Mr. Z Scenario
Mr. Z is a 63-year-old retired banker with a long history of chronic obstructive pulmonary disease (COPD). He is a longtime smoker, smoking four packs of cigarettes each day for 30 years. For the last week, Mr. Z has experienced a flulike illness with fever and chills. He also complains of nausea, exhaustion, anorexia, diarrhea, and a productive cough with thick, dark brownish yellow, purulent sputum.
Mr. Z is admitted to the telemetry unit with acute respiratory insufficiency. He is sitting up in a chair, leaning forward, with his elbows resting on the over-the-bed table. Mr. Z is breathing through his mouth, taking rapid shallow breaths, using his accessory muscles to ventilate. He appears anxious, angry, irritable and is barely having audible words between each breath. He is not very cooperative and is using profanity to express how he feels. Auscultation reveals crackles posteriorly over the lower right and left lung fields. When asked to inhale, his nostrils flare, and his intercostal muscles retract. On exhalation, he uses pursed-lip breathing, and his intercostal muscles bulge.
Mr. Zâ€™s admission chest radiograph reveals infiltrates in bilateral lobes. Gram stain of Mr. Zâ€™s sputum shows numerous gram-positive diplococci.
Mr. Zâ€™s admission chest radiograph reveals infiltrates in bilateral lobes. Gram stain of Mr. Zâ€™s sputum shows numerous gram-positive diplococci. His baseline vital signs are as follows:
His baseline arterial blood gas (ABG) values on a 100% non-rebreather mask are:
Community-acquired pneumococcal pneumonia is diagnosed.
Use Mr. Zâ€™s case information to address/answer the following questions
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