Haemophilus Pneumonia Case Review Sheet

Another Consultation Report dated 12/06/2016, indicated that the claimant presented with exacerbation of COPD, acute bronchitis, and pseudomonas aeruginosa. The CT scan of the chest revealed bilateral lower lobe atelectatic changes, fibrosis, and a small 1 cm left lower lobe nodular density. A pulmonary consultation was recommended. His blood pressure was 142/79 mmHg. The physical examination revealed bilateral decreased breath sounds and scattered wheezes. His glucose was 189. DuoNeb, IV Solu-Medrol, and IV antibiotics were prescribed.

EH is a 68-year-old male who comes into the clinic complaining of a fever with a temperature of 103 °F. He has had a cough for the last three days that is producing some thick green brown mucous. The MD feels he most likely has bacterial pneumonia. He also has a history of having rheumatoid arthritis, and being immune compromised as he is on an immunosuppressant methotrexate. He has noted that over the last year he has lost weight unintentionally and feels he is underweight.

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

Generally, this is a well-developed man sitting comfortably in no acute distress. Skin is warm and dry. HEENT: Head is normocephalic, atraumatic. Pupils equal, reactive to light and accommodation. Sclerae are anicteric. Oral mucosa is moist without lesions. No JVD. No thyromegaly. Lymphatics: No cervical, supraclavicular, axillary, or inguinal adenopathy appreciated. Respiratory: Lungs are clear to auscultation bilaterally. Heart: Regular rate and rhythm. Abdomen: Soft, nontender. Positive bowel sounds. Liver and spleen not palpable. Strength is 5/5 throughout. Neurological exam is

Patient’s WBC were on the normal parameter (11.6). Patient did not present signs and symptoms of

Pneumonia is classified according to the organism causing the infection and where the infection was acquired. Community-acquired pneumonia is contracted by individuals with minimal contact with health care facilities – such as a hospital, nursing home, or rehabilitation facility – and contract the infection by people in the wider community (MedlinePlus, 2016). Hospital-acquired pneumonia and ventilator assisted pneumonia, can be caused by a wide variety of bacteria and other organisms that can originate from the health care environment (Oxford Journals, 2016). Pneumonia that develops whilst an individual is in hospital, can be extremely severe and is more likely to be fatal. This is due to the fact, that individuals within a health care setting, often already have a serious illness, causing a weakened immune system. Also, the types of bacteria present in hospitals, are often more dangerous and resistant to treatment – then the bacteria found in the outside community (MedlinePlus, 2016). Aspiration pneumonia – or anaerobic pneumonia - results after the inhalation of a foreign matter into the lungs. If foods, liquids, saliva, or vomit make their way into the airways or lungs, instead of the oesophagus and stomach, it can cause aspiration pneumonia. It is more likely in individuals with a disturbed gag reflex – commonly due to having a brain injury or being under the influence of drugs or anaesthetics (MedlinePlus,

Furthermore, after reviewing J.B.’s past medical, surgical, social and family history, medication, allergies, and review the systems, the nurse practitioner student ruled out postnasal drip as the differential diagnosis because J.B. denied having a postnasal drip that might cause coughs. Upon the physical examination, the student ruled out pneumonia because J.B. had clear bilateral lung sounds. The student did not rule out pneumonia before the physical examination is because signs and symptoms alone are not reliable to rule out pneumonia. Long, Long, & Koyfman (2017) states that the diagnosis of pneumonia requires a combination of clinical presentation, medical history, and physical examinations. The physical examinations, including dullness to percussion, wheezes, and crackles are the most reliable findings. Therefore, the final

A: Janie is a 60 year old Female with PMH of A-Fib, COPD, Hypothyroidism, HTN, Lung Cancer and recently diagnosed Pulmonary Embolism. Janie presents to ER for evaluation on SOB, cough with greenish sputum, sore thoart, hoarseness and generalized weakness. Janie lives at home with her husband, use to smoke ½ pack per week, but quit many years ago, denies alcohol or drugs. Family history is non-contributory. Allergies: NKDA. Differential diagnosis includes worsening Lung Ca, PE, COPD and CHF. Janie uses home O2 at 4 L/NC. V/S: T=98.7, HR=89, R=16, B/P=132/56, O2 sats=100% on 4L/NC, Pain=6/10. Labs: WBC=7.6, H&H=8.5/27, Na=141, Troponin=0.08/0.06, BNP=495, INR=4.2, UA=3+ protein, 1+ blood and 6-10 RBC. CXR: Impression:1). COPD with nonspecific coarsening of the basilar interstitium. 2). Mild cardiomegaly with borderline cardiac compensation. 3). Right

