Reference no: EM133310426
Case Study: Colin Walker is 84 yo. He lives the Mount Morgan Residential Aged Care Home. The Nurse Practitioner who provides Colin's care at the residence has called the Community Rapid Response Team because Colin has not responded to the prednisolone (oral corticosteroid) and azithromycin (antibiotic) prescribed 3 days ago for a productive purulent cough. At the time, sputum and blood samples were sent to pathology.
Collect cues
Past medical history: Osteoarthritis Early dementia Prostate cancer - received his third dose of chemotherapy last week Colin has been vaccinated for the following: influenza, Covid-19
Physical assessment: Respiratory rate = 32 bpm SpO2 = 92% on 2L oxygen via nasal prongs BP = 178/96 mmHg: MAP 123 mmHg HR = 110 bpm Temp = 39.6oC Colin has experienced episodes of severe shivering (rigors) Palpation: enlarged neck lymph nodes
Respiratory assessment: Productive cough - tenacious, green sputum Complaining of dyspnoea Inspection: accessory muscle use, respirations shallow, can only speak in single words Auscultation: unequal air entry, crackles heard in all lung fields, reduced breath sounds, widespread wheezing
Pain assessment: P (provoking) - breathing Q (quality) - sharp & stabbing R (region and radiation) - chest S (severity) - at worst 6/10 T (time) - past 24 hours Pathology results: Haemoglobin: 140 g/L (ref range (male): 140 - 175 g/L) White cell count: 6.0 X 10^9/L (ref range: 4.5 - 11.0 x 10^9/L Neutrophils: 2.0 X 10^9/L (ref range: 1.8 - 7.8 X 10^9/L (1.8 million - 7.8 million neutrophils per millilitre of blood))
Question: Sputum culture: positive for Streptococcus pneumoniae which is resistant to azithromycin, susceptible to amoxicillin
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