Please comment to the case analysis below.You may support his diagnosis or other differential diagnosis, may suggest possible treatment or management.How do you support the diagnosis base on the symptoms and history of the pt.Thank you! Also
Case Study 2 DB
The patient being seen today is a 44-year-old male with complaints of worsening cough for 4 days. Patient states he’s had a high-grade fever. Patient states he is feeling weak and for the last two days he’s been bedridden. The patient complains of exertional dyspnea, followed by dyspnea at rest with non-productive cough and pleuritic chest pain. Upon examination patient presents as an anorexic male, febrile, tachypneic, tachycardic, with rales and rhonchi decreased breath sounds, dullness, and egophony. Pertinent history includes history of hypertension, hepatitis C, HIV/AIDS, thrush, past IV drug abuse and lives in a group home. Current medications include, Zovirax, Diflucan, magic mouth wash, Zofran, mycostatin, and filgrastim.
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Primary diagnosis is likely Bacterial Pneumonia (gram-positive bacteria) S. pneumoniae. This form of pneumonia (PNA) can affect any age group yet is typical with patients who are immunocompromised(Buttaro et. Al, 2017). Per(Buttaro et. Al, 2017) the patients’ symptoms such as fever, malaise, egophony, rhonchi, and dullness are distinctive indicators of this type of contagion.
Differential diagnoses include but not limited to. Secondary Diagnosis can include Pulmonary emboli,Pulmonary embolism is an obstruction of the pulmonary arterial bed by a dislodged thrombus, heart valve growths, or a foreign substance. Symptoms include dyspnea, tachycardia, chest pain, and cough(Lippincott, Williams, & Wilkins, 2013).
Secondary differential diagnosis is Chronic heart failure symptoms include tachypnea, tachycardia. This is ruled out due to dependent edema and no hypoxia (Lippincott, Williams, & Wilkins, 2013). Third differential diagnosis included is SARS-CoV per (Lippincott, Williams, & Wilkins, 2013) is contracted through contact with others due to droplet contamination due to the patient living in a group home this has a high probability. SARS symptoms and causes include cough, PNA, high fever, achiness, chills, and shortness of breath (Lippincott, Williams, & Wilkins, 2013).
The history and physical were imperative to determining the correct disease process. Due to the patient being immunocompromised, living in a group home, social history of IV drug use These are significant factors that assist in narrowing down the primary diagnosis.
Potential treatment includes IV/Oral antibiotics depending on the severity of the patient’s symptoms inpatient care to an intermediate care or intensive care unit due to patients’ comorbidities would be beneficial. Medication treatment based on diagnostic testing and current medical and social history can include immunosuppressive drugs, respiratory fluoroquinolone or B lactam, plus a macrolide for outpatient care. Inpatient ICU treatment can include a B-lactam antibiotic, plus either azithromycin or a respiratory fluoroquinolone (Buttaro et. Al, 2017).
Diagnostic testing beneficial in determining the particular infectious properties include, chest x-rays, Ct of chest, CBC, ABG’s, pulse oximetry, telemetry, and sputum culture (Buttaro et. Al, 2017).
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