NU 664B Week 3 Discussion 1: Hispanic / Nondocumented Patient with Acute Illness Differential Diagnosis: Community acquired pneumonia (CAP)

 NU 664B Week 3 Discussion 1: Hispanic / Nondocumented Patient with Acute Illness

Differential Diagnosis:

1. Community acquired pneumonia (CAP) – The is the most likely diagnosis for this patient. Subjective findings for this patient include many of the symptoms that are commonly reported in CAP including cough, fatigue, fever, chills, and sore throat (Dunphy et al.,2019). This patient has risk factors for pneumonia which include age greater than 65, the fact that she is a smoker, the fact that she has not been immunized against pneumonia, her asthma history, and the fact that she lives with extended family including elderly and infants (Mendez-Brich et al., 2019). The fact that she has hemoptysis also supports the diagnosis of pneumonia because one of the most common causes of hemoptysis is respiratory infections such as pneumonia ( O’Gurek & Choi, 2022). Annually CAP develops in 5 million people in the United States ( Dunphy et al., 2019). Worldwide CAP is one of the most commonly diagnosed illnesses (Klompas, 2023). Due to its common incidence CAP is the leading diagnosis in this case and would be confirmed with a chest xray.
2. Tuberculosis (TB)- TB needs to be considered in this case due to the fact that the patient recently immigrated from a Latin American country and did not receive BCG vaccination ( Dunphy et al., 2019). This diagnosis also needs to be considered because when considering the worldwide population as a whole TB is the most common cause of hemoptysis ( O’Gurek & Choi, 2022). According to Wei et al. (2020) the incidence of TB in Columbia is 10-99 per 100,000 population per year. Factors that make the diagnosis of TB less likely in this case is that the patient is not immunocompromised with contributing diagnosis such as HIV or the use of immunosuppressive medications (Dunphy et al.,2019). Sputum gram stain and culture and chest xray would help to rule in or out this diagnosis.
3. Influenza- Influenza is another diagnosis to consider because its classical presentation includes fever, chills, and nonproductive cough (Dunphy et al.,2019). A risk factor in this case is that the patient did not receive influenza vaccination (Dunphy et al.,2019). This was placed lower on the list of differentials due to the fact that the patient reports these symptoms have been going on for 2 weeks. Typically, in influenza the cough is present early in the course of illness. Also the fever typically lasts 3-5 days (Dunphy et al.,2019).
4. Covid-19- Covid-19 needs to be included in the differential diagnosis because the patient has many of the symptoms classically identified in this illness such as fever, cough, sore throat, breathlessness, and fatigue (Singhal,2020). The fact that she has known exposure to other people who are acutely ill and lacks vaccination place her at risk for Covid-10 (Singhal,2020). Negative PCR testing will rule out the diagnosis (Pascarella et al.,2020).

Plan:

Primary Differential Diagnosis: Community acquired pneumonia (CAP)

Pharmacology

ibuprofen [Motrin, Advil] 400 to 600 mg PO every 6 to 8 hours as needed for sore throat, myalgias, or headache.

acetaminophen [Tylenol] 650 mg PO every 4 to 6 hours as needed for sore throat, myalgias, or headache.

guaifenesin 200 to 400 mg PO every 4 hours as needed for cough

Albuterol hfa 90 mcg inhaler 2 puffs every 4 hours as needed for sob

Augmentin 875 mg twice a day orally for 5 days

Azithromycin 500 mg orally  day 1, then 250 mg daily days 2-5

(Dunphy et al.,2019)

Non-Pharmacology

Advise the patient to rest. Drink plenty of fluids. Gargle with salt water to help alleviate the sore throat. Discuss appropriate hygiene including washing the hands frequently to avoid transmission to others and to avoid future infections (Dunphy et al, 2019).

Diagnostics:

Influenza PCR to rule out influenza. Covid-19 PCR to rule out Covid-19. Chest xray to confirm diagnosis of pneumonia and then in this case I would do follow up chest xray film in 4 weeks to check for resolution due to her increased lung cancer risk due to smoking and her report of hemoptysis ( Klompas,2023). CBC and CMP to evaluate for any signs of sepsis which may require hospitalization such as leukocytosis, abnormal renal, or liver function (Klompas, 2023). In this case there is a suspicion for TB so sputum culture with gram stain would be obtained to help rule this out (Dunphy et al.,2019).

Consults/Referrals

No Specialist referral is indicated at this time

Patient education: 1. The patient should receive the influenza vaccine annually. 2. The patient should receive the Prevnar1