Derek Smith a 31 y o Caucasian Male Injection Drug User

Derek Smith a 31 y o Caucasian Male Injection Drug User

Derek Smith, a 31 y.o.,  Caucasian male injection drug user, who is homeless, presents to the ED with a chief complaint of shortness of breath. He describes a 1-month history of intermittent fevers and night sweats associated with a nonproductive cough. He has become progressively more short of breath, initially only with exertion, but now he feels dyspneic at rest.

He appears to be in moderate respiratory distress. His vital signs are abnormal, with fever to 39°C, heart rate of 112 bpm, respiratory rate of 20/min, and oxygen saturation of 88% on room air. Physical examination is otherwise unremarkable but notable for the absence of abnormal lung sounds. Chest x-ray film reveals a diffuse interstitial infiltrate characteristic of pneumocystis pneumonia, an opportunistic infection.

In this discussion:

  1. Describe and discuss with your colleagues the underlying disease most likely responsible for this patient’s susceptibility to pneumocystis pneumonia.
  2. Describe and discuss the immunosuppression caused by this underlying disease.
  3. Describe and discuss the natural history of this disease and some of the common clinical manifestations seen during its progression.
  4. Describe your plan of care for this patient following his hospitalization (he will likely be admitted to the “medical respite floor,” of a local homeless shelter, which has the services of a Nurse Practitioner three times per week—with on-call weekend consultation, and a registered nurse, Monday through Friday).

Include citations from the text or the external literature in your discussions.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Case Study for Derek Smith Example Approach

It is apparent from the description that Derek Smith is has the Human Immunodeficiency Virus (HIV). It is a condition that advances into the acquired immunodeficiency syndrome (AIDS) if not treated during the initial stages. Thus, it becomes chronic and thus potentially life threatening. It damages the immune system and makes it difficult for the body to fight any invasive conditions. As indicated by Wallace et al., (2012), the virus is mainly sexually transmitted and is spread via several body fluids.

It attacks the CD4 cells and mostly the T cells. With time, it causes destruction to many of these cells to the point that it cannot fight diseases. If it is not treated; it reduces the number of CD4 cells leading to the invasion by opportunistic infection and cancers. Pneumocystis pneumonia (PCP) is one of the serious infections that are caused Pneumocystis jirovecii fungus. Most of the people who suffer from it have weakened immune system as a result of HIV/AIDS or the use of drugs that lower the ability by the body to fight diseases (Skarbinski et al., 2015).

The advent of antiretroviral therapy has reduced the chances of infection with PCP. However, it is still a significant health problem that is accompanied by chest pains, fatigue, chills, fever and cough. Derek should be put on antiretroviral drugs as well as other antibiotics to help in the management of the chest conditions. There is also the need to put him under several analgesics to help in pain management. He should be placed under a medical respite floor where he can be safe from some of the too cod or dusty conditions. A follow up on the medication should be done to confirm adherence (Wallace et al., 2012).

Derek Smith a 31 y o Caucasian Male Injection Drug User References

  • Skarbinski, J., Rosenberg, E., Paz-Bailey, G., Hall, H. I., Rose, C. E., Viall, A. H., … & Mermin, J. H. (2015). Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA internal medicine, 175(4), 588-596.
  • Wallace, J. M., Rao, A. V., Glassroth, J., Hansen, N. I., Rosen, M. J., Arakaki, C., … & Pulmonary Complications of HIV Infection Study Group. (2012). Respiratory illness in persons with human immunodeficiency virus infection. American Review of Respiratory Disease

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In reply to Samuel Jackson

Re: Week 8 Discussion 8

By Faye Felicilda-Reynaldo – 

Hi Samuel,

Thanks for your post. What types of antibiotics should we administer to our patients with PCP? What are the different first-line and second-line treatments for this condition?

Dr. Reynaldo

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In reply to Faye Felicilda-Reynaldo

Re: Week 8 Discussion 8

by Samuel Jackson – 
Antibiotics recommended for treatment of mild, moderate, or severe P jiroveci pneumonia (PJP). TMP-SMX has been shown to be as effective as intravenous pentamidine and more effective than other alternative treatment regimens. [2, 34] The parenteral route may be considered in patients who present with serious illness or in those with gastrointestinal side effects.
(Medscape.com)PCP has to be treated with prescription medicine. No treatment, PCP can cause death. The most common form of drugs for treatment is trimethoprim/sulfamethoxazole (TMP/SMX), which is also known as co-trimoxazole and by several different brand names, including Bactrim, Septra, and Cotrim. This medicine is given by mouth or through a IV for 3 weeks. (CDC.gov)
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