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Tue 14 Mar, 2006 12:22 pm
Need Help_Case Study
Case Study
It has been raining in Oxford for 5 concecutive days. Numerous students have come down with colds(coryza), with runny noses, coughs, and frequent sneezing.
One such student, Luv A. Andp, begins to feel much worse. She presents the following symptoms at the clinic:
General malaise (means she feels yucky)
Fever of 103.5
Difficulty in breathing, with shallow respirations
Green or rust colored sputum
Chest pain, increases with cough
Chills
PO2 = 60mmHg
PCO2 = 55mmHg
For Complete credit you must answer the following questions:
1) Whar is your diagnosis? be very specific as possible, including the causative organism. You must address the above symptoms-- report how as they influence your diagnosis
2) What additional tests would you order to confirm your diagnosis?
3) What would you expect these tests to show?
4) How would you treat this disorder?
Case study
I would have to say Pneumonia, because of the fever.and rust colored sputum. I have the other symptoms right now, r/t type A flu, diagnosis reactive airway disorder. The organism could be the initial virus, or an advanticious bacteria. The high temp seems to point to the virus, as does the green sputum. I would want a cbc with diff and sed rate, chest xray, sputum c+s for definitive dx. UA to r/o a Uti causing the fever, and mono spot, to r/o mono, as this is a student situation, + a TB test to r/o tb. I would expect if its purely respiratory, that the ua would be ok, the WBC would be high, and if viral even higher, the sed rate high. The chest xray would show an area of consolidation. Of course you cannot make an accurate diagnosis until you examine the patient and see those lab results. I would treat with Tylenol for fever+aches, plenty of fluids, quiafenesin, and dextromethorpan to ease the coughs, and a broad spectrum antibiotic until all test results were returned.
I agree with Martina, probably a pneumonia. Organism might be a gram + cocci, streptococci, for example. I disagree with the choice to use a cough suppressant. Most evidence is now showing that it is better to "cough up" the sputum in order to heal. ABX therapy is certainly indicated. But, before starting Tx, we shoud get blood cultures to r/o sepsis. Although the pneunomia index scale would not indicate hospitalization, close monitoring is needed. May consider a bronchodialator to help with breathing and bringing up some of that phelgm. Tylenol is a good choice for an antipyretic, but initially, one should avoid it's use because it can mask fever possible indication ABX failure or worsening of illness. Good luick with your case study!