
Mean Corpuscular
Volume
79 fL
Potassium,
Serum
4.0
mmol/L
Mean
Corpus HgB
28.9
pg
Chloride,
Serum
100 mmol/L
Mean
Corpus HgB Conc
32.5
g/dL
Carbon
Dioxide
26
mmol/L
RBC
Distribution Width
12.3%
Calcium
8.7
mg/dL
Platelet
Count
178 x
10E3/uL
Protein,
Total, Serum
6.0
g/dL
Albumin
4.8
g/dL
Globulin
2.4
g/dL
Bilirubin
1.0
mg/dL
AST
17
IU/L
ALT
15
IU/L
Allergies: Penicillin
Current Medications:
· Atorvastatin 40mg p.o. daily
· Multivitamin 1 tablet p.o. daily
· Losartan 50mg p.o. daily
· ProAir HFA 90mcg 2 puffs q4–6 hrs. prn
· Caltrate 600mg+ D3 1 tablet p.o. daily
Diagnosis: Pneumonia
Directions: Answer the following 10 questions and upload your document to Canvas site by due date.
Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia?
Question 2: Define further what type of pneumonia Ms. Baker has, HAP (hospital-acquired pneumonia) or CAP (community-acquired pneumonia)? What’s the difference/criteria?
Question 3:
· 3A) What assessment tool should be used to determine the severity of pneumonia and treatment options?
· 3B) Based on Ms. Baker’s subjective and objective findings, apply that tool and elaborate on each clinical factor for this patient.
Question 4: Ms. Baker was diagnosed with left lower lobe pneumonia. What would your treatment be for her based on her diagnosis, case scenario, and evidence-based guidelines?
Question 5: Ms. Baker has a known history of COPD. What is the gold standard for measuring airflow limitation?
Question 6: Ms. Baker mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would be the best choice for a potential diagnosis for this? Explain your reasoning.
a. DVT (Deep Vein Thrombosis)
b. Intermittent Claudication
c. Cellulitis
d. Electrolyte Imbalance
Question 7: Ms. Baker mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain. What test could be ordered to further evaluate this?
Question 8: Name three (3) differentials for Ms. Baker’s initial presentation.
Question 9: What patient education would you give Ms. Baker and her daughter? What would be your follow-up instructions?
Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Baker’s Pneumonia? Explain why or why not.