Topic- Community-Acquired Pneumonia (PNA-CA)

PNEUMONIA – COMMUNITY AQUIRED (SH)Metlay, J., Waterer, G., Long, A., Anzueto, A., … Whitney, C. (2019). Diagnosis and treatment of adults with community-acquired pneumonia. American Journal of Respiratory and Critical Care Medicine, 200(7), e45-e67. https://www.atsjournals.org/doi/full/10.1164/rccm.201908-1581ST

Information about the patient seen with this condition

Minutes: 90
Date of Clinical: 05/17/2021
Patient Initials: JR
Age Range: 56-65 years
Gender: Female
Ethnicity: White
Client Complexity: Episodic (Acute Condition)
Student Level of Function: 25% Student/75% Preceptor
Type of Site: Family Medicine
Type of Encounter: Acute / Episodic Care
Physical Exam: Cardiac, Constitutional / Vital Signs, Heat, Medical Reconciliation, Respiratory
Type of Diagnostics: Laboratory, Radiology, Other
Ordering Diagnostics: Blood Test, Rapid Flu testing, Urine test, CXR
Procedures: Not Available
Medications: Diuretics, Insulin/Other diabetic agents, Vitamins/Herbs
Therapeutics: Initiate medication, Meditation
Education Comments: Must go to the hospital for further evaluation to rule out Pneumonia and/or COVID-19.
Referrals: N/A
Follow-up: 1 week
Coding: I10 – Essential (primary) hypertension
N18.1 – Chronic kidney disease, stage 1
J18.9 – Pneumonia, unspecified organism
E11.9 – Type 2 diabetes mellitus without complications

Notes: 62-year-old female

Patient’s CC: fever, chest pain, cough
-Rapid COVID-19 test- completed upon arrival- test result was negative
-Rapid Influenza Virus Type A and Type- B- completed upon arrival- test result was negative.

Objective:

Vital signs
-T- 100.7 F
-B/P- 128/76
-HR-76
-RR-19
-SaO2- 97%
-Weight- 148 lbs.
-Height- 66 inches
-Lung sounds- crackles

Subjective :

-Fatigue- constant- began 2 days ago- aggravated by physical activity
-Cough- cough up sputum- every few minutes- rust-colored sputum- began 2 days ago
-Chest pain- more severe when coughing- lower right side of chest- dull pain- began 2 days ago. Deep breath, speaking and physical activity aggravates chest pain. Pain scale when no coughing 3/10 when coughing 6/10.
-Sinus congestion- constant- began 2 days ago
-Fever- constant- began 24 hours ago
-Muscle soreness

Non-medical treatment
-Rest
-Tea
-Humidifier steam
Past medical history
-Hypertension- diagnosed 10 years ago
-Diabetes Mellitus type 2- diagnosed 10 years ago
-Chronic Kidney Disease stage 1- diagnosed 2 years ago

Medications:
-Karta 180 mg/2mg tablet- one tablet by mouth daily
-Chlorothiazide 500mg tablet- one tablet by mouth twice a day
-Aspirin 81 mg tablet- one tablet by mouth daily
-Vitamin D- 2,000 IU- take one tablet by mouth daily
-Calcium 1,200 mg- take one tablet by mouth daily
-Metformin 500 mg tablet- one tablet by mouth twice a day
Social history
-Denies use of alcohol, tobacco, and illicit drugs
-Diet: Vegetarian
-Exercise: walk daily for 30 minutes

Treatment
-Chest x-ray- STAT
– Labs- CBC, CMP, blood gases,
-Doxycycline 100 mg every 12 hours by mouth for 5 days
-Bed rest.
-Encourage increase fluid intake.
-Must go to the hospital for further evaluation to rule out Pneumonia and/or COVID-19.

CPT (E&M)- 99215

Acquired Pneumonia (PNA – CA)

Clinical practice guidelines (CPGs) are written to provide recommendations that are intended to assist providers in making decisions for specific circumstances or disease conditions. CPGs are based on systematic reviews of the best available evidence-based medicine research. Interpreting and learning to apply guidelines into practice is necessary to develop and enhance diagnostic reasoning skills.

Activity Learning Outcomes

Through this assignment, the student will demonstrate the ability to:

Read and interpret a primary care-related CPG for use in practice. (CO 3)
Identify the CPG recommendations and strength of evidence. (CO 3)
Compare and contrast the diagnosis and treatment of a patient seen in the clinical setting to the recommendations given in the CPG. (CO 3)
Due Date:
Students will post a brief, narrated, PowerPoint presentation along with a copy of their CPG and a written transcript of their presentation.

