CONCEPT MAP

CLINICAL PROFILE PHYSICAL FINDINGS

 23 years old  BP : 80/60 mmHg (hypotensive)

 Male  HR : 118 bpm (tachycardic)
 Construction worker  RR : 29 cpm (tachypneic)
 5 days non-productive cough  T: 38.9 C (febrile)
 5 days recurrent undocumented fever  O2 Sat (room air) : 88% (low)
 Chest pain aggravated with coughing, relieved at rest, and with a PRS of  BMI : 23 kg/m2
3/10  Presence of subcostal retractions
 Progressive worsening of dyspnea  Decreased tactile fremitus on the Right
 No hemoptysis  Dullness on the right basal areas upon percussion
 History of asthma since 2009  Presence of expiratory wheeze
 Allergy to seafood and Mefenamic acid  Crackles on bilateral basal areas
 Sibling with PTB on 3rd month treatment
 Known smoker (4 pack-year)
 Exposure to dust
 weight loss
 body malaise since onset of illness
 Febrile
 recurrent colds noted mostly early morning associated with sneezing
 recurrent throat itchiness
 anorexia since onset of illness Pivot: DYSPNEA
 (+) easy fatigability

Differential: 4th differential Differential: 3rd differential Differential: 2nd differential Differential: 1st differential
HEART FAILURE ASTHMA IN EXACERBATION PULMONARY TUBERCULOSIS COMMUNITY ACQUIRED PNEUMONIA – HIGH RISK
R/I: R/I: R/I: R/I:
 80/60 mmHg  80/60 mmHg  Weight loss  80/60 mmHg
 RR : 29 cpm  RR : 29 cpm Arrange your  Chest pain aggravated with coughing, relieved at  RR : 29 cpm
 PR : 118 bpm  PR : 118 bpm differentials. Nearest rest, and with a PRS of 3/10  PR : 118 bpm
 Rales  O2 Sat (room air) : 88%  Body malaise since onset of illness  O2 Sat (room air) : 88%
 5 days non-productive cough  5 days non-productive cough differential should be  Sibling with PTB on 3rd month treatment  5 days non-productive cough
 Chest pain aggravated with coughing  recurrent colds noted mostly early morning mentioned first  Anorexia since onset of illness  Recurrent fever
 Progressive worsening of dyspnea associated with sneezing  (+) easy fatigability  Recurrent throat itchiness
 History of asthma  Chest pain aggravated with coughing, relieved at  Chest pain aggravated with coughing, relieved at
 Known smoker (4 pack-year) rest, and with a PRS of 3/10 R/O: rest
 Easy fatigability  Presence of subcostal retractions  5 days non-productive cough  Presence of subcostal retractions
 Progressive worsening of dyspnea  5 days recurrent undocumented fever  Crackles on bilateral basal areas
R/O  Presence of expiratory wheeze  No hemoptysis  Dullness on the righ basal areas upon percussion
 No neck vein distention  (+) easy fatigability  No night sweats  Exposure to dust
 No cardiomegaly  Known smoker (4 pack-year)  History of asthma
 No paroxysmal nocturnal dyspnea  Exposure to dust  Known smoker
 No heart murmurs  Recurrent colds
 No edema R/O:  Easy fatigability
 Febrile
 BP: 80/60 mmHg
 Decreased tactile fremitus on the right
 Dullness on the right basal area upon percussion

Admitting Diagnosis:

COMMUNITY ACQUIRED PNEUMONIA – HIGH RISK

Pathophysiology

Entry of infecting organism

to the lower respiratory tract

Stimulation of the infllamatory

response

Excessive stimulation of
inflammatory response
due to uncontrolled
Alveolar filling
infection

Hypoxia and
Generalized vasodilation
dyspnea

Hypotension

ARTERIAL BLOOD GAS ANALYSIS CHEST X-RAY

COMPLETE BLOOD COUNT
Test Result Normal Range  Complete opacification of the right mid and
RBC 5.0 x 10 12/L 4.5–5.5 x lower zones due to fluid in the pleural cavity
Analyte Result Normal range
10 12/L
pH 7.32 7.35-7.45  Meniscus sign- concavity of the fluid due to
WBC 10 x 10 9/L 5.0–10.0 x
pCO₂ 48 mmHg 35-45 mmHg surface tension with the pleura
10 9/L
HCO3- 26 mmol/L 21-28 mmol/L
Hgb 16 g/dL 14–18g/dL
pO₂ 55mmHg 80-110 mmHg  Blunting of costophrenic angle maybe due to
Hct 0.50 0.42–0.52
Neutrophils 72% 50%–62% small pleural effusion or focal pleural
Lymphocytes 25% 25%–40% thickening
Monocytes 2% 3%–7%
Eosinophils 1% 0%–3%
Basophils 0% 0%–1%
Platelets 400 x 10 9/L 150-450x10 9/L