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Chief Complaint

I am having difficulty catching my breath, I have been coughing for 2 days and had a fever today. Today when I walked up the stairs at home and I got lightheaded, couldn’t catch my breath and I start coughing.

History of Present Illness

Cindy Milner is a 62-year-old woman who presents to the emergency department with difficulty breathing, coughing and fever for the past 24-48 hours. She has some mild-to-moderate chest discomfort but denies any sharp pains or heaviness in her chest. She does not have nausea, vomiting, or diarrhea.

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. What signs, symptoms, and diagnostic tests support the diagnosis of pneumonia in the patient?

    Hint: See Treatment in PPP

  2. What are the organisms most likely causing pneumonia and what resistance issues are associated with these organisms?

    Hint: See Table 74-1 and Epidemiology and Etiology in PPP

  3. What patient factors need to be considered prior to selecting an empiric treatment regimen?

    Hint: See Treatment in PPP

  4. What therapeutic regimen would you select (including the duration of therapy)?

    Hint: See Table 74-2 and Treatment in PPP

  5. How would you monitor the patient?

    Hint: See Outcome Evaluation in PPP

  6. Should the patient be vaccinated, and if so, what vaccinations should she receive?

    Hint: See Prevention in PPP


What would happen to the therapeutic regimen or monitoring for each of the following situations:

  • (a) What if the patient had risk factors for pseudomonas or MRSA?

  • (b) What if the patient had a β-lactam allergy (rash vs. hives/tongue swelling)?

  • (c) What if the patient had a condition that required warfarin therapy?

Hint: See Table 74-2 in PPP


Global Perspective

Viral pneumonia (specifically influenza) is of much greater concern for global spread causing pandemics than is bacterial pneumonia. Not all patients infected with influenza develop pneumonia, but those that do have a greater mortality risk than those without pneumonia. Vaccination against influenza can prevent the disease or minimize symptomatology if the disease is contracted. The polysaccharide vaccine against Streptococcus pneumoniae covers 85-90% of the isolates responsible for causing disease in human beings. A conjugated pneumococcal vaccine was recently approved for adults 50 years of age and older, which may provide an improved immune response.

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