The clinical manifestations of pneumonia will be different according to the causative organism and the patient’s underlying conditions and/or comorbidities (Smeltzer, et al). Some of the manifestations are

This is a case of a 74 year old woman who was diagnosed with Community Acquired Pneumonia.

This paper explores Pneumonia and the respiratory disease process associated with bacterial and viral pathogens most commonly located in the lung. The paper examines the process, symptoms and treatments most commonly viewed in patient cases of Pneumonia. My goal is to educate the reader and to warn of the

Pneumonia severity index (PSI) is a score based on patient age, medical history, current symptoms, vital signs, and blood work. Reference? Each value will have a score given if it meets the criteria. All of the scores are added up giving a total score that puts the patient into a risk category. The pneumonia severity index has five risk categories based on the score. The risk factor category that the patient falls under will help the health care provider determine how to go about treating the patient’s community acquired pneumonia. Risks 1-3 are considered low risk and the patient can be treated as an outpatient. Risks 4-5 are considered to be of high risk and the patient should be admitted to the hospital for treatment. Reference? With this

Pneumonia is an inflammation of the lung which results into an excess of fluid or pus accumulating into the alveoli of the lung. Pneumonia impairs gas exchange which leads to hypoxemia and is acquire by inhaling a contagious organism or an irritating agent. (Ignatavicius & Workman, 2013). Fungal, bacteria and viruses are the most common organisms that can be inhale. Pneumonia could be community-acquired or health care associated. Community –acquired pneumonia (CAP) occurs out of a healthcare facility while health care associated pneumonia (HAP) is acquired in a healthcare facility. HAP are more resistant to antibiotic and patients on ventilators and those receiving kidney dialysis have a higher risk factor. Infants, children and the elderly also have a higher risk of acquiring pneumonia due to their immune system inability to fight the virus. Pneumonia can also be classified as aspiration pneumonia if it arises by inhaling saliva, vomit, food or drink into the lungs. Patients with abnormal gag reflex, dysphagia, brain injury, and are abusing drug or alcohol have a higher risk of aspiration pneumonia (Mayo Clinic, 2013). In the case of patient E.O., this patient had rhonchi in the lower lobe and the upper lobe sound was coarse and diminished. Signs and symptoms of pneumonia include difficulty breathing, chest pain, wheezing, fever, headache, chills, cough, confusion, pain in muscle or

The patient's overall symptoms and lab work suggest that she is suffering from hospital acquired pneumonia. Currently the patient is presenting a moist chesty cough. Additionally, her heart rate is elevated, her oxygenation is low, and her RR is high. She has a raised white blood cell count, which indicates infection. Finally, the patient is acting confused and disoriented, which can be the direct result of a lack of oxygenation to the brain. All of these symptoms point to pneumonia (Torres, 1999).

Mrs. A (pseudonym) is an 83-year-old Samoan female of Christian religion who was admitted to an urban hospital on 02/04/15 by GP referral. She came in with chest pain associated with productive cough and shortness of breath (SOB) on exertion. She also complained of having recurrent episodes of vomiting mixed with saliva and fatigue. She has a history of asthma, hypertension, type 2 diabetes mellitus on Metformin and double incontinence due to a long-standing history of intermittent constipation. Her chest computed tomographic (CT) revealed right lower lobe opacity indicating pulmonary consolidation, which means that her right lower lung has accumulated exudates in the alveoli that would have normally been filled by gas, indicative of bacterial pneumonia. Furthermore, a sputum gram stain sample collected from Mrs. A showed gram-positive bacteria, which is also a characteristic of pneumonia. Her blood tests revealed a high haemoglobin count, which may be caused by an underlying lung disease, as well as high white blood cell count confirming the presence of infection. Considering all diagnostic results, Mrs. A was diagnosed with right lower lobe bacterial pneumonia.