Case Study: An Elderly Man With Pneumonia

Mr. Johnson is a 71-year-old male who was brought in to the hospital by his caregiver with
complaints of shortness of breath at rest, wet cough with thick yellow sputum x 2 days,
temperature of 101.5F orally x 1 day, fatigue, lethargy, and new onset confusion.
Mr. Johnson has a past medical history of stroke, gastroesophageal reflux disease, right hip
replacement, hypothyroidism, and recurrent pneumonia. He is 5’9 and weighs 132lbs. He is a
full code and has allergies to Morphine.

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His current medications are:
Levothyroxine 50mcg PO daily in the morning before food
Plavix 75 mg PO daily
Protonix 20mg PO daily before food
Oxycodone 5mg PO tablet Q6H PRN (as needed) for pain
His vital signs are:
B/P 95/65, HR 92 BPM, RR 27 breaths/minute, temp 101F orally and SpO2 92% on room air
Mr. Johnson had a chest x-ray which was followed up with a CT scan to rule out other
conditions. The ER doctor writes orders for Mr. Johnson to be admitted to the cardiac telemetry
floor. The orders are: IV access, administer main IV fluids of normal saline with 20meq
potassium chloride to be administered continuously at 50ml/hr, start broad spectrum antibiotics
of Zosyn 3.75mg IVPB Q6H and Vancomycin 1g IV Q24H, Albuterol 2.5mg (3ml) inhaled
Q6H, Lasix 20mg IVP twice daily, and Tylenol 650mg PO Q4H as needed(PRN) for temp >
100F and mild pain rated 1-5/10.
Upon your assessment you find the patient is struggling to breath, appears pale, has weak upper
and lower extremity pulses, right lower lung sounds diminished on auscultation, patient has a
consistent cough with loose yellow thick secretions and feels very warm to the touch on his
forehead.
The pulmonologist orders for a bronchoscopy to be done tomorrow morning. He orders to hold
the Plavix for this procedure. He orders the following lab tests: blood culture and sputum
culture, comprehensive metabolic panel, CBC (complete blood count), lactic acid, arterial blood
gas and another follow up CXR for the morning.
The following are some of the lab results:
Sputum culture: gram negative bacilli in clusters
Blood culture: no growth
CXR: white opacities in right lower lung
WBC (White blood cells): 15K per microliter of blood
K (Potassium): 3.2meq/LMr. Johnson is a retired lawyer who spends most of his days fishing on his boat, reading, and
cycling. He is married with 2 kids who moved out years ago. Mr. Johnson does smoke 1-2
cigarettes/day but has been trying to quit for the past 2 years. He is Christian and tries to make it
to church at least 2x/month with his wife.