Total Points Possible: 100

Requirements:

Students will RANDOMLY be assigned a CPG on a disease topic by their instructor in Week 1.
In Week 7, students will provide a brief, narrated PowerPoint presentation using Kaltura while following the directions and rubric listed below.
In addition to the presentation, students will provide a written transcript to the Week 7 assignment box for the instructor’s preference. (NOTE: A written transcript is a word-for-word script of exactly what is said in the PowerPoint Narration. It is not a paper and does not need to be in APA format. See the transcripts under each lecture in the weekly lessons for examples).
Students will share a copy of their given CPG by attaching it to the discussion board where their presentation (or link) is posted. This will allow the instructor and peers to review along with your presentation.
Preparing the presentation:

The presentation should be developed using the following guidelines:

All presentations must be in PowerPoint format and narrated using Kaltura.
Slides should be professional in appearance and easy to read.
The presentation should be no more than 15min.
Attach the CPG article to the Week 7 discussion board by using the paperclip icon.
Correct grammar, punctuation, and spelling should be observed in all slides.
A reference slide should be included as the final slide and APA format should be observed.

ASSIGNMENT CONTENT
Category

Points

Description

Disease & Background

15%

Identify the disease condition and give a brief statement of incidence and prevalence in the U.S. Discuss the pathophysiology of the disease and typical clinical presentation seen in patients with the condition.

Publication & Applicability in Primary Care

15%

Identify the author, organization or group that developed the CPG along with the year of the original guideline publication. Discuss why the CPG is applicable in the primary care setting.

Key Action statements and Body of Evidence

30%

Provide each of the CPG’s “Key Action” or “Guideline Statements” up to a maximum of 5 relevant recommendations. Identify the evidence strength for each recommendation. If the statement has applicability to other groups, only discuss the relevant primary care ones.

Application in your Clinical Rotation

30%

Using an example of a patient from your clinical rotation with the same condition, discuss how the diagnosis and treatment of your patient compared to the recommendations given in the guidelines.

90%

Total CONTENT Points= ______ out of 90 points

ASSIGNMENT FORMAT

Total FORMAT Points= ______ out of 10 points

ASSIGNMENT TOTAL= _______ of 100 points

Rubric
Week 7 CPG Assignment_Sept19
Week 7 CPG Assignment_Sept19
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeAssignment Content Possible Points = 90 Points
Disease & Background
The student:
1. Identifies the disease condition
2. Gives a brief statement of incidence and prevalence in the US
3. The student briefly summarizes the disease pathophysiology
4. Identifies the typical clinical presentation seen in a patient with the disease
(4 critical elements)
15 pts
Excellent
All 4 critical elements are present and complete
14 pts
V. Good
All 4 critical elements are present but some information may be only partially addressed or inaccurate
12 pts
Satisfactory
3 critical elements are present
8 pts
Needs Improvement
2 critical elements are present
0 pts
Unsatisfactory
1 or less critical elements are present
15 pts
This criterion is linked to a Learning OutcomeApplicability in Primary Care
The student:
1. Identifies the author, organization or group that developed the CPG
2. Student denotes the year of the original guideline publication
3. Student identifies any subsequent revisions (student’s reference should be the most recent version), and
4. Student discusses the applicability for use of this CPG in the primary care setting
(4 critical elements)
15 pts
Excellent
All 4 critical elements are present and complete
14 pts
V. Good
All 4 critical elements are present but some information may be only partially addressed or inaccurate
12 pts
Satisfactory
3 critical elements are present
8 pts
Needs Improvement
2 critical elements are present
0 pts
Unsatisfactory
1 or less critical elements are present
15 pts
This criterion is linked to a Learning OutcomeKey Action Statements & Body of Evidence
The student:
1. Provides each of the CPG’s “Key Action” or “Guideline Statements” up to a maximum of 5 relevant recommendations
2. Provides the body of evidence strength for each, and
3. If the statement has applicability to other groups, only discuss the relevant primary care ones
(3 critical elements)
30 pts
Excellent
All 3 critical elements are present and complete
27 pts
V. Good
3 critical elements are addressed but some information may be only partially addressed, or not completely accurate
25 pts
Satisfactory
2 critical elements are present
15 pts
Needs Improvement
1 critical element is present
0 pts
Unsatisfactory
0 critical elements are present
30 pts
This criterion is linked to a Learning OutcomeApplication in Clinical
1. Using an example of a patient from their clinical rotation with the same condition
2. Student discusses how the diagnosis and treatment of their patient compared to the recommendations given in the guidelines
3. Specific examples of what was done well or what could have been done better is noted
(3 critical elements)
30 pts
Excellent
All 3 critical elements are present and complete
27 pts
V. Good
3 critical elements are present, but some information may only be partially addressed
25 pts
Satisfactory
2 critical elements are present
15 pts
Needs Improvement
1 critical element is present
0 pts
Unsatisfactory
0 critical elements are present
30 pts
This criterion is linked to a Learning OutcomeAssignment Format Possible Points = 10 Points
Presentation
1. The student used PowerPoint and Kaltura & presentation was professional in quality
2. Slides were well organized and aesthetically pleasing
3. Student’s narration was understandable and well-paced
4. References were noted
5. Presentation was under 15min in length
(5 critical elements)
10 pts
Excellent
All 5 critical elements are present
9 pts
V. Good
4 critical elements are present
8 pts
Satisfactory
3 critical elements are present
5 pts
Needs Improvement
2 critical elements are present
0 pts
Unsatisfactory
1 or less critical elements are present
10 pts

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Diagnosis and treatment of adults with community-acquired pneumonia.