Edwin is a 69 year old male who comes in to the clinic today stating that over the past few days, he has had a fever and chills, cough, and has been quite fatigued. He didn’t take his temperature because he did not have a thermometer but he “felt hot”. He says he is coughing up a little phlegm. He states that it hurts when he takes a deep breath. He also states that his appetite has not been very good. He has been taking Tylenol with minimal relief. He has also been drinking teas to try to break up the phlegm.
Edwin is a nonsmoker and non drinker. He has been very healthy and has no medical problems. He has never had surgery.
On exam, his vital signs are: BP 130/80; P 84; R 14; T 103.2; Pulse ox: 94%.
Exam reveals decreased rales and rhonchi, more pronounced in the left lower lung fields, with increased fremitus and dullness to percussion. Chest x-ray reveals a consolidation in the left lower lobe. This appears to confirm that he has pneumonia?
Which bacteria is the leading cause of pneumonia and the one that he most likely has?
What is unusual about this pts history as compared to most pts that are at risk for s.pneumoniae?
- In this type of pneumonia, the sputum analysis indicates gram _________ (negative/positive) diplococci. There are also a large number of _______________.
- What other bacteria must be considered?
- What is the best way to identify the pathologic agent?
- The best sputum sample comes from the saliva in the mouth. TRUE OR FALSE
- When is the best time to get a sputum sample? Why is that the best time?
- When sending the sputum to the lab, how does the lab determine it is an adequate sample?)
- Name four other diagnostics that can be done on this patient to further understand his condition.
- If obtaining blood cultures, how many sets are typically obtained?
- When choosing an antibiotic to treat this pt, it is important to try to cover for all pathogens, especially gram-negative organisms.
- When treating on an outpatient basis, what class of drug should be used for this previously healthy man with no use of antimicrobial therapy within the previous 3 months?
- Although there have been cases of resistance against this class, it is still recommended for pts without risk. Please write out the rx directions the way with the med and the sig how you would write it for the pt.
- The choice of antibiotic therapy depends on three Important factors. What are they?
- In most cases, improvement is seen within __________ to _________ hours of initiation of antibiotics
- Should cough medicine be recommended? _______ Why or why not?
- Name two teaching points to tell the patient.
How to solve
WU Focused SOAP Note for Pneumonia Paper
Introduction:
Based on the given patient case, it is evident that Edwin, a 69-year-old male, presents with symptoms suggestive of pneumonia. In order to provide the appropriate diagnosis and treatment to the patient, the leading cause of pneumonia needs to be identified. Additionally, it is important to understand any unique aspects of the patient’s history as compared to typical pneumonia patients at risk for S.pneumoniae. Furthermore, various diagnostic tests and treatment considerations will be explored to enhance understanding and clinical management of Edwin’s condition.
1. The leading cause of pneumonia, and the most likely bacteria Edwin has, is Streptococcus pneumoniae.
2. Unusual aspects of Edwin’s history, in comparison to most patients at risk for S.pneumoniae, are:
– Edwin is a nonsmoker and non-drinker.
– He has been very healthy and has no medical problems.
– He has never had surgery.
3. In this type of pneumonia, the sputum analysis indicates gram positive diplococci. There are also a large number of neutrophils.
4. Other bacteria that must be considered in the context of pneumonia are:
– Haemophilus influenzae
– Moraxella catarrhalis
– Staphylococcus aureus
– Legionella pneumophila
5. The best way to identify the pathologic agent causing pneumonia is through sputum culture and sensitivity testing, which can identify the specific bacteria and determine the most effective antibiotic treatment.
6. FALSE. The best sputum sample comes from deep coughs that bring up sputum from the lower respiratory tract, not saliva in the mouth.
7. The best time to get a sputum sample is in the early morning since the patient has likely had time to accumulate secretions overnight. This increases the likelihood of obtaining a good quality sample.
8. When sending the sputum to the lab, the lab determines it as an adequate sample by assessing its quality, including the presence of squamous epithelial cells (indicating it is a good lower respiratory tract sample) and the presence of numerous neutrophils.
9. Four other diagnostics that can be done on Edwin to further understand his condition are:
– Complete blood count (CBC)
– Blood cultures
– Chest CT scan
– Pulse oximetry
10. Typically, two sets of blood cultures are obtained when blood cultures are being collected for diagnostic purposes.
11. When treating Edwin on an outpatient basis, a class of drug that should be used is a macrolide antibiotic, such as azithromycin.
12. Although there have been cases of resistance against macrolides, they are still recommended for previously healthy patients without risk factors. The prescription directions could be written as follows: “Azithromycin 500mg, take one tablet by mouth once daily for five days.”
13. The choice of antibiotic therapy depends on three important factors:
– The severity of the infection
– The patient’s comorbidities or risk factors
– Local antibiotic resistance patterns
14. In most cases, improvement is seen within 24 to 48 hours of initiation of antibiotics.
15. Cough medicine should not be recommended for the patient. Coughing helps to clear the phlegm from the lungs and improve ventilation.
16. Two teaching points to tell the patient are:
– Ensure adequate hydration to help loosen phlegm.
– Complete the full course of prescribed antibiotics, even if symptoms improve.
