[Solved]: Mrs

Mrs. T.R. is a 74-year-old white female, who is widowed and a retired school secretary. She has a 34-year-old female caretaker who permanently lives with her. Mrs. R. reports has a three- week history of upper respiratory symptoms and a three-day history of increasing weakness and fatigue. Four days ago, the patient developed a cough that has gradually become much worse, and she now has difficulty breathing after moving. The caretaker also reports that T.R. was sundowning (very confused) last night and nearly fell while confused. T.R. has been coughing up a lot of phlegm that is thick and green in color but has no fever. The caretaker has become concerned by the patient’s reduced daily activities and inability to get rid of her “cold” after several weeks. Medical History Daily Tobacco Use 1⁄2 PPD – 60 years Chronic bronchitis – 9 years Urinary incontinence – 2 years HTN – 5 years, BP has been averaging 140/80 mm Hg with medication Blood Test Results Lung Exam (Stethoscope) Breathing labored and Tachypnea Right Upper Lobe and Left Upper Lobe reveal regions of crackles and diminished breath sounds. Right Lower Lobe and Left Lower Lobe reveal absence of breath sounds and dullness to percussion. X-Ray