CCS - Pneumonia (abdominal pain)

Question 1

PRESENTATION

Common Features of Pneumonia

Answer 1

Typical Symptoms:

• Cough
• Dyspnea
• Hemoptysis
• Fever, Chills, Diaphoresis

Atypical Symptoms:

• RUQ Abdominal Pain - worsening, dull, moderate-intensity non-radiating
• Elderly or Hx of Diabetes

Other Symptoms:

• Fatigue & Exercise intolerance
• +/-Chest Pain

Question 2

PHYSICAL EXAMS

Physical Exams for Pneumonia

Answer 2

• General Appearance - Mild Discomfort (otherwise well-appearing)
• HEENT - normal
• Lymph Nodes - normal
• Lungs - Dullness to percussion, Decreased breath sounds, Rhonchi and Crackles over Lung Base
• Heart - normal
• Abdomen - normal
• Rectal - normal
• Extremities/Spine - normal
• Neuro - normal

Question 3

DIAGNOSIS

Orders for Pneumonia

Answer 3

1. Pulse Oximetry: ~ 90% O2 Sat.
2. Physical Exam - Lungs: Rales, Rhonchi, Crackles
3. CXR (PA/Lat) - Right/Left Lower Lobe (RLL/LLL) infiltrate

Question 4

TREATMENT

Therapy for Pneumonia

Answer 4

Antibiotics:

• Outpatient & Healthy = Azithromycin (PO)
• Outpatient + Comorbid Conditions = Ciprofloxacin (PO)
• Inpatient = Levofloxacin (IV)

Oxygen:

• start NC Oxygen at 4L/min

Question 5

MONITORING

Monitoring for Pneumonia

Answer 5

Pulse Oximetry

Question 6

SEQUENCING

CCS Order Sequence for Pneumonia

Answer 6

1. Pulse Oximetry
2. Physical Exams - General Appearance, HEENT, LNs, Lungs, Heart, Abdomen, Rectal, Extremities/Spine, Neuro
3. Orders - Oxygen, CXR (PA/Lat)
4. Clock - advance to CXR results (lower lung infiltrate)
5. Location - Outpt + Healthy, Outpt + Comorbids, or Inpatient (criteria)
6. Orders - Antibiotics, Acetaminophen, CBC, BMP, Blood Culture, Reassurance, Advise no smoking
7. Clock - advance to additional updates and next day
8. Interval Physical Exams - Lungs
9. Clock - advance to case end.
10. End Orders - None