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Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services (userservices@mheducation.com) for more information.
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After completing this case study, the reader should be able to:
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Discuss the possible etiology of bacterial disease following a viral illness such as influenza.
Discuss the use of rapid diagnostic testing methods that help differentiate coagulase-negative staphylococci from Staphylococcus aureus.
Design a therapeutic plan to treat a bloodstream infection due to Staphylococcus aureus based on laboratory-based information.
Evaluate culture and sensitivity results, and determine the clinical significance of the MIC for S. aureus.
Recommend a plan for monitoring efficacy and adverse effects of antimicrobial therapy.
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Patient’s wife states of her husband, “Lately he has not been acting like himself. He has been very dizzy, tired and has not been eating or drinking well.”
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David Covey is a 72-year-old man who came to the ED via ambulance. The patient’s history is obtained from his wife. She describes a change in mental status, lethargy, and shortness of breath, along with a significant decrease in activity and nutritional intake. The symptoms started 3 days ago and have progressively worsened. Over the past 24 hours he has become very nauseated and developed a fever (39°C). She states that Mr Covey has not eaten anything over this time period. He was recently hospitalized (last week) for 4 days due to influenza A pneumonia confirmed by PCR.
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Diabetes mellitus
Resistant hypertension
Depression
Influenza pneumonia
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Both parents are deceased (mother, aged 88, of PE; father, aged 71, of stroke). He is married without any children.
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Retired steel mill worker and union chief, distant history of tobacco and alcohol use with no current use
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Metformin 1000 mg PO BID
Glyburide 5 mg PO daily
Spironolactone 25 mg PO daily
Lisinopril 40 mg PO Q HS
Amlodipine 10 mg PO daily
Paroxetine 10 mg PO daily
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Patient’s primary complaint is of nausea and dizziness but due to current status unable to review further
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The patient is frail, disheveled, appearing in respiratory distress
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BP 108/58, P 108, RR 36, T 39°C; Wt 64.2 kg, Ht 68 in
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