Allergies are Erythromycin
Case study 1
Client Profile
Mrs. Harriet is a 68-year-old woman who is alert and oriented. Allergies are Erythromycin. She presents to the emergency department with complaints of chest tightness, shortness of breath, cough, and congestion. She states, “I have been having these symptoms for three days now. I have been taking Maximum Strength Robitussin for my cough but it has not helped very much. When I woke up this morning. I felt very weak so I came in to be checked out.” Her vital signs are blood pressure 110/70, pulse 94, respiratory rate of 28, and temperature of 102.7 F. Her oxygen saturation on room air is 92%. She is placed on 2 liters (L) of oxygen by nasal cannula. The HCP prescribes a 12-lead electrocardiogram (ECG, EKG) and chest X-ray (CXR). Laboratory tests prescribed include complete blood count (CBC), basic metabolic panel (BMP), brain natriuretic peptide (B-type natriuretic peptide assay or BNP), total creatine kinase (CK, CPK), creatine kinase-MB (CPK-MB), and troponin. The HCP will also assess blood cultures x 2, AGs on room air, sputum culture and sensitivity (C &S), and asks that the client have a Mantoux (tuberculin, purified protein derivative, or PPD) test.
Case Study
Mrs. Harriet’s ECG shows normal sinus rhythm (NSR) with a heart rate of 98 beats per minute. The CXR reveals a right lower lobe(RLL) infiltrate. Laboratory tests include the following results: white blood cell cot (WBC) 12,2000 cells/mm3, 72& seg neutrophils with a left shift of 11% bands, and a BNP of 50.9 pg/mL. ABGs on room air is pH 7.44, partial pressure of carbon dioxide (PaCO2) 39 mmHg, bicarbonate (HCO3) 26.9 mEq/L, partial pressures of oxygen (PaO2) 58 mmHg, and oxygen saturation (SaO2) of 92%. Results of the sputum culture show Streptococcus pneumoniae. The CPK, CPK-MB, and troponin are all within normal limits. Mrs. Harriet is five feet three inches tall and weighs 224 pounds (101.8 kg). On assessment, the nurse hears expiratory wheezes and rhonchi bilaterally with diminished lung sounds in the right base. Her thoracic (chest) expansion is equal but slightly decreased on inspiration. Accessory muscle retraction is not noted, and she does exhibit central cyanosis. The capillary refill of the client’s nail beds is four seconds.
