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Woo Pharmacotherapeutics 5e

Page 1 of 2 Ch45 Instructor CS

Chapter 45: Pneumonia Instructor Case Study

Complaint “I’ve been coughing for 2 days.” History A 48-year-old man presents to the clinic with a 2-day history of fever and productive cough (sputum reported to be greenish). His history includes mild hypertension and a half-pack per day smoking habit. He reports that he used to smoke one pack per day, but he has cut back. He is currently not taking medication for his high blood pressure because he did not like the adverse reactions. No other family members are ill, but “something is going around” at work. Assessment On physical examination, George is pale and ill appearing, but able to ambulate into the examination room and onto the table without assistance. His oral temperature is 100.9°F, and his blood pressure is 135/82 mm Hg. Decreased breath sounds in the left lower lobe with scattered crackles are observed. A chest x-ray reveals a consolidation in the left lower lobe.

1. What would be the initial management plan? Viruses, bacteria, and fungi can all cause pneumonia. In the United States, common causes of viral pneumonia are influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19). A common cause of bacterial pneumonia is Streptococcus pneumoniae (Torres & Liapikou, 2016).

Woo Page 2 of 2 Pharmacotherapeutics 5e Ch45 Instructor CS Community-acquired pneumonia is when someone develops pneumonia in the community (not in a hospital) like this patient who says, “something is going around” at work. Healthcareassociated pneumonia is when someone develops pneumonia during or following a stay in a healthcare facility. Healthcare facilities include hospitals, long-term care facilities, and dialysis centers. Ventilator-associated pneumonia is when someone gets pneumonia after being on a ventilator, a machine that supports breathing. The bacteria and viruses that most commonly cause pneumonia in the community are different from those in healthcare settings (Torres & Liapikou, 2016). This patient has developed community-acquired pneumonia, which is a suspected bacterial pneumonia infection because chest X-rays reveal lobal infection, decreased breath sounds in the left lower lobe with scattered crackles auscultated (Watkins & Lemonovich, 2011). The differential symptom that sway towards bacterial pneumonia include the sputum that is yellow or green mucus while coughing as against a dry cough, because there is rarely sputum produced with viral pneumonia (Watkins & Lemonovich, 2011). Treatment includes medication and therapy. Antibiotics: To treat bacterial infection include levofloxacin or Azithromycin, Analgesics: To ease symptoms of pain. Acetaminophen or Ibuprofen, since the patient has hypertension, Acetaminophen will be the prescribed analgesics. Cough suppressants: To relieve cough medication such as Dextromethorphan will be prescribed to reduce coughing spells. Therapy include self-care options like taking rest at home, drinking plenty of fluids to loosen the cough and phlegm, and avoid straining the body during recovery and oxygen therapy as needed to improve lung fuction.

2. What education should the patient receive Please cover your mouth and nose when you sneeze because bacterial pneumonia spread through inhalation of airborne droplets by coughing or sneezing (Marrie et al., 2004). It is important you take time off work to self-care for example, taking rest at home, drinking plenty of fluids to loosen the cough and phlegm, and avoid straining the body during recovery. Education should teach prevention which include getting vaccinated, although vaccines are available to prevent some types of pneumonia and the flu, getting these shots can prevent pneumonia, practice good hygiene, one of which include washing hands regularly or using an alcohol-based hand sanitizer protect you against respiratory infections that sometimes lead to pneumonia, don’t smoke because smoking damages your lungs' natural defenses against respiratory infections, and finally, Keep your immune system strong by getting enough sleep, exercise regularly and eat a healthy diet. References Torres, A., & Liapikou, A. (2016). Diagnosis and management of community-acquired pneumonia. Oxford Medicine Online. https://doi.org/10.1093/med/9780199600830.003.0116 Watkins, R., & Lemonovich, T. (2011, June 1). Diagnosis and Management of CommunityAcquired Pneumonia ... https://www.aafp.org/afp/2011/0601/p1299.html#sec-4. http://www.ahaphysicianforum.org/resources/appropriate-use/ACSC/content/AAFP-CAPadult.pdf. Marrie, T. J., Poulin-Costello, M., Beecroft, M. D., & Herman-Gnjidic, Z. (2004, July 7). Etiology of community-acquired pneumonia treated in an ambulatory setting. https://www.sciencedirect.com/science/article/pii/S0954611104002197....