Question

Case Study

Amnah is a 55-year-old female patient who has been admitted to the medical ward with acute shortness of breath, chesty cough, wheezing and chest discomfort. Amnah’s vital signs were: SpO2 82% on room air, BP 150/90 mmHg, Pulse 110 beats/min, RR 28 breaths/min, and Temperature 38.7 °C. Amnah has a history of COPD and hypertension for 15 years. She was also diagnosed with heart failure 2 years ago. While doing the physical examination, the patient seemed to use her accessory muscles and have cyanosis in the lips and nose. She also started to get mixed up during the nursing assessment as she could not figure out that she was in the hospital. Amnah also complaint of weakness and fatigue and her lower limbs were very edematous. After a medical review, ABG was taken, CXR was done and venous blood samples were sent for complete blood count, chemistry and culture and sensitivity. Amnah’s lab results were as follows:

Chemistry	Patient Value	Normal Values	ABG & CXR
Sodium	148	136-146 mmol/L	pH 7.25 PaO2 49mm Hg PaCo2 58mm Hg HCO3 27mEq/L
Potassium	4.4	3.5-5.3 mmol/L
Chloride	106	98-108 mmol/L
BUN	68	7-22 mg/dl
Creatinine	1.66	0.7-1.5 mg/dl
Blood culture and sensitivity	streptococcus pneumoniae		CXR: opacity of right lower loop with consolidation and pleural effusions with cardiomegaly
Calcium	7.8	8.9-10.3 mg/dl
Phosphorus	10.4	2.6-6.4 mg/dl
Alkaline Phosphatase	321	30-110 IU/L
Hemoglobin	14.5	14-17 gm/dl

Based on the medical review and the diagnostic tests results, Amnah was mainly diagnosed with impaired respiratory functions. She was also found to have some cardiac and renal abnormalities. The doctor ordered immediate treatment and requested very close monitoring of Amnah.

1. Suggest one main medical diagnosis for Amnah and give one rational behind your suggestion?

Answer 1

Patient is having severe pnemonia as along with the signs and symptoms shown by the patient,the doctor has send for x-ray along with other diagnostic tests.also the laboratory investigations (culture) shows organism streptococci pneumoniae.

Pnemonia

Infection that inflames air sacs in one or both lungs, which may fill with fluid.

With pneumonia, the air sacs may fill with fluid or pus. The infection can be life-threatening to anyone, but particularly to infants, children and people over 65.

Signs and symptoms

Pneumonia symptoms can be mild to life-threatening. They can include:

• coughing that may produce phlegm(mucus)
• fever
• sweating or chills
• shortness of breath that happens while doing normal activities or even while resting
• chest pain that’s worse when you breathe or cough
• feelings of tiredness or fatigue
• loss of appetite
• nausea or vomiting
• headaches