A 14-year-old male comes into the clinic to be seen by the FNP. He presents with a sudden onset of 102-104� F
fevers over the past 2 days. He has a persistent cough, malaise, and a headache. He had a sore throat a few days
ago. Mom states he was exposed to strep pharyngitis at a soccer game 1 week ago and she feels this is the problem.
The patient denies vomiting or diarrhea, but has little appetite. No rash on exam today. No abdominal pain. The
patient presents on physical exam tired-looking with a harsh, mucousy cough and scattered crackles bilaterally.
Pulse Ox in the office reveals an oxygen saturation of 96%. HR is 100/min and RR @ 28/min. After the rapid strep
test returns negative, you send the patient for a 2-view chest x-ray. The chest films come back with interstitial
infiltrates, no lobar consolidations, and a white "fluffy" patchy area in the right lung field. You
diagnose the patient with pneumonia. Three days later he has returned to the clinic for follow-up with a scattered
maculopapular rash on his lower extremities. No fever on the second visit and his lung fields are clear when
auscultated bilaterally. Mom is concerned about the rash because he needs to get back to school.
In a narrative format, address the following questions below. Your answers need to be scholarly based. Use at
least two current (preferably 5 years or less) peer-reviewed journals to assist you in addressing the case study.
1) How do you interpret the above data?
2) What type of pneumonia do you suspect this patient has?
3) What do you expect to be the clinical course for this patient?
4) Are there any treatment options you would offer this patient?
5) How often would you like to see this patient in follow-up?
6) What type of rash does he most likely have?
7) What expectations do you provide for the patient and parent?
8) What education do you provide for the patient and parent?