This patient is a 62-year-old female who required inpatient hospitalization due to right-sided empyema questionable secondary to community-acquired pneumonia versus aspiration pneumonia. Ms. W was transferred patient from Mercy Folsom for her right-sided empyema to the Emergency Department. She presented to Mercy Folsom with 4-weeks history of shortness of breath and cough as well as chest pain. She went to her primary care physician, and she was given Z-Pak at that time but her symptoms were not resolving. A chest x-ray was done, and she was informed that there was no evidence of pneumonia. Then, she was given cough medication and inhaler for possible COPD, but her symptoms were still not improving. She went again to her primary care physician …show more content…
CT scans of the chest with contrast was also done which showed right lower lobe consolidation with air bronchogram as well as region of decreased density suggesting possible pulmonary necrosis in the medial right lower lobe and moderate right-sided pleural effusion with right middle lobe atelectasis, trace pericardial effusion or thickening on the right medially, mildly enlarged mediastinal, and right hilar lymph nodes likely reactive in etiology and moderate centrilobular emphysematous changes bilaterally most prominent in both upper lobes. Then, administration of antibiotic azithromycin and Rocephin was initiated. A Pulmonologist at Mercy Folsom evaluated her and recommended to continue the broad-spectrum antibiotic and thoracentesis of the right-sided pleural effusion was done with 700 mL of fluid were removed consistent with exudate and empyema. Afterwards, antibiotic was switched to vancomycin and cefepime and was evaluated by Surgery. Chest tube placement was done on the right side drained some serosanguineous fluid discharge from the right-sided chest tube and empyema is noted. She was transferred to Mercy San Juan Hospital to be evaluated by thoracic surgeon, for possible VATS and surgical intervention for her right-sided
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
R.S.’s clinical findings as a consequence of his chronic bronchitis are likely to include: being overweight, experiencing shortness of breath on exertion, producing excessive amount of sputum, having a chronic productive cough, as well as edema and hypervolemia just to name a few. (Copstead & Banasik, 548) Some of these signs and symptoms would be different if R.S. had emphysematous COPD. In emphysema (or “pink puffers”), there is weight loss, the cough is absent or negligible, and edema is not present. While central cyanosis and jugular vein distention are present in late chronic bronchitis, these pathologic manifestations are absent in emphysema. . (Copstead & Banasik, 549)
Hospital-acquired infections (HAI) are preventable and pose a threat to hospitals and patients; increasing the cost, nominally and physically, for both. Pneumonia makes up approximately 15% of all HAI and is the leading cause of nosocomial deaths. Pneumonia is most frequently caused by bacterial microorganisms reaching the lungs by way of aspiration, inhalation or the hematogenous spread of a primary infection. There are two categories of Hospital-Acquired Pneumonia (HAP); Health-Care Associated Pneumonia (HCAP) and Ventilator-associated pneumonia (VAP).
R.S. has chronic bronchitis. According to the UC San Francisco Medical Center “Chronic bronchitis is a common type of chronic obstructive pulmonary disease (COPD) in which the air passages in the lungs — the bronchi — are repeatedly inflamed, leading to scarring of the bronchi walls. As a result, excessive amounts of sticky mucus are produced and fill the bronchial tubes, which become thickened, impeding normal airflow through the lungs.” (Chronic Bronchitis 2015) There are many things that can be observed as clinical findings. R.S. will have a chronic cough that has lasted from 3 months to two years or more, and a lot of sputum. The sputum is due to
Ventilator Associated Pneumonia (VAP) is a very common hospital acquired infection, especially in pediatric intensive care units, ranking as the second most common (Foglia, Meier, & Elward, 2007). It is defined as pneumonia that develops 48 hours or more after mechanical ventilation begins. A VAP is diagnosed when new or increase infiltrate shows on chest radiograph and two or more of the following, a fever of >38.3C, leukocytosis of >12x10 9 /mL, and purulent tracheobronchial secretions (Koenig & Truwit, 2006). VAP occurs when the lower respiratory tract that is sterile is introduced microorganisms are introduced to the lower respiratory tract and parenchyma of the lung by aspiration of secretions, migration of aerodigestive tract, or by contaminated equipment or medications (Amanullah & Posner, 2013). VAP occurs in approximately 22.7% of patients who are receiving mechanical ventilation in PICUs (Tablan, Anderson, Besser, Bridges, & Hajjeh, 2004). The outcomes of VAP are not beneficial for the patient or healthcare organization. VAP adds to increase healthcare cost per episode of between $30,000 and $40,000 (Foglia et al., 2007) (Craven & Hjalmarson, 2010). This infection is also associated with increase length of stay, morbidity and high crude mortality rates of 20-50% (Foglia et al., 2007)(Craven & Hjalmarson, 2010). Currently, the PICU has implemented all of the parts of the VARI bundle except the daily discussion of readiness to extubate. The VARI bundle currently includes, head of the bed greater then or equal to 30 degrees, use oral antiseptic (chlorhexidine) each morning, mouth care every 2 hours, etc. In the PICU at children’s, the rates for VAP have decreased since the implementation of safety ro...
The EB’s case study said the female patient is 50 years old with symptoms of fever, chills, congestion, three weeks of coughing, shortness of breath when walking. The study implies that the patient is now seeking medical advice due to vital signs recording and the noting of decreased breath sounds and wheezing. She denies smoking and not taking any chronic medication.
