Questions for Discussion:
- Does this patient have pneumonia?
- What are the generally accepted criteria for a diagnosis of pneumonia?
- Should this patient be admitted to the hospital? Is she at increased risk for a complicated course?
- What further history regarding exposure should be asked of this patient and her family before bed assignment?
- Explain the physical findings present in consolidation versus pleural effusion.
- What further lab studies should be ordered to ascertain the etiology of her pneumonia? What is the percentage of patients who have a febrile bacteremia associated with pneumonia? What is the most common early sign of pneumonia in the elderly?
- Discuss the sensitivity and specify of the gram stain and the sputum culture.
- What four ways do micro-organisms get to the lung and which of these four is most common?
- What is the most common pathogen in community acquired pneumonia? What antibiotic coverage might you suggest initially?
- What pathogens are involved in nosocomial pneumonia and what antibiotic coverage might you suggest?
- When should the patient have a repeat CXR? How long might it take before her CXR is normal?
- What care can be given this patient in your OPC to prevent another pneumonia next year?