NR 603 Week 5 iHuman Virtual Patient Encounter and Reflection Attempt 3815503 - Frank Russo

History Notecard by Nicole Owens on case Frank Russo - Chamberlain Use this worksheet to organize your thoughts before developing a differential diagnosis list. 1. Indicate key symptoms (Sx) you have identified from the history. Start with the patient's reason(s) for the encounter and add additional symptoms obtained from further questioning. 2. Characterize the attributes of each symptom using "OLDCARTS". Capture the details in the appropriate column and row. 3. Review your findings and consider possible diagnoses that may correlate with these symptoms. (Remember to consider the patient's age and risk factors.) Use your ideas to help guide your physical examination in the next section of the case. HPI Sx = SOB Sx = Cough Sx Sx Sx Sx = = = = Onset a few weeks ago a few weeks ago Location respiratory respiratory Duration constant, progressively constant worsening Characteristics feels “winded” Nonproductive, “annoying” Aggravating minimal activity None Relieving None None Timing / albuterol albuterol, steamy Treatments showers Severity “pretty bad” mild Attempt: 3815503 Report generated on 2/5/2026, 7:32:24 PM America/Denver Management Plan by Nicole Owens on case Frank Russo - Chamberlain Management Plan a. Diagnostic Tests Complete blood count (CBC), blood: multiple low normal levels, suggestive of bone marrow suppression. Slight neutropenia present. Comprehensive metabolic (CMP), blood: Within normal limits X-ray chest PA and lateral: diffuse, bilateral interstitial infiltrates. Correlate clinically. Further diagnostic evaluation is indicated to assess disease severity and guide management of opportunistic fungal pneumonia in patients with untreated HIV infection (Weyant et al., 2021). Measurement of CD4 T- lymphocyte count is necessary to determine the degree of immunosuppression and associated risk for opportunistic infections (Weyant et al., 2021). HIV viral load testing is recommended to evaluate disease burden and to assist with longitudinal HIV management planning following acute stabilization (Weyant et al., 2021). Pulse oximetry and/or arterial blood gas analysis should be obtained to assess the presence and severity of hypoxemia, as oxygenation status influences both prognosis and the need for adjunctive therapy (Weyant et al., 2021). If clinically feasible, microbiologic confirmation via induced sputum or bronchoalveolar lavage with organism-specific testing may be pursued to support the diagnosis, although empiric treatment is appropriate when clinical and radiographic findings are strongly suggestive (Weyant et al., 2021). b. Medications First-line treatment for opportunistic fungal pneumonia consistent with pneumocystis-type infection is trimethoprim–sulfamethoxazole (TMP-SMX) due to its established efficacy in reducing morbidity and mortality in immunocompromised patients (Weyant et al., 2021). Prescription: Trimethoprim–Sulfamethoxazole DS 160 mg/800 mg tablets Take two tablets by mouth every 8 hours for 21 days Dispense: 126 tablets Refills: 0 Adjunctive systemic corticosteroids are recommended only in cases of moderate to severe hypoxemia, typically defined by reduced arterial oxygen tension or an elevated alveolar–arterial gradient (Weyant et al., 2021). As no objective oxygenation data demonstrating qualifying hypoxemia are currently available, no corticosteroid therapy is warranted at this time (Weyant et al., 2021). c. Suggested Consults / Referrals Referral to infectious disease is appropriate for coordination of care related to opportunistic fungal pneumonia and to guide