The following is a case involving a patient with fever. As the case evolves, I will present assessment findings, lab results, and diagnostic results in the hope of eliciting responses on how we would approach the care of this patient.
The following is a case involving a young male who presents with fever associated with respiratory symptoms. This is based on a real case. The events leading to his hospitalization and his course in the hospital will be portrayed in an attempt to stimulate discussion on ways to approach his care not only from a nursing standpoint but also to understand the complexity of his care from the perspective of other disciplines who will be involved in his care particularly his medical management.
Background History
Rolando is a 19-year old college student who is the son of first-generation immigrants from the Philippines. His parents are divorced and he lives with his mother in a coastal town close to where he attends college. He decided to skip the fall semester and live with his father in California's Central Valley region to help him run a small business.
He presented to his family physician with complaints of productive cough for about 7 days and feeling warm and flushed. He said his phlegm looked white in color and not excessive. He appeared healthy and has no medical history other than having had his appendix removed at age 14. The physician prescribed him Azithromycin and cautioned him to seek further care if his symptoms do not improve. He recalls having some tests done at the clinic but was not sure what they were.
Three days later, Rolando was feeling worse. He feels he is warmer and may have a high fever, is having chest discomfort with coughing while not expectorating any phlegm, and is experiencing joint pains and muscle aches. He has no appetite and is feeling weaker. His father was concerned and brought him to the nearest ED at a community hospital setting.
Social History
His social history is notable for being a college student with an undecided major. He admits to drinking alcohol occasionally but denies binge drinking, he does not smoke, he admits to having smoked marijuana in the past but not recently. He has a girlfriend in college and is sexually active.
You are Rolando's first contact in the ED as the triage nurse.
After gathering the above, you obtained the following data
Subjective complaints: "feeling warm, headache, little short of breath".
Vital Signs: Temperature 39 C, HR 112, RR 32, BP 110/65, O2Sat 88% on room air
Neuro: AOx3, moving all extremities, pupils equal and reactive.
CV: EKG showed Sinus Tachycardia with no ST changes, no murmurs were heard on auscultation, no edema in extremities.
Pulm: Harsh breath sounds bilaterally but no accessory muscle use. He does breathe fast as you noted in his respiratory rate.
Skin: Warm and flushed, you notice what looks like a red rash in his bilateral shins.
Remainder of the system exam is WNL.
How would you triage Rolando and what tests would you expect to be done in his case?
What would you tell the next ED nurse who will take care of Rolando once you determined the appropriate ED treatment area he should be treated at?
What concerns do you have about what is likely the reason for his symptoms?
