COURSE
NRNP 6540 Advanced Practice Care of Older Adults
Case Title: A 67-year-old With Tachycardia and Coughing
Ms. Jones is a 67-year-old female who is brought to your office today by her daughter Susan. Ms. Jones lives with her daughter and is able to perform all activities of daily living (ADLs) independently. Her daughter reports that her mother’s heart rate has been quite elevated, and she has been coughing a lot over the last 2 days. Ms. Jones has a 30-pack per year history of smoking cigarettes but quit smoking 3 years ago. Other known history includes chronic obstructive pulmonary disease (COPD), hypertension, vitamin D deficiency, and hyperlipidemia. She also reports some complaints of intermittent pain/cramping in her bilateral lower extremities when walking, and has to stop walking at times for the pain to subside. She also reports some pain to the left side of her back, and some pain with aspiration.
Ms. Jones reports she has been coughing a lot lately, and notices some thick, brown- tinged sputum. She states she has COPD and has been using her albuterol inhaler more than usual. She says it helps her “get the cold up.” Her legs feel tired but denies any worsening shortness of breath. She admits that she has some weakness and fatigue but is still able to carry out her daily routine.
Vital Signs: 99.2, 126/78, 96, RR 22
Labs: Complete Metabolic Panel and CBC done and were within normal limits
| CMP Component | Value | CBC Component | Value |
| Glucose, Serum | 86 mg/dL | White blood cell count | 5.0 x 10E3/uL |
| BUN | 17 mg/dL | RBC | 4.71 x10E6/uL |
| Creatinine, Serum | 0.63 mg/dL | Hemoglobin | 10.9 g/dL |
| EGFR | 120 mL/min | Hematocrit | 36.4% |
| Sodium, Serum | 141 mmol/L | Mean Corpuscular Volume | 79 fL |
| Potassium, Serum | 4.0 mmol/L | Mean Corpus HgB | 28.9 pg |
| Chloride, Serum | 100 mmol/L | Mean Corpus HgB Conc | 32.5 g/dL |
| Carbon Dioxide | 26 mmol/L | RBC Distribution Width | 12.3% |
| Calcium | 8.7 mg/dL | Platelet Count | 178 x 10E3/uL |
| Protein, Total, Serum | 6.0 g/dL | ||
| Albumin | 4.8 g/dL | ||
| Globulin | 2.4 g/dL | ||
| Bilirubin | 1.0 mg/dL | ||
| AST | 17 IU/L | ||
| ALT | 15 IU/L |
Allergies: Penicillin Current Medications:
- Atorvastatin 40mg o. daily
- Multivitamin 1 tablet daily
- Losartan 50mg o. daily
- ProAir HFA 90mcg 2 puffs q4–6 prn
- Caltrate 600mg+ D3 1 tablet daily
Diagnosis: Pneumonia
SOLUTION
Directions: Answer the following 10 questions directly on this template.
Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia?
A typical report of a chest x-ray significant for pneumonia indicates areas of white, or infiltrates, in the affected lobe. There is airspace opacity, consolidation of lobes, or interstitial opacities.
Question 2: Define further what type of pneumonia Ms. Jones has, HAP (hospital- acquired pneumonia) or CAP (community-acquired pneumonia)? What’s the difference/criteria?
Mrs. Jones has community-acquired pneumonia as she became ill outside of the hospital. Hospital acquired pneumonia is any pneumonia contracted by a patient 48-72 hours after admission to the hospital. HAP is typically bacterial in origin whereas CAP is likely viral………please click the icon below to purchase full solution at $15