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Pneumonia

Pneumonia. Esmaeli , A.; Francisco U.; Golpeo, K. A. G. 75 year old Male Single From Sta. Mesa, Manila Unemployed CC: progressive and productive cough, 3 days duration. TEMPORAL PROFILE. Past Medical History

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Pneumonia

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  1. Pneumonia Esmaeli, A.; Francisco U.; Golpeo, K.

  2. A. G. • 75 year old • Male • Single • From Sta. Mesa, Manila • Unemployed • CC: progressive and productive cough, 3 days duration

  3. TEMPORAL PROFILE

  4. Past Medical History • PTB (2002) – sputum AFB (+); 6 months quad-tab treatment completed; Chest X-ray after treatment – resolved • S/P Cataract surgery (2002) • COPD (2011) – Symbicort 2 puffs BID  1 puff BID (2012) • Allergy to seafood and chicken • (-) HTN, (-) DM • Family History • (+) HTN (father and younger brother) • (+) stroke (father) • (+) Lung CA (brother)

  5. Social and Environmental History • Smoker (51 pack years); started 14 years old, stopped 2002, 1 pack per day • Occasional alcohol drinker (1960 -1970); Last drink was 1985, 1 small bottle of pale pilsen per week • Denies illicit drug use

  6. Review of Systems • (-) anorexia • (-) vomiting • (-) diarrhea • (-) blood in sputum • (+) exertional dyspnea • (+) sputum production • Weight loss

  7. Physical Examination Awake, weak-looking, alert, ambulatory, febrile VS: 110/60 > 72 > 32 > 39 degrees celsius AS, PPC, (-) TPC, (-) CLADS ECE, (+) crackles in L lower lung AP, NRRR, distinct S1 and S2, (-) murmur Flat abdomen, NABS FEP, (-) cyanosis, (-) edema

  8. Primary Impression Community Acquired Pneumonia, Moderate Risk (CAP, MR); Chronic Obstructive Pulmonary Disease (COPD)

  9. Laboratories Ordered • CBC • UA • Blood CS • Sputum GS/CS • Na, K, Crea, BUN • Chest Xray

  10. CBC

  11. Chest Xray Impression: • Pneumonitis/ Bronchitis Right Lower Lung • Pneumonia Left Lower Lung • Residual Fibrosis Right Upper Lung

  12. Urinalysis

  13. Blood Chemistries

  14. Cultures • Sputum GS – Gram (+) cocci in pairs with neutrophils • Sputum CS – • Blood CS, 2 sites –

  15. IV FLUID: 1 liter D5NSS to run to 10 hours (100 cc/hr) • DIET: 2100 kcal/day • TFR

  16. Antibiotic started upon admission • Ceftriaxone 2 gm IV Q24 • Levofloxacin 750mg/tab, 1 tab Q48 (Azithromycin)

  17. COPD • Symbicort 2 puffs BID

  18. Hypokalemia • KaliumDurule, 1 durule TID

  19. Pneumonia

  20. Plan

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