NR 609 Exam #2Part 1This section is 20 points (5 points for each question). In order to get the full 5 points for each question please handle these cases in adetailed fashion as you would in practice as an NP. The exam rubric for grading is included. You will be working up a total of 4 case studies(choose 4/5)For each patient in question A and B below calculate the pneumonia severity index (PORT) score, then the risk class. State if you think thepatient will require hospitalization or not and explain the rationale for your decision and state and write up your plan of care and treatment(including drug treatment if needed) with these patients and include their follow-up. Question C does not use the pneumonia severity index.A. Mr. Green is 70 years old. He has a pneumonia on xray and has come to the clinic with a temp of 40C. He has been able to drink onlysmall amounts. His heart rate is 100 and B/P is 110/70. His respiratory rate is 30min. He has a history of CHF. His pulse oximetry is 92%. Hisother lab values are normal. He lives with his 65 year old wife who has severe arthritis. Ne denies any allergies.B. Ms. Blue is 60 years old. She has a history of breast cancer 4 years ago with left mastectomy with 6 months of chemo but is currentlystable and not on treatment. Her temp is 38.8C. Her pulse is 96 and her respiratory rate is 26 min. She is alert and complaining of feelingtired. The lab values are normal and she is able to take in fluids in small amounts. Her pulse oximetry is 94%. She lives with her husband whois 70 and well except for arthritis. She denies any allergies. You are R/O pneumonia.C. Lillie is an adorable child, 3 years of age, who presents to your clinic with pallor, temp of 38.7 C, respiratory rate of 36 breaths perminute, pulse ox is 94% and a capillary fill of 3 seconds. The child’s aunt took a cab to bring the child to the clinic. The aunt reports thatthe child’s mom works two jobs and she is a primary caregiver. The aunt reports the child has not eaten more than two cheese doodles and a fewsips of water. The aunt believes the child has no allergies. The aunt also reports the child does not have a primary pediatrician because theyhave no insurance. How will you proceed with this child who is now in your care.*****Select either D or E as the question you choose to do- Not BOTH!!D. Missy is a 6 year old child who comes to your office with her mom by car for an evaluation of a sore throat for 2 days, fever of 39C.Missy goes to Latchkey after school and had a bout of some “viral” illness 1 month ago which her mom states “gave her a running nose and feverfor 2 days”. You find exudates bilaterally on exam of her throat and palpate anterior enlarged lymph nodes bilaterally on her neck. Missy has noallergies. How will you proceed?E. Bobby is a 2-year-old child who comes by car to your office with his parents and both sets of grandparents. Bobby presents to youroffice pulling on his ear and crying. The child has a temp of 38.9C and the child has taken limited fluids in the past 24 hours. His capillaryfill is 2 sec. How would you proceed with this child and what treatment course would you recommend for the child if he does not respond to yourinitial treatment. The parents are allergic to PCN (Type 1) and the child has never had antibiotics in the past.
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