Community-Acquired Pneumonia (CAP)
A 50 year old Caucasian female presents to the clinic with complaints of cough for almost 2 weeks. Positive productive green sputum with associated chills, sweating, and fever up to 101.5. She manages a daycare and states that many of the children have had upper respiratory symptoms in the last two weeks. PMH: DM diagnosed 7 years ago, controlled on medications. Community-Acquired Pneumonia (CAP)
ORDER A PLAGIARISM – FREE PAPER NOW
MEDS: Glyburide 10mg qd
PE: She looks ill with continuous coughing and chills.
BP 100/80, T: 102, HR: 110; O2Sat 97% on RA.
Lungs: +Crackles, increased fremitus
Labs: CBC 17,000 cells/mm3 , blood sugar is 120
Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study you were selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.
Community-Acquired Pneumonia (CAP)
Introduction
The patient in this case study is a female aged 50 years old. She has been having signs and symptoms of a productive cough, chills, fever, and sweating for about two weeks; and is a known diabetic well controlled on the oral hypoglycemic sulfonylurea glyburide. She presents with a continuous cough and chills. Her SpO2 is 97%, indicating some degree of insufficient pulmonary ventilation (Jameson et al., 2018). She has a marked fever of 102 °F or 38.9°C. On physical examination, auscultation reveals some crackles and she also has increased tactile fremitus (vibratory sounds to the chest wall) (Jameson et al., 2018). Laboratory tests show marked leucocytosis (17,000 cells/ mm3) but with a normal random blood sugar of 120 mg/ dl or 6.7 mmol/l. Community-Acquired Pneumonia (CAP)
Primary Diagnosis
The primary diagnosis for this patient is pneumonia, specifically community-acquired pneumonia or CAP (Jameson et al., 2018). The conclusion of CAP is derived from the patient’s history indicating that she manages a home for children who have recently been having respiratory symptoms. According to Hammer and McPhee (2014), majority of the patients who have pneumonia usually present with a cough and a fever. They also state that pneumonia is most common in patients whose immunity is weakened, but uncommon in those who are immunocompetent. The patient in this case study has been having diabetes for the last seven years, according to her medical history. A repeatedly elevated blood sugar level in patients with diabetes is known to weaken their immune systems, making them prone to acquiring infections (Ross, 2019). Jameson et al. (2018) also confirm that a patient with a cough, fever, sweating, and chills most likely has pneumonia. Pneumonia is also known to afflict the elderly and those who are immunocompromised more than the general population (Hammer & McPhee, 2014). The patient in this case study is not only fifty years old but also a known diabetic. This makes her a susceptible candidate for pneumonia.
Differential Diagnoses
Three possible differential diagnoses for this patient would be chronic obstructive pulmonary disease or COPD, bronchiectasis, and bronchitis (Gamache, 2019). Patients with a history of COPD have been known to also present with productive cough yielding green sputum, fever, and chills (Hammer & McPhee, 2014, p. 86). Crackles on chest auscultation and a continuous productive cough are also classic clinical presentations of bronchiectasis (Jameson et al., 2018, p. 1,984). Lastly, bronchitis also normally presents with a history of productive cough (Hammer & McPhee, 2014, p. 232). Community-Acquired Pneumonia (CAP)
The Role of the Patient’s History and Physical Examination in the Diagnosis
First, the information about her involvement at a day care facility with children suffering recently from respiratory infections was important. Combined with her history of diabetes, this pointed to a susceptible immunocompromised host to respiratory microbes. Added to a history and finding (on physical examination) of fever, crackles, and increased fremitus; the diagnosis was not in doubt. The leucocytosis was just a confirmation that an active infection was underway.
Suggested Treatment Options
Treatment would be either levofloxacin 750mg orally once a day, or cefuroxime axetil 500mg orally twice a day combined with doxycycline 100mg orally twice a day (Jameson et al., 2018). Acetaminophen 500mg orally twice a day would help with the fever, to be stopped when it subsides (Katzung, 2018).
References
Gamache, J. (6 June 2019). Bacterial pneumonia differential diagnoses. Retrieved 19 June 2019 from https://emedicine.medscape.com/article/300157-differential
Hammer, D.G., & McPhee, S.J. (Eds). (2014). Pathophysiology of disease: An introduction to clinical medicine, 7th ed. New York, NY: McGraw-Hill Education.
Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2018). Harrison’s principles of internal medicine, 20th ed. New York, NY: McGraw-Hill Education.
Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14th ed. New York, NY: McGraw-Hill Education.
Ross, H.M. (24 Apr. 2019). What infections are you at risk for with diabetes? Retrieved 19 June 2019 from https://www.verywellhealth.com/what-are-the-common-infections-with-diabetes-1087622
Community-Acquired Pneumonia (CAP)
