Question

• 63 yof bank manager presents to clinic in Nov
• 1 wk hx of upper respiratory symptoms, 2 day hx of fever, malaise, nausea
• cough productive yellow sputum
• right-sided pleuritic chest pain

Additional hx:

• no rash, no headache or vomiting, no hemoptysis, friends recently ill
• nonsmoker
• negative past medical hx
• no allergies
• had flu shot last year

Physical exam:

• alert, flushed, oriented using accessory muscles
• T-39.2 orally, P 100 and regular, RR 32 BP 110/80
• skin warm and moist
• ears slight serous fluid
• purulent nasal drainage
• decreased expansion over right chest
• increased fremitus
• inspiratory rales-right middle, clear RUL,RLL, LLL, LUL
• no cyanosis, no clubbing, no edema
• ABG ph 7.56 CO2 26 O2 90 on RA
• WBC 15, 000--5% bands, 83% segs, 10% lymphs, 3%monos, 1% eoso
• Sputum +muliple gram diplococci

Describe your plan of treatment in detail (from this point to discharge)

Answer 1

The patient's symptoms with the laboratory result of multiple gram positive diplococci in sputum is suggestive of streptococcus pneumoniae. The plan of treatment for this elderly patient are

• For infection
  • Antibiotics to destroy the microorganisms
  • Infection control practice
  • Teaching cough etiquette
• Fever
  • Antipyretics to reduce body temperature
  • Tapid sponge or cold sponge to reduce fever
  • Increasing fluid intake to regulate temperature
• Ears
  • Assessing the hearing capacity
  • Administration of ear drops as per order and ensuring the serous drainage cause is identified and treated with appropriate antibiotics
  • Ear hygiene
• Others:
  • Infection control practice
  • Medication adherence after discharge
  • Encouraging for screening and antibiotics for the people who had contact with the patient
  • Encourage family members to get vaccinated
  • Proper follow up