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Mr Bank’s is an 80 year old resident at the long-term care facility where you are rounding. His care giver tells you that Mr. Banks did not eat his breakfast this morning, which is unusual for him. Ms. Harper (she and Mr. Banks are good friends, some would even say they are dating- she is also a resident of the facility) tells the nurse’s aid he “couldn’t catch his breath.” When Mr. Bank’s daughter visited, she insisted you be called. You round at the long term care facility three times a week before you go to the office. You have been seeing Mr. Banks for the past two years in the clinic before his family felt he would be better at Plain Acres. He knows you well and his family has been appreciative of your thorough and caring approach. 

 

When you enter the room, his daughter looks concerned, stating “I’ve never seen him like this. He’s sweating really bad and his breathing looks terrible.

 

You begin evaluating the patient. He tells you he started feeling ill yesterday afternoon after Bingo. He was coming back to his room and walking up the stairs and felt winded. He denies coughing. You have his chart with you and are reviewing it with the patient. You recall the patient has diabetes that is well controlled, hypothyroidism and HTN. His current meds include: metformin, levothyroxine and an ACE inhibitor. He also takes a baby aspirin daily. His chart notes allergy to

“-micins”. He smoked in the distant past and does not drink alcohol.

 

You carefully assist Mr. Banks back to bed, noting his shirt is soaked with perspiration, and conduct a thorough physical examination. Overall, he appears to be quite fatigued. His vital signs reveal a temperature of 38.8 C, HR 110, RR 18. He is mildly orthostatic. His breathing, while not labored, permits him to complete only short sentences without interruption. His skin is dry and there are other signs of volume depletion. His cardiac exam reveals tachycardia without any extra heart sounds. Auscultation of his lungs demonstrates decreased breath sounds in the bilateral mid-lung zones. There are accompanying crackles.

 

Upon further review of Mr. Bank’s chart, you see that he has not been admitted to the hospital and there is no recent prescription for antibiotic therapy documented in the record. He has no other recent microbiological testing results to provide information about colonizing strains of bacteria. 

 

 

What is your differential for this patient and primary diagnosis? (rationale please).
What diagnostic tests/labs would you order?
Based on your experience with such patients, and after a quick consultation with a pocket guide to antibiotic therapy, you conclude the most likely pathogens responsible for Mr. Bank’s symptoms include?
What treatments would you order at this time?
What does current research note about this patient’s likely diagnosis?
SCIENCE
HEALTH SCIENCE
NURSING

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