Reference no: EM133950406

Question

Mr. Jin is a 55-year-old Chinese man. Mr. Jin is hospitalized for pneumonia.

Mr. Jin tells you that, for the past few days, he has been experiencing shortness of breath, wheezing, and fatigue. He is coughing up copious amounts of thick yellow/green colored sputum. He denies chest pain. He is tired and does not have much of an appetite.

He has smoked cigarettes for 49 years and has no intention of stopping or decreasing the amount he smokes. He thinks he smokes 2 packs a day, but doesn't really keep count. For the past several years, he has had "breathing problems".

Past medical history: Congestive heart failure and COPD

Medications: Hydrochlorothiazide, Proventil (albuterol) and Advair inhalers. When his lungs get "really bad", he takes prednisone.

Allergies: Sulfa and penicillin.

Vital signs: Temperature 38.0°C (oral), pulse 102 beats per minute, respirations 24 breaths per minute, blood pressure 156/78, O2 sats (oxygen saturation) 89%. Alert and oriented. General impression: Patient sitting in chair with increased respiratory effort. Nasal flaring and pursed lip breathing. Needs to pause to breathe in the middle of sentences. Skin: Color pale, lips are bluish in color. Clubbing present in fingers. Respiratory: Using neck muscles to breathe, no intercostal retractions. Coughing up moderate amounts of thick, yellow sputum. Increased dyspnea and respirations increase to 32 breaths per minute when ambulating in the hall.

Percussion: Right base dull to percussion.

Auscultation: Coarse expiratory wheezes throughout all lung fields bilaterally. Decreased breath sounds throughout. Coarse crackles in right lower lung field.

Give an example of worsening respiratory status when you would call the provider other than ones mentioned.