CASE LEARNING OBJECTIVES
Recognize the signs and symptoms of mild and moderate-to-severe pneumonia
Identify the goals of therapy for pneumonia
Develop an appropriate empiric treatment and monitoring plan for pneumonia on the basis of individual patient characteristics
Properly educate patients taking their antibiotic therapy
Discuss the role of vaccination in pneumonia
"For the last 2 days I have been more and more short of breath, even occurring at rest. I have also been coughing and the color of the secretions is now green."
History of Present Illness
Cindy Milner is a 65-year-old woman who presents to the emergency department complaining of increasing SOB and increasing coughing. She has had a fever for the last 24 hours. She has some mild-to-moderate chest discomfort, but denies any sharp pains or heaviness in her chest.
Father died in a car accident at age 50. Mother had diabetes, HTN, and CRF, and died at age 56. She has 1 sister who has diabetes and HTN.
She lives with her husband and has no children. She works as a legal secretary.
Social drinker; + tobacco history 1 ppd × 30 years, quit 5 years ago, no illicit drug use
Allergies/Intolerances/Adverse Drug Events
Lisinopril 20 mg PO daily
Insulin glargine 40 units subcutaneous daily
Insulin aspart subcutaneous sliding scale
Fluticasone/salmeterol DPI 250 mcg/50 mcg 1 inhalation twice daily
Albuterol 1–2 puffs every 4–6 hours as needed for SOB
Acetaminophen 500 mg PO as needed for headache
Occasional headaches relieved with acetaminophen; occasional tinnitus; (−) vertigo; (−) history of seizures, syncope, or loss of consciousness; mild pain/discomfort in her chest/abdomen; SOB; (−) nausea, vomiting, or diarrhea.
Breathing fast, with increased work of breathing, appears in moderate-to severe respiratory distress
BP 88/58 mm Hg, P 100, RR 30, T 38.8°C, pulse oximetry 89% (0.89) on room air
Normal; (−) rashes or lesions
PERRLA, EOMI; trace periorbital edema; (−) ...