James Thompson is a 55-year-old African-American man with a 3-day history of worsening shortness o. Question
Answered step-by-step
Asked by drhijazi81
James Thompson is a 55-year-old African-American man with a 3-day history of worsening
shortness of breath, subjective fevers, chills, right-sided chest pain, and a productive cough. He
states, “I have been short of breath and have been coughing up rust-colored mucus for the past 3
days.”
The patient states that his initial symptom of shortness of breath began approximately 1 week ago
after delivering mail on an extremely cold winter day. After several days of not feeling well, he
went to an immediate care clinic and received a prescription for levofloxacin 750 mg orally once
daily for 5 days, which he did not fill due to financial reasons. He has been taking acetaminophen
and an over-the-counter cough and cold preparation, but feels that his symptoms are getting
“much worse.” The patient began experiencing pleuritic chest pain and a productive cough over
the past 3 days, and feels that he has been feverish with chills, although he did not take his
temperature. On presentation to the ED, he is febrile and appears visibly short of breath. Mr.
Thompson has a history of Hypertension × 15 years and Type 2 diabetes mellitus × 10 years. He
lives with wife and four children, and is employed as a mail carrier for the US Postal Service. He
denies alcohol, tobacco, or intravenous drug use
Patient states that he only sporadically takes his medications due to financial reasons.
Lisinopril 10 mg orally once daily, HCTZ 25 mg orally once daily, Metformin 1,000 mg orally
twice daily. Acetaminophen 650 mg orally every 6 hours as needed for pain,
Guaifenesin/dextromethorphan (100 mg/10 mg/5 mL) two teaspoonfuls every 4 hours as needed
for cough. Allergies: Amoxicillin (rash—as a child). Patient has received cephalexin as an adult
without problem.
Physical exam: BP 155/85, P 127, RR 30, T 39.5°C; Wt 110 kg, Ht 5′11′′
Skin is warm to the touch; poor skin turgor, with dry mucous membranes. No cervical
lymphadenopathy, pharyngeal erythema, enlarged tonsils. Tachypneic, labored breathing; coarse rhonchi throughout right lung fields; decreased breath sounds in right middle and right lower lung
fields. A & O × 3; CN II-XII intact
Labwork:
Na 140 mEq/L Hgb 12.1 g/dL WBC 23.1 × 103/mm3
K 4.3 mEq/L Hct 35% Neutrophils 67%
Cl 102 mEq/L RBC 3.8 × 106/mm3 Bands 15%
CO2 22 mEq/L Plt 220 × 103/mm3 Lymphs 12%
BUN 42 mg/dL MCV 91 μm3 Monos 6%
SCr 1.4 mg/dL MCHC 35 g/dL
Glu 295 mg/dL
ABG: pH 7.38; PaCO2 29; PaO2 70 with 87% O2 saturation on room air
CXR: Right middle and right lower lobe consolidative airspace disease, likely pneumonia. Left
lung is clear. Heart size is normal.
Sputum and blood cultures x 2 sets are pending. Streptococcus pneumoniae urine antigen—
Pending Legionella pneumophila urine antigen—Pending
1- What is the relevant objective and subjective assessment data from the case study?
2- What does this data indicate? What conclusions can you make? What is your preliminary
diagnosis(es)?
3- Search the literature using databases, and select a clinical practice
guideline (CPG) to guide your prescribing for these diagnosis(es). Which CPG did you
select? (Include the reference for the CPG). Why did you select it?
4- Based on the CPG you have selected, what non-pharmacologic and pharmacologic
interventions will you use for your treatment plan? How does each intervention treat the
pathophysiology of the diagnosis(es)? What is the priority for each intervention (which
interventions are first versus later)?
5- What are the important prescribing considerations for the pharmacologic interventions?
6- write prescription for each medication you would prescribe, including all elements of a
prescription.
7- What outcomes would you anticipate – therapeutic effects and adverse effects? How will
you evaluate for these outcomes?
8- What patient education and follow up is required for the medications you have prescribed?
SCIENCE
HEALTH SCIENCE
NURSING
NUR 3420
James Thompson is a 55-year-old African-American man with a 3-day history of worsening shortness o
