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The patient reported shortness of breath, right-sided chest pain, chills and fever, productive cough, and rust-colored mucus. His physical examination showed tachypnea, decreased breath sounds on the right, and coarse rhonchi through the right lung field.
Additional Laboratory and Radiological Tests
- Chest X-ray – it will help see the problem that is causing all the symptoms. I would expect to find that the airspace of the right lung is filled with a consolidation of bacteria or pus but no volume loss. Also, such test will help determine the location and size of the filling; If the airspace is filled with fluid, it would not be distinguished using a radiological test (University of Virginia, 2013).
- Blood tests – they will help to see if there is an infection and what kind of organism is its cause (Mayo Clinic Staff, n.d.). I would expect to see the signs of a bacterial infection.
- Sputum test – it will also help identify the cause of the disease; in its results, I would also expect to see the cause of this infection. Most likely – pneumococcal bacteria.
- Pulse oximetry – this is the test that measures to measure the level of oxygen in the blood (NIH, n.d). I would expect to see that due to shortness of breath, the patient has not been receiving enough oxygen.
Diagnosis
The diagnosis is pneumonia; the particular cause and type of the disease will become clearer after the results of the tests arrive.
Medication
The patient should be prescribed Amoxicillin 500mg orally (repeat every 8 hours) for at least 5 days. This medication can be combined with other drugs. The patient will need cough suppressors that would help relieve his symptoms. Also, he should take pain and fever relieving drugs such as ibuprofen and acetaminophen for as long as the symptoms continue.
References
Mayo Clinic Staff. (n.d.). Pneumonia. Web.
NIH. (n.d.). Diagnosis. Web.
University of Virginia. (2013). Pneumonia. Web.