Week 3 Discussion 1: Hispanic / Nondocumented Patient with Acute Illness Four differential diagnoses: 1. Influenza.

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

Four differential diagnoses:
1. Influenza.

Influenza (flu) is an acute respiratory virus that is caused by influenza A or B (Dolin, 2022). This is considered as a possible diagnosis because of the symptoms of fever, nonproductive cough, and myalgias (Dolin, 2022). Other symptoms that are common are sore throat and headache (Dolin, 2022). I would swab to rule this one out, but it can be ruled out since the patients illness has been going on for the past month. Flu typically lasts anywhere from 5-7 days.

1. Bacterial Pneumonia.

Bacterial pneumonia is the lead diagnosis because of the symptoms she is describing. She has had a cough for almost a month, that is very congested but nonproductive. There is a presence of chest pain, especially when coughing. Other symptoms common in a pneumonia presentation are sudden onset of fever, fatigue, chills, and myalgia (Dunphy et al., 2019). This patient is 75 years old, so if she does have pneumonia she could have mental confusion and increased weakness.

1. COVID-19.
   COVID-19 is the respiratory disease caused by SARS-CoV-2. This diagnosis should be considered because of the severity of symptoms. Shortness of breath is not typically present in flu. Along with her symptoms (sore throat, headache, fever, chills, myalgia, chest pain, SOB, non-productive cough), she is at high risk for severe disease due to her advanced age and chronic medical condition (asthma) (Cohen & Gebo, 2022). COVID-19 can be ruled out or confirmed with a SARS-CoV-2 PCR nasal swab. When dyspnea and increasing chest discomfort/tightness are experienced, those symptoms are indicative of pulmonary involvement (Cohen & Gebo, 2022).
2. Sepsis.

This is a must not miss diagnosis. She has had a cough and has felt unwell for about a month. Her body temperature in office in 102, she has lost a significant amount of weight from not eating, and is only voiding a few times a day. Because she is so ill-appearing, I would want to get labs for a septic work up. Labs would include CBC, CMP, serum lactate, and blood cultures (Neviere, 2022). Then giving an IM dose of ceftriaxone 1G in office. A broad-spectrum antibiotic like ceftriaxone has the potential to cover many bacteria and can jump-start eradicating the infection if it has gone to her blood. Blood cultures would take a couple of days, but the rest of the lab work would be returned quickly. Depending on the results, she may need to be admitted to the hospital for IV antibiotics and fluid resuscitation. In the outpatient setting, adults with comorbidities and no recent antibiotic use should be prescribed a cephalosporin and a macrolide, or Augmentin and doxycycline (Hollier, 2021).
Diagnosis: Bacterial Pneumonia

Pharmacology:
Ceftriaxone 1gram IM. Ceftriaxone 1gm given IM, STAT once.

Azithromycin- Take 2 (500mg) tablets by mouth on day 1, then take 1 (250mg) tablet once daily for 4 days.

Ibuprofen 200mg tablets. Take 2-3 tablets (400-600mg) by mouth every 6-8 hours for pain and fever control.

Acetaminophen 325mg tablets. Take 1-2 tablets (650mg) by mouth every 4-6 hours for body aches and fever control. Do not exceed 4000mg daily.

Ventolin HFA 17-g cannister. 200 actuations. Use 2 puffs every 4-6 hours for bronchospasm, or 1 puff every 4-6 hours during acute illness. Shake well before use.

Benzonatate 100mg gel capsules. Take 1-2 capsules (100-200mg) by mouth 3 times a day for cough.

Non-Pharmacology:
-increase fluid intake 1-2L per day
-rest, but be sure to move around several times a day
-sleep with cool-mist humidifier

Labs/Diagnostics:
-Chest xray
-CBC, CMP, Lactic Acid, and 2 sets of blood cultures.
-SARS-CoV-2 PCR Nasal swab (Cohen & Gebo, 2022).
-Influenza antigen nasal swab (Dolin, 2022).

Referrals/Interprofessional Communications: No referrals are needed for this patient at this time.

Patient Education:
-Increase your intake fluids. Water is best, but hydration is your goal. Drink something with electrolytes like Gatorade.
-Reduce your activity until your symptoms start improving.
-Alternate Ibuprofen and Acetaminophen every 3 hours. Example: Take ibuprofen @3pm and acetaminophen @ 6pm. Alternating the medications will help with body aches, chest pain, and better control fevers.
-Azithromycin is only a 5-day course but continues working for 10 days. This is why follow-up will be in one week if you are not improving. Avoid aluminum or magnesium containing anta