This case study should approximately 5-7 pages in length with at least 3 pages of content. A separate title page and reference page is to be included. Use the questions as headers for your answers. The entire case study is to be in APA format and submitted as a Word document (.doc or .docx). Grading is done with the Case Study Rubric.

Mrs. Barbara Ingalls is an 84-year-old white female, who is widowed and a retired bank manager. She owns her own home and has a 45-year-old female caregiver who lives in the home. Currently, Mrs. Ingalls uses a walker and takes daily strolls to the park with her caregiver. She is able to perform most activities of daily living; however, the caregiver prepares all meals. The patient presents to the clinic accompanied by her caregiver, who reports that Mrs. Ingalls. has a one-week history of upper respiratory symptoms and a two-day history of increasing weakness and malaise. Approximately three days ago, the patient developed a cough that has gradually become worse and she now has difficulty catching her breath. The patient has been coughing up a significant amount of phlegm that is thick and green in color. She has no fever. The caregiver has become concerned by the patient’s reduction in daily activities and an inability to get rid of her “cold.” The patient is also coughing and using accessory muscles to breathe. She is tachypneic and appears to be uncomfortable and in moderate respiratory distress.

Patient’s relevant medical history/examination findings:

Tobacco dependence for 64 years

Chronic bronchitis for approximately 13 years

Hypertension for 6 years, BP has been averaging 140/80 mm Hg with medication

Influenza shot 3 months ago

Completed COVID shot series 3 months ago; negative COVID PCR test

Smokes 1/2 pack per day

Some friends recently ill with “colds”

Occasional alcohol use, none recently ROS

Caregiver states that patient has had difficulty sleeping due to persistent cough

Caregiver has not observed any episodes of emesis but reports a decrease in appetite

Caregiver denies dysphagia, rashes, and hemoptysis

1. What is your best guess as to the patient’s diagnosis? Provide a strong rationale for your answer.

2. Propose a likely microbe that is causing the illness in this patient and provide a strong rationale for your answer.

3. Identify two antimicrobial agents that might be helpful in treating this patient and provide a strong rationale for your answer.

4. Should this patient be admitted to the hospital for treatment? Why or why not?

5. Based on the patient’s history of illness, is this type of infection considered community-acquired or nosocomial? Why?

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