Managing the nonsurgical candidate with an empyema related to community-acquired lobar pneumonia

This case study reviews the medical management for a 76-year-old patient wi th a cardiac history and recurrent admissions for a persistent pneumonia. C omputed tomography showed evidence of an empyema in the right middle and lo wer lobes of his lung. The standard treatment for an empyema is a thoracoto my and long-term antibiotics. However, the patient's cardiac history disqua lified surgery as an option. Therefore the management plan was composed of antibiotics and treatment of his symptoms. The patient's symptoms improved after a week of levofloxacin (Levaquin), prednisone, bilevel positive airwa y pressure mask as required, and oxygen. He was discharged with home care, oxygen, Levaquin, tapering doses of prednisone, and previous medications. A t a 6-week follow-up examination, the patient was asymptomatic and had mark ed improvement noted on chest radiograph. The advanced practice nurse playe d an important role in this patient's recovery by conducting patient educat ion and coordinating follow-up after his release.