CASE NUMBER 2

A 35-year-old male resident of Barangay Tabunok, Cebu City, presents

with fever and cough. He was well until 3 days earlier, when he suffered the
onset of nasal stuffiness, mild sore throat, and a cough productive of small
amounts of clear sputum. Today, he decided to seek physician assistance
because of an increase in temperature to 38.3°C and spasms of coughing
that produce purulent secretions. On one occasion, he noted a few flecks of
bright-red blood in his sputum.

It is March. He lives in a home in the city with his wife and 3 children, aged
7, 9, and 11 years. The children are fully immunized. The 11-year-old child
is recovering from a “nagging” cough that has persisted for 10–14 days.

The family has a pet parakeet who is 5 years old and appears to be well.
The patient has not traveled outside the city in the past year. He is an office
manager.

The patient smokes 1 pack/day and has done so since the age of 15 years.
Several times a month, especially during the winter, on arising from sleep,
he produces ∼1 tablespoon of purulent sputum.

The patient has no history of familial illness, hospitalizations, or trauma.

There are no drug allergies or intolerance. The only medication he takes is
acetaminophen occasionally, for headaches. He drinks beer or wine in
moderation.

His body temperature is 38.9°C (100°F), his pulse is 110 beats/min and
regular, and his respiratory rate is 18 breaths/min. His oxygen saturation is
83% while breathing room air. There is mild erythema of the mucosa of the
nose and posterior oropharynx. Inspiratory “rales” are heard at the right
lung base.

His hemoglobin level is 12.5 g/dL, with a hematocrit of 36%. His WBC
count is 13,500 cells/µL, with 82% polymorphonuclear cells, 11% band
forms, and 7% lymphocytes. His platelet count is 180,000 cells/µL. The
results of a multi chemistry screen are unremarkable.

Chest CT showed a 4 cm mass in the RLL (Figure 1) with abnormal

bronchopulmonary or mediastinal lymph nodes. At bronchoscopy, an
endobronbchial tumor was seen in the medial basal segmental bronchus of
the right lower lobe and biopsies confirmed the diagnosis of squamous
carcinoma.
 Laboratory Normal Values Result Nursing Significant

Appearance Clear Cloudy -May indicate

infection or
inflammation.

Color Straw/amber Dark yellow orange -Indicator of

dehydration.

Specific Gravity 1.003-1.0035 1.085 -Indicator of

dehydration

pH 5.0-8.0 9.0 -Indicator of UTI

-Indicator for kidney

Protein Negative 3+ problem

-Indicator for high

glucose or Diabetes
Glucose Negative 4+ Mellitus

-Indicator of UTI

Leucocytes Negative Moderate -Indicator of UTI

Nitrite <1.0 Moderate -Indicator for high

glucose or Diabetes
Ketone Negative 3+ Mellitus

Casts Negative None -Indicator of infection

WBC 0-5 ≤4 WBCs/hpf 6-9 WBCs/hpf -Indicator of an

infection or irritation

RBC ≤4 RBCs/hpf 12-15 RBCs/hpf -Indicator of UTI or

infection

Bacteria Abundant
Laboratory Normal Values Result Nursing
Significant
Hemoglobin 13.8 to 17.2 g/dL 12.5 g/dL -May indicate
anemia.

Hematocrit 45% to 52% 36% -May indicate

anemia.

WBC 4,300 and 10,800 13,500 µL -May indicate

infection.

Polymorphonucle 40% to 80% 82% -May indicate a

ar cells bacterial infection
or a parasitic
infection.

Bandforms <10 % 11% -Indicator for

7% infection
150000 to 240,000 180,000 cells µL -Normal
Lymphocytes µL
Platelets

Chest X-ray Findings:

Plan:
Base on the findings patient is scheduled for lobectomy.

Stage 2 squamous lung carcinoma

Pneumonia - complication of cancer

Ascariasis (positive sa FECALYSIS)

Diabetes ( 4+ and this is is very high)

Kidney complication (+3protein UA - Maybe due to high glucose in blood so kidneys have to
work hard that can lead to damage)

Ketones 3+ ( related to diabetes coz of diabetic ketoacidosis wherein too much sugar in blood
na and wala sa tissues maong magkuha ang cells ug energy from fat instead of sa
carbs/glucose. Ketones -result sa breakdown of fat)

Bacteria-abundant Nitrites- moderate INDICATOR FOR POSSIBLE INFECTION

Augmentin (amoxicillin/clavulanate) is a combination antibiotic used to treat bacterial

infections including sinusitis, pneumonia, ear infections, bronchitis, urinary tract
infections, and infections of the skin.