Mr Harry Ng, an 80-year-old male, seemingly healthy and with no coronavirus symptoms, presented to the local hospital three (3) days ago after a close contact with a relative diagnosed with COVID-19. Under routine protocols, as the patient was asymptomatic on admission, the patient would not be given a Chest X-Ray. However, as he has now become symptomatic a Chest X-Ray (Figure 1) has been completed. This morning Mr Ng informs you that he could not sleep last night as he was coughing the whole night. He also informs you that he is feeling extremely tired and cold. You notice that Mr Ng is shivering and has a productive cough. Mr Ng also complains of pain in his right chest that intensifies with inspiration.
SITUATION:
Mr Harry Ng, an 80-year-old male, seemingly healthy and with no coronavirus symptoms, presented to the
local hospital three (3) days ago after a close contact with a relative diagnosed with COVID-19. Under
routine protocols, as the patient was asymptomatic on admission, the patient would not be given a Chest
X-Ray. However, as he has now become symptomatic a Chest X-Ray (Figure 1) has been completed.
This morning Mr Ng informs you that he could not sleep last night as he was coughing the whole night. He
also informs you that he is feeling extremely tired and cold. You notice that Mr Ng is shivering and has a
productive cough. Mr Ng also complains of pain in his right chest that intensifies with inspiration.
BACKGROUND
Mr Harry Ng has a history of hypertension for the last 20 years, controlled with medication. He has
hyperlipidaemia for the last 10 years and a history of atrial fibrillation which was reverted six (6) months
ago. Mr Ng has no past surgical history. Mr Ng used to smoke two (2) packs of cigarettes per day but has
stopped for the last ten (10) years.
ASSESSMENT
Vital signs are as follows: blood pressure 152/90, apical heart rate 112 beats/minute and regular,
respiratory rate 24 breaths/minute and somewhat laboured, SaO2 91% and temperature 37.9⁰C. On
examination, Mr Ng appears tired, haggard and his complexion is sallow. He coughs continuously.
Auscultation reveals bilateral diminished vesicular breath sounds with rhonchi and late inspiratory crackles
in the area of the left mid-anterior and right bases lung fields
RECOMMENDATION
Increase frequency of observations for Mr Ng, keep him hydrated with small frequent feed until he is able
to eat solids. He was administered supplemental O2 @2L/min via nasal cannula.
question:
Review and think about Mr Ng’s presentation, and the observations that have been carried out: What are your
priority problems at this moment? Discuss and justify with evidence-based literature two (2) priority problems for
Mr Ng?
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