NSG6420_aquifercasestudy_week3_king.m2.pdf - Internal Medicine 22 71-year-old male with cough and fatigue User Miranda King Email

NSG6420_aquifercasestudy_week3_king.m2.pdf - Internal...

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Internal Medicine 22: 71-year-old male with cough and fatigue User: Miranda King Email: [email protected] Date: March 8, 2020 1:34AM Learning Objectives The student should be able to: Discuss the common causes of acute dyspnea, their pathophysiology, symptoms, and signs. List the common pneumonia pathogens (viral, bacterial, mycobacterial, and fungal) in immunocompetent and immunocompromised hosts. Describe radiographic findings associated with specific pathogens. Identify bronchial breath sounds, rales (crackles), rhonchi, and wheezes, signs of pulmonary consolidation, and pleural effusion on physical exam. Recognize the most common complications of pneumonia. Identify /recommend when to order diagnostic laboratory tests—including complete blood count, sputum Gram stain and culture, blood cultures, and arterial blood gases—how to interpret those tests, and how to recommend treatment based on these interpretations. Select an appropriate empiric antibiotic regimen for community-acquired, nosocomial, immunocompromised-host, and aspiration pneumonia, taking into account pertinent patient features. Discuss the Centers for Medicare and Medicaid Services (CMS) and Joint Commission’s quality measures for smoking cessation advice and vaccination against pneumonia and influenza in patients with pneumonia and other pulmonary disorders. Knowledge Important Historical Findings in a Patient with Cough Fever is an important part of the history in a patient with cough because it makes an infectious cause more likely. The severity of fever (e.g., 100.4 vs. 104.0) is not specific and therefore does not help distinguish between different causes of inflammation. Fever is both detrimental and beneficial. It leads to increased metabolism, which can cause dehydration, promote inflammation, and inhibit function of proteins at very high temperatures. The primary potential benefit of fever is to decrease bacterial reproduction and growth, because most bacteria function best in a limited temperature range. Patients are unable to accurately assess their temperature based on touch. Chest pain needs to be carefully assessed in patients with cough. Coughing is a violent action, which frequently causes injury to the intercostal muscles and ribs. Patients with severe coughing spells will often complain of chest pain that is diffuse and bilateral that occurs primarily with the coughing episode. If the chest pain is due to a pulmonary process, then you can be certain that the pleura are involved and inflamed (because the pulmonary parenchyma is insensate). Such a condition is called pleurisy and the chest pain is worse with deep inspiration or coughing, which is most commonly unilateral. Hemoptysis is a non-specific finding of cough. It is important to determine whether a patient has massive or life-threatening hemoptysis, which is defined as greater than 100 mL over a 24-hour period. Patients often do not estimate the amount of their hemoptysis accurately, so it is difficult to make this determination by history alone.
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