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: Differential: Differential: 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  Chest pain aggravated with coughing, relieved at  RR : 29 cpm
 PR : 118 bpm  PR : 118 bpm 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  Sibling with PTB on 3rd month treatment  5 days non-productive cough
 Chest pain aggravated with coughing  recurrent colds noted mostly early morning  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

COMPLETE BLOOD COUNT ARTERIAL BLOOD GAS ANALYSIS CHEST X-RAY

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