Use the following patient vignette to answer questions 7 – 8…

Questions

Use the fоllоwing pаtient vignette tо аnswer questions 7 – 8. A 65-yeаr-old woman is evaluated for a week-long fever, productive cough with purulent sputum, and increasing dyspnea. She smokes one pack of cigarettes a day. Her medical history includes hypertension and hypercholesterolemia, for which she is treated with simvastatin, hydrochlorothiazide, and aspirin. On physical examination, the patient is in mild respiratory distress. Temperature is 38.5°C (101.3°F), blood pressure is 145/85 mm Hg, pulse rate is 92/min, and respiration rate is 21/min; BMI is 28. Oxygen saturation is 92% with the patient breathing ambient air and 95% on oxygen, 2 L/min by nasal cannula. Pulmonary auscultation reveals bilateral expiratory wheezes and rhonchi. Physical exam reveals no digital clubbing but 1+ ankle edema. Lips are slightly bluish. Chest radiograph shows increased bronchovascular markings. Laboratory values indicate normal CBC, except for an increase in neutrophils and hemoglobin. Arterial blood gases, while the patient was breathing ambient air, are pH 7.40, PCO2 41 mm Hg, and PO2 53 mm Hg. Spirometry shows an FEV1 of 45% of predicted and an FEV1/FVC ratio of 52%. 8. What is the best management plan for this patient?

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