[Solved]: Mrs

Mrs. B.I. is an 84-year-old female who presents to her primary care provider, accompanied by her home caregiver. The caregiver explains, “Mrs. I is confused and very sick. She was up most of last night coughing.” The patient has a one-week history of upper respiratory symptoms and a two-day history of increased weakness and malaise. Approximately three days ago, she developed a cough that has gradually become worse and she now has difficulty catching her breath. The caregiver also reports that the patient was confused last night and nearly fell while going to the bathroom. The patient has been coughing up a significant amount of phlegm that is thick and green in color. Personal History Mrs. B.I. is widowed and a retired bank manager. She owns her own home and has a 45-year-old female caregiver who lives in the home. Currently, Mrs. I. uses a walker and takes daily strolls to the park with her caregiver. She is able to perform most activities of daily living; however, the caregiver prepares all meals. She has a 50-year history of cigarette use, but quit ten years ago. She suffered chronic bronchitis as a child. She has mild left hemiparesis caused by CVA (cerebrovascular accident) 4 years ago. She received the influenza shot one month ago. Medical Update Caregiver has not observed any episodes of emesis or change in bowel movements, but reports a decrease in appetite. The patient has a productive cough and is using accessory muscles to breathe. She is tachypneic and appears to be uncomfortable and in moderate respiratory distress. Blood pressure is slightly elevated and her skin is warm and clammy. Auscultation reveals crackles and diminished breath sounds in the upper regions of the lungs and absence of breath sounds in the lower regions of the lungs. Sputum culture is positive for pathogenic organisms.