Help me with the diagnosis

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My patient in clinical last week had medical diagnoses in the notes from the admitting physician of medication monitoring, obstructive sleep apnea, chronic airway obstruction, asthma, thryotoxicosis without mention of goiter, pneumonia, malignant neoplasm of colon, and A-fib. She had rhonchi and diminished lung sounds in the lower lobes and rhonchi in the middle and upper lobes. Her WBC was 19.7. She had been in the ER several times in the past month and had been treated with several different antibiotics, but wasn't getting any better. She continued to have fevers and SOB, although she is a COPD patient. All of her urine and blood cultures had come back negative. They seemed to be guessing and just trying different antibiotics. They had tried Azithromyocin, fluconazole, and amoxicillin. When my instructor asked for her medical problem that she was admitted for, I said pneumonia because that's what was written all over in her chart, but my instructor said that she didn't have pneumonia. I have to written a patho card for her and I have no idea what the diagnosis would be. Would it be COPD exacerbation or pneumonia?

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Specializes in NICU, PICU, PACU.

Kind if like what came first, the chicken or the egg :) Which one would lead to the other...what does her X-ray show?

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The X-ray they did said lower left lobe atelectisis vs. bronchitis. I'm thinking she had pneumonia that led to COPD exacerbation, but maybe I'm really far off. I'm second semester so I'm still trying to put the pieces of the puzzle together.

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Specializes in Critical Care, Capacity/Bed Management.

the admitting diagnosis of pneumonia was just a diagnosis that would get the patient admitted to the hospital. based on all the diagnostic studies she does not have a pneumonia.

She could have had a URI that lead her to a COPD exacerbation.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
My patient in clinical last week had medical diagnoses in the notes from the admitting physician of medication monitoring, obstructive sleep apnea, chronic airway obstruction, asthma, thryotoxicosis without mention of goiter, pneumonia, malignant neoplasm of colon, and A-fib. She had rhonchi and diminished lung sounds in the lower lobes and rhonchi in the middle and upper lobes. Her WBC was 19.7. She had been in the ER several times in the past month and had been treated with several different antibiotics, but wasn't getting any better. She continued to have fevers and SOB, although she is a COPD patient. All of her urine and blood cultures had come back negative. They seemed to be guessing and just trying different antibiotics. They had tried Azithromyocin, fluconazole, and amoxicillin. When my instructor asked for her medical problem that she was admitted for, I said pneumonia because that's what was written all over in her chart, but my instructor said that she didn't have pneumonia. I have to written a patho card for her and I have no idea what the diagnosis would be. Would it be COPD exacerbation or pneumonia?
Lets see.......fever, cough, elevated WBC.....still could be pneumonia or it could be Bronchitis......CXR negligible.....even though pneumonia is noted on the chart....I would go simply with Acute bronchitis/URI/COPD exacerbation.
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Hyperthyroidism can cause dypsnea and SoB as well as AFib. What about her malignancy? Could that cause leukocytosis?

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Where does colon cancer often metastasize to?

What does thyrotoxicosis (check your spelling) do to your temperature?

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