Your patient is a 72-year-old female, alert and oriented, sitting up in bed at a nursing home. She is in mild respiratory distress. The staff describes a four-day history of fever, malaise, and productive cough. The patient also states that she has been experiencing chills and chest pain with deep inspiration. Physical examination reveals rales and rhonchi in the right upper lobe and warm, moist skin. HR = 116, BP = 104/76, RR = 20, SaO₂ = 93%. Based on the clinical exam findings, the most appropriate diagnosis would be:

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The patient's symptoms of fever, productive cough, chills, and chest pain with deep inspiration, along with the physical exam findings of rales and rhonchi in the right upper lobe, suggest a diagnosis of pneumonia. The tachycardia and mild respiratory distress also support a diagnosis of pneumonia. Emphysema would present with a chronic cough and difficulty breathing, while congestive heart failure would present with fluid buildup in the lungs, causing shortness of breath and crackles on auscultation. Chronic bronchitis would present with a chronic cough and sputum production.

Your Patient Is a 72-Year-Old Female, Alert and Oriented, Sitting