Weekly Clinical Experience 5

Sample Answer

My experience in the gerontology rotation has been fulfilling despite experiencing several challenges. I have also gained more insight into different disease conditions, such as heart and renal failure, cerebrovascular accidents, benign prostatic hyperplasia, and malignancies that are more common in the geriatric population than the rest of the population (Simakoloyi et al., 2020).

I have also learned that some diseases, such as renal failure, pneumonia, and urinary tract infections, may have different clinical presentations among the geriatric population. However, I have also experienced some challenges, especially in patients with severe dementia and stroke, and had difficulties communicating and interacting with some of the patients in the ward.

During my experience, I encountered a 69-year-old female who presented with a four-day history of a yellow purulent productive cough, chest pain that worsened on coughing and taking deep breaths, and dyspnea. She was also experiencing confusion, fever, chills, loss of appetite, myalgia, arthralgia, and fatigue. On examination, she had a Glasgow Coma Scale of 14/15 and mild central cyanosis, but pallor, edema, and dehydration were absent.

Her vitals included RR 24, HR 123, BP 121/79, SpO2 89% at room air, and T 101F (Eshwara et al., 2020). Her respiratory examination revealed dull percussion notes and crackles and rales on auscultation. A chest radiograph was requested that showed the presence of diffuse opaque consolidations and infiltrations in both lungs.

Additional tests included a complete blood count, inflammatory markers, urea, electrolytes, and creatine that revealed leukocytosis, elevated C-reactive protein, and normal urea level. A diagnosis of community-acquired pneumonia (CAP) was made with pulmonary edema, embolism, and tuberculosis as differential diagnoses.

The patient was admitted and placed on oxygen and fluids. Cefotaxime2 g PO TDS for five days, azithromycin 500 mg PO for three days, and paracetamol 500 mg PRN were prescribed for inpatient management, and the patient’s vitals were closely monitored. The patient was discharged three days after the fever and chills were subsidized, and the vitals were back to normal and continued on the same therapy for the next five days (Eekholm et al., 2020).

Upon discharge, the patient was encouraged to adhere to her antibiotics and educated on the warning signs that would necessitate immediate concern, such as dyspnea, fever, and confusion. The patient was requested to come back to the hospital after she completed the antibiotics for a repeat chest radiograph that revealed a reduction in areas of lung consolidation and infiltration (See et al., 2023). The patient was advised to seek pneumococcal and influenza vaccinations to reduce the incidence of respiratory tract infections.

I have learned a lot from this case, including how to diagnose CAP in a clinical setting. I have also learned about CURB-65, a severity grading criteria for pneumonia that includes confusion, elevated urea above 19mmol/L, respiratory rate of 30 breaths per minute, low blood pressure of 90/60, and age above 65 years(Eekholm et al., 2020). In addition, I have learned how CURB-65 determines inpatient, outpatient, or ICU care for the patient. Lastly, I have learned about the medications used to manage CAP and crucial follow-up information.

References

• Eekholm, S., Ahlström, G., Kristensson, J., & Lindhardt, T. (2020). Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia a descriptive cross-sectional study. BMC Infectious Diseases, 20(1). https //doi.org/10.1186/s12879-019-4742-4
• Eshwara, V. K., Mukhopadhyay, C., & Rello, J. (2020). Community-acquired bacterial pneumonia in adults An update. The Indian Journal of Medical Research, 151(4), 287-302. https //doi.org/10.4103/ijmr.IJMR_1678_19
• See, K. C., & Lau, Y. H. (2023). Acute management of pneumonia in adult patients. Singapore Medical Journal, 64(3), 209-216. https //doi.org/10.4103/singaporemedj.SMJ-2022-050
• Simakoloyi, N., & Erasmus, E. (2022). The characteristics of geriatric patients managed within the resuscitation unit of a district-level emergency centre in Cape Town. African Journal of Emergency Medicine, 12(1), 39-43. https //doi.org/10.1016/j.afjem.2021.11.005