Upper Respiratory Infection - Essay Example

Upper respiratory infection ive Data Patient initials: D.C Age: 68 years Sex: Male History of Present Illness: DC presented to the urgent care clinic with chief complains of cough and cold, which has lasted for a duration of two weeks. He also complains of fatigue, shortness of breath, fever and chills. The patient reports yellowish sputum upon a cough, which increases in frequency and amount over time. The patient equally reports a stabbing chest pain on the right side. Past medical history: The patient reports a history of hypertension that has lasted for the last fifteen years and is currently on hypertensive medications. DC reports a history of a right knee surgery that was operated eight years ago without present residual problems. Social and family history: DC is a retired university professor who is married with three adult children and two grandchildren who are all healthy and in good condition. The patient is a non-smoker but drinks 12 glasses of wine every day. The mother of the patient died at the age of 80 years from a lymphoma, but the father is 92 years old, alive, had suffered a cardiovascular accident as well as hypertension. No member of the family has a history of upper respiratory tract infection. Pre admission medications 1. Hydrochlorothiazide 25 mg po daily 2. Metoprolol 50 mg po bid 3. Sertraline 50 mg po daily 4. ASA 325 mg po daily 5. Acetaminophen 500 mg two tabs bid Objective data Vital signs: Temp: 102.5°F; HR: 80 bpm; BP: 125/78 mmHg; RR: 32 bpm; Wt: 195 ibs; Ht 6’1” Review of system CNS: alert and oriented to time, space and person. Respiratory: slight splinting on the left side with inspiration; crackles and rales heard in the left lower base. Oxygen saturation 88%. Radiology: Left lower lobe consolidation Diagnosis of community acquired pneumonia Community-acquired pneumonia is an infection resulting from a social contact. Based on the history presentation of the patient and physical examination findings, the production of yellowish sputum associated with elevation in temperature is an indication of active infection. Additionally, a chest x-ray revealing left lower lobe consolidation indicates an infection on the left lower lobe with pneumonia. Historical findings reveals that the patient is a nonsmoker and no member of the family has a history of pneumonia provides a lead that the infection was acquired through social contact, in addition, to increasing in frequency and amount of sputum production (Brown & Dean, 2010). Community-acquired pneumonia is common among individuals who are not previously hospitalized but develop infections of the lungs, the infection can occur in all ages and often manifest with difficulty in breathing, fever, chest pain and cough as the typical signs and symptoms the patient presents with. The infection occurs mainly in the alveoli thus reducing the oxygen absorption ability of the alveoli. This is indicated by the oxygen concentration of the patient’s lungs, thus indicating the patient only absorbs a small amount of the total inhaled oxygen. Risk factors to community acquired pneumonia Age is a risk factor for the acquisition of community-acquired pneumonia. Children lower than two years old and adults more than 65 years are at an increased risk of acquisition of the infection due to the incompetence of their immune system to fight the infection. Chronic infections like cardiovascular diseases increase the risk of acquiring a community pneumonia. A compromise in the functionality of the cardiovascular system impairs blood supply to the lungs thus impairing availability of the white blood cells to fight infection. Suppression of the immune system because of infections HIV/AID, chemotherapy or a long-term use of steroid medication impairs the immune competency of an individual thus predisposing the individual to a community-acquired pneumonia. Hospitalization and smoking are among the factors that increase the risk of community-acquired pneumonia. Nevertheless, in the case of DC, acquisition of the infection is as a result of compromised immunity in relation to the age factor, the presence of a cardiac condition (hypertension) equally increases the risk of development of a community-acquired pneumonia in the patient. Management Treatment of the community-acquired pneumonia involves treatment of the infection and management of the complications. Treatment of the infection results to easing of the symptoms within a few days, however, fatigue may persist for more than a month. The course of treatment will in cooperate periodic visits to the hospital setup after discharge for monitoring the clearance of the infection through a chest X-ray. Treatment of the patient would thus combine both secondary care for the cure of the infection and primary care to prevent reinfection with the same condition once discharged to the community. The medication dosage given is dependent on the age of the patient and the severity of the infection. The patient will thus be managed with antibiotics as well as a continuation of his current medications for the management of other conditions (Solomon, Wunderink, & Waterer, 2014). Prescribed medications Medication Dose Time Side effects Gentamycin 40mg IM Bid × 2 weeks Ototoxicity, nephrotoxicity, headache, nausea and vomiting Erythromycin 500 mg po Qid × 2 weeks Pseudo membranous colitis, GIT disturbance, reversible hearing loss, agranulocytosis, hepatic dysfunction, pancreatitis The antibiotic therapy prescribed for the treatment of the patient are under classes aminoglycosides and macrolides respectively. Gentamycin is a broad spectrum acting antibacterial that would help in the elimination of a large amount of microbials that may be attributed to the community acquired pneumonia. Erythromycin is a macrolide that is an alternative for a penicillin-allergic patient. The medication is effective in the treatment of lower respiratory tract infection. The two drugs do not show any form of drug interaction thus work in a synergistic approach to the elimination of the infection Gentamicin achieves its antimicrobial action by inhibiting biosynthesis of DNA and RNA of the microbe. This is achieved by binding to the 30s ribosomal subunit causing misreading of the t-RNA thus interfering with the bacterial synthesis of protein and ultimately inhibiting its growth. Erythromycin on the other hand acts by penetration of the bacterial cell membrane thus binding reversibly to the 50s subunit of the ribosome of bacterial thus blocking the binding of tRNA hence inhibiting the multiplication of the bacteria (Neut et al., 2011). Medication to continue 1. Oxygen 2L via nasal prongs whenever there is an indication of labored breath 2. Acetaminophen 1000 mg tds for five days for management of fever and chest pain 3. Hydrochlorothiazide 25 mg po daily for the management of hypertension 4. Metoprolol 50 mg po bid for the management of hypertension 5. Sertraline 50 mg po daily for management of anxiety 6. Aspirin 325 mg po daily for management of fever and pain Health education The patient is managed through a collaboration with the community social worker. In the course of the management, the patient will be informed of the need to avoid overcrowded areas that may limit oxygen supply thus worsening the pneumonia. The patient will be advised on the need for a proper diet as a means of improving the immune competence as a mechanism for fighting the infection. During the treatment, the nurse, and the social worker would teach the patient deep breathing and coughing exercises as a means of eliminating excess mucus from the airway thus making respiration less labored (Sligl & Marrie, 2013). Conclusion Pneumonia is a life threatening condition especially among young children and the elderly. It is paramount that a proper course of treatment must be sort to ensure quick recovery. In the case of the patient presented above, allergic reaction to penicillin necessitates the application of erythromycin and gentamycin as broad-spectrum antimicrobials. Combination of treatment with the primary health care would help in the prevention of reinfection once the patient is discharged to the community. References Brown, S. M., & Dean, N. C. (2010). Defining and predicting severe community-acquired pneumonia. Current Opinion in Infectious Diseases, 23, 158–164. Neut, D., Dijkstra, R. J. B., Thompson, J. I., Van Der Mei, H. C., & Busscher, H. J. (2011). Antibacterial efficacy of a new gentamicin-coating for cementless prostheses compared to gentamicin-loaded bone cement. Journal of Orthopaedic Research, 29, 1654–1661. Sligl, W. I., & Marrie, T. J. (2013). Severe Community-Acquired Pneumonia. Critical Care Clinics. Solomon, C. G., Wunderink, R. G., & Waterer, G. W. (2014). Community-Acquired Pneumonia. New England Journal of Medicine, 370, 543–551. Read More