10-17-2007, 07:51 PM
A 102-year-old man is brought to the clinic from his apartment by a neighbor because of a cough productive of green sputum. He has a past medical history of a stroke 10 years ago with residual left arm weakness. The patient is widowed and lives alone. He takes no medications. Vital signs are: temperature 38.8 C (101.8 F), blood pressure 100/50 mm Hg, pulse 110/min. On physical examination, the patient has rhonchi in the right lower lung field. A chest x-ray reveals an infiltrate in the right lower and middle lobes. The patient has a score of 30/30 on a mini mental status examination. The patient states that he has "lived a good life and now wants to go home". He refuses any intravenous medications and will only take pills. After discussing that the pneumonia could potentially be fatal without intravenous antibiotic treatment, the patient continues to ask to be sent home. The neighbor insists that the patient should be admitted to the hospital. The next step in the care of this patient is to
A. admit the patient to hospital care with intravenous antibiotics
B. admit the patient to hospital care without intravenous antibiotics
C. admit the patient to psychiatric ward with antibiotics
D. discharge the patient home with oral antibiotics
E. discuss the case with the hospital attorney
F. initiate antidepressant therapy and administer intravenous antibiotics
A. admit the patient to hospital care with intravenous antibiotics
B. admit the patient to hospital care without intravenous antibiotics
C. admit the patient to psychiatric ward with antibiotics
D. discharge the patient home with oral antibiotics
E. discuss the case with the hospital attorney
F. initiate antidepressant therapy and administer intravenous antibiotics