Ventilator-associated pneumonia (VAP) remains to be a common and potentially serious complication of ventilator care often confronted within an intensive care unit (ICU). Ventilated and intubated patients present ICU physicians, nurses, and respiratory therapists with the unique challenge to integrate evidence-informed practices surrounding the delivery of high quality care that will decrease its occurrence and frequency. Mechanical intubation negates effective cough reflexes and hampers mucociliary clearance of secretions, which cause leakage and microaspiration of virulent bacteria into the lungs. VAP is the most frequent cause of nosocomial infections and occurs within 48 hours of intubation. VAP is a major health care burden with its increased morbidity, mortality, longer ventilator days and hospital stay, and escalating health care cost.
My disease is Streptococcal pneumonia or pneumonia is caused by the pathogen Streptococcus pneumoniae. Streptococcus pneumoniae is present in human’s normal flora, which normally doesn’t cause any problems or diseases. Sometimes though when the numbers get too low it can cause diseases or upper respiratory tract problems or infections (Todar, 2008-2012). Pneumonia caused by this pathogen has four stages. The first one is where the lungs fill with fluid. The second stage causes neutrophils and red blood cells to come to the area which are attracted by the pathogen. The third stage has the neutrophils stuffed into the alveoli in the lungs causing little bacteria to be left over. The fourth stage of this disease the remaining residue in the lungs are take out by the macrophages. Aside from these steps pneumonia follows, if the disease should persist further, it can get into the blood causing a systemic reaction resulting in the whole body being affected (Ballough). Some signs and symptoms of this disease are, “fever, malaise, cough, pleuritic chest pain, purulent or blood-tinged sputum” (Henry, 2013). Streptococcal pneumonia is spread through person-to-person contact through aerosol droplets affecting the respiratory tract causing it to get into the human body (Henry, 2013).
Smith brings his 4-year-old to your office with chief complaints of right ear pain, sneezing, mild cough, and low-grade fever of 100 degrees for the last 72 hours. Today, the child is alert, cooperative, and well hydrated. You note a mildly erythemic throat with no exudate, both ears mild pink tympanic membrane with good movement, lungs clear. You diagnose an acute upper respiratory infection, probably viral in nature. Mr. Smith is states that the family is planning a trip out of town starting tomorrow and would like an antibiotic just in case.
Influenza, or the "flu," is an infection that is caused by the influenza virus. It is a virus that generally infects the olfactory organ, pharynx, and it can sometimes spread to the lungs (2007). Symptoms of influenza can be identified as acute fever, cough, chills, fatigue, body aching and, in young children, ear aches. Unlike the viruses that cause the common cold, the influenza virus can cause severe illnesses like pneumonia, especially in those who are very young or very old, or who have conditions such as cancer, heart disease, bronchial asthma and diabetes. Influenza can be spread by something as simple as an infected individual coughing or sneezing, through little droplets that go up to a meter (3 feet) and land on any nearby individuals
can be prevented by a vaccine. In 20 - 30% of the cases the infection spreads
The purpose of this literature review is to assess and appraise research studies in the last five years, investigating the latest management of community acquired pneumonia in immunocompromised adults patients. A literature search was performed using CINAHL Plus, Google Scholar, MEDLINE, EBSCOhost, UpToDate and PubMed databases. Boolean terms included: community acquired pneumonia, pneumonia, immunocompromised, adults, management, treatments, preventions, effectiveness, antibiotics, promotion, and outcomes. For each database, advance search was used and then limitations included systematic reviews, retrospective analysis, randomized control trial studies that were published, peer reviewed, full text, year of publication between 2010-2015, and English language, were applied.
Streptococcus pneumoniae is a Gram-positive and fast-growing bacteria which inhabit upper respiratory tract in humans. Moreover, it is an aerotolerant anaerobe and usually causes respiratory diseases including pneumonia, otitis media, meningitis, peritonitis, paranasal sinusitis, septic arthritis, and osteomyelitis (Todar, 2003). According to Tettelin et al., more than 3 million of children die from meningitis or pneumonia worldwide (2001). S.pneumoniae has an enzyme known as autolysin that is responsible for disintegration and disruption of epithelial cells. Furthermore, S.pneumoniae has many essential virulence factors like capsule which is made up of polysaccharides that avoids complement C3b opsonization of cells by phagocytes. Many vaccines contain different capsular antigens which were isolated from various strains (Todar, 2003). There are plenty of S.pneumoniae strains that developed resistance to most popular antibiotics like macrolides, fluoroquinolones, and penicillin since 1990 (Tettelin et al., 2001). Antibiotic resistance was developed by the gene mutation and selection processes that, as a consequence, lead to the formation of penicillin-binding proteins, etc. (Todar, 2003).
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
Patient profile: Heterosexual Muslim Woman who has been in the United Stated for three years. She came from Pakistan. She is 42 forty-two years old, from low socioeconomic standing, English language barrier, and is Muslim rituals and practices. She came to emergency department with her husband due to shortness of breathing, high fever, severe cough. She was dignosed with new onset of pneumonia and currently on antibiotic. she also has history of Vitamin D deficiencies and diabetes mellitus type II. She admitted to medical-surgical floor for observation...