[Verified Answer]: Section Details Chief Complaint “My father…

Section Details Chief Complaint “My father has been coughing and wheezing for several days. He has been staying with my brother for the past month, but he didn’t even take my father to the doctor, let alone start him on antibiotics.” HPI Cough productive and purulent for 5 days; wheezing and rhinorrhea improved. No fever, chills, or myalgia. Patient feels better now, but reports family stress. PMH Hypertension (10 years), diabetes (5 years), hyperlipidemia (2 years) FH Wife passed away 6 months ago (stroke), parents lived into their 90s. Vaccinated for pneumonia last year. SH Former children’s book writer; no job, relies on children for housing. Smokes 1 pack per day for 30 years, tried to quit last year but failed. Denies alcohol use. Meds Lisinopril 40 mg daily, Metformin 1,000 mg BID, Simvastatin 20 mg daily Allergies No known drug allergies ROS No fever, chills, myalgia, chest pain, shortness of breath, nausea, vomiting, or diarrhea Physical Examination Well-developed, overweight male. Slightly disheartened but communicative and clean. VS BP: 142/92 mm Hg, Pulse: 84, RR: 17, Temp: 37°C, Weight: 78 kg, Height: 5’6″ HEENT PERRLA, conjunctivae clear, TMs intact, no epistaxis or nasal discharge, moist mucous membranes, no oropharyngeal lesions, wears dentures Neck Supple, no adenopathy or thyromegaly Chest No rhonchi, rales, increased fremitus, wheezing, or egophony Heart Regular rhythm, no murmurs, rubs, or gallops Abd Soft, nontender, positive bowel sounds Ext Pulses 2+ throughout Neuro Alert and oriented × 3, 2+ reflexes, 5/5 strength, CN II–XII intact Labs Sputum culture: No pathogens isolated Assessment 63-year-old male with presumed acute bronchitis, likely viral. Smoking history. Diabetes and dyslipidemia well-controlled. Family/caregiver issues noted. QUESTIONS Problem Identification 1.a. Create a list of the patient’s drug therapy problems. 1.b. What information (signs, symptoms, laboratory values) indicates the presence or severity of acute bronchitis? 1.c. Could any of the patient’s symptoms have been caused by drug therapy? 1.d. What additional information must be considered before deciding whether antimicrobial therapy is indicated? Desired Outcome 2. What are the goals of pharmacotherapy in this case? Therapeutic Alternatives 3.a. What nondrug therapies might be useful for this patient? 3.b. What feasible pharmacotherapeutic alternatives are available for treatment of uncomplicated acute bronchitis? 3.c. What are the most likely alternatives for the uncontrolled hypertension and smoking cessation attempt? 3.d. What psychosocial considerations are applicable to this patient? Optimal Plan 4.a. What drugs, dosage form, dose, schedule, and duration of therapy are best to alleviate this patient’s symptoms of acute bronchitis? 4.b. What medication and dosage should be recommended for this patient’s elevated blood pressure and smoking cessation plan? Outcome Evaluation 5. What clinical and laboratory parameters are necessary to evaluate the therapy for achievement of the desired outcome and to detect or prevent adverse effects? Patient Education 6. What information should be provided to the patient to enhance compliance, ensure successful therapy, and to minimize adverse effects? ■ FOLLOW-UP QUESTION 1. What vaccinations should this patient receive?