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December 2010, Volume 40 Number 12 , p 60 - 61


  • Steven J. Schweon MPh, MSN, RN, CIC, HEM


SHORTLY AFTER a family get-together, Mrs. Jacob, a 65-year-old woman with no known medical problems, suddenly develops severe myalgia, headache, fatigue, pharyngitis, fever, and chills. She calls her healthcare provider, who tells her to come to his office that same day. He adds that she'll be given a surgical mask to wear upon entering the office and be kept apart from other patients in the waiting room.At the healthcare provider's office, Mrs. Jacob's oral temperature is 102.0[degrees] F; apical heart rate, 110; respiratory rate, 22; and BP, 124/76 mm Hg. Her heart sounds are normal and breath sounds are clear. Based on Mrs. Jacob's signs and symptoms, the healthcare provider suspects seasonal influenza and obtains a nasal-pharyngeal specimen for confirmation. She's prescribed the antiviral agent oseltamivir.The healthcare provider asks Mrs. Jacob whether she'd received office reminders to obtain both a seasonal influenza and pneumococcal polysaccharide vaccine (PPSV) in October. She replies that she did, but hadn't gotten around to getting them. The healthcare provider doesn't offer PPSV now due to her moderate illness.1 Instead, he asks the nurse to give Mrs. Jacob a PPSV information sheet and set up an appointment to receive the vaccine in 2 weeks.At home, she improves for 10 days, then her condition worsens. Mrs. Jacob calls her healthcare provider complaining of fever and a productive cough and is referred to the local ED. In triage, her oral temperature is 103.2[degrees] F; pulse, 116 beats/minute; respiratory rate, 24 breaths/minute; and BP, 124/82 mm Hg. SpO2 is 90% on room air, and she has right-sided inspiratory crackles and rhonchi on auscultation.Mrs. Jacob has a gray, anxious appearance and complains of sharp, "stabbing" chest pain, which worsens with inspiration and coughing. Supplemental oxygen is administered, peripheral venous access is established, and she's placed on a cardiac monitor. Blood specimens are obtained for a complete blood cell count,

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