ISM Speech

Good afternoon everyone and thank you for coming to my presentation. I am Peijun
Zhao, a Clear Horizons student presenting on Pneumonia and some of its penicillin-based
antibiotics. However, before I even start my presentation, I would like to present some facts. Did
you know, according to the American Thoracic Society, pneumonia stands as the leading cause
of death for children under the age of five, accounting to roughly 15% of all deaths.
Additionally, this plagues roughly 50 thousand people in the US alone in 2015 and causes
thousands of hospitalizations each year. This problem continues to plague us today, and for this
reason, we must raise awareness of such an issue. With that said, let us continue onto my
presentation of my internship and my project.
From the end of August to now, I mentor under Dr. Bay V. Nguyen, a pediatrician and
internal medicine provider. I came under his guidance through a recommendation of one of my
friends, Clarisse Truong, and since then, I have not regretted following his guidance. Throughout
the start of my internship, I learned about his life story, his difficulties in admitting into medical
school, his participation in studies of insulin, his transition of life goal of assisting the
community, and how even his own son pursues a medical field. These type of inspiration stories
push me forward to do better in my own studies. Each Tuesday and Thursday, I shadow him and
his nurse, Gloria, and watch them assess the patients, give shots, and fill out paperwork. I
decided to take on pneumonia as the topic of my project due to personal interest and the
understanding that pneumonia highly affects many children. I remember having pneumonia as a
child, and due to such, I wanted to explore the field and learn more about how this may impact
my community. Throughout this internship project, I have also completed many ISM
assignments such as interviews and journal entries of my overall internship which I will talk
about next.
In ISM, my independent study mentorship class, I needed to create an online website that
would keep track of all my work throughout the internship. This first image is the home page of
my website where I attached a few pictures of the office including the image of my mentor and I.
This is the front of the website where you could access different assignments that I turned in. On
this page, there are several journal entries where I would have a prompt with my types answers
to recall my experiences through each step of the internship. I have other assignments as seen
here, my mentor interview where I asked about his personal experiences in the medical field and
what type of recommendations, he would have for us students. I also included the different drafts
of my Mid-term presentation which states my progress on my internship. Finally, I listed out
different parts of the final internship, including the invitations and the speech outline for this
presentation. All this allows me to reflect on my progress in my internship in the future. Now,
since I’ve discussed my portfolio and internship experience, let us continue with the main
objective or topic: pneumonia and its antibiotics.
Pneumonia at its core is the infection of the lungs, usually from a virus or bacteria. When
a bacteria or virus infect the lungs, white blood cells, neutrophils, and plasma proteins called
opsonin attempt to kill the invader. During this process, products created by these combat cells
are damaging to both the enemy cells and the lungs, causing inflammation and fluid-buildup
called pulmonary edema. Pulmonary for lungs and edema representing a condition when excess
fluid builds up in the tissue cells. Over time, this process prevents enough oxygen from reaching
the bloodstream. Oxygen level lower and if patient fails to treat their oxygen levels, they may die
from heart failure. Additionally, this infection could cause other symptoms, depending on the
severity of the condition.
Currently, as I have stated before, pneumonia represents one of the leading causes of
death for children under the age of five, the elderly, and those with a compromised immune
system. Pneumonia has plagued the world for centuries and even in the 1900s, when
technological developments pushed for higher standards of sanitation, pneumonia was the
leading cause of death according to Illinois University study. Although this disease was
identified in the late 1800s, improved understanding did not form until George Sternberg and
Louis Pasteur discovered the form Streptococcus pneumonia, one of most prominent strains of
pneumonia. Other individuals throughout the 1900s contributed to the medical revolution. For
instance, Alexander Fleming first discovered penicillin, an antibiotic that could eliminate
multiple strains of bacteria. Years later, Howard Florey took penicillin and purified the drug so
that it could be used as a synthetic product. Companies noticed the impact of penicillin and
invested in manufacturing the drugs, giving rise to the distribution of antibiotics. Thus, with the
efforts of these individuals, the mortality rate of pneumonia decreased considerably over the last
few years. Due to the efforts of current vaccinations, sanitation standards, and better healthcare,
pneumonia now represents the 8th leading cause of death with the mortality rate decreasing each
year. We should continue to learn about such prevalent illnesses so that our efforts will continue
this downward trend.
Now to briefly discuss the incidence and various statistics surrounding pneumonia.
Although pneumonia may stand as the 8th leading cause of death, it has murdered millions of
individuals throughout the last 30 years. Pneumonia mortality rates rise in developing countries
or areas such as that of Central Africa and South Asia with mortality rates for children around
20%. In developed countries, this lies around 15 percent, which makes sense due to the level of
industrialization and sanitation standards throughout the country. The US accounts for roughly
50 thousand deaths each year, much less than surrounding developing areas. In the next slide, we
see that the levels of mortality correlate deeply to the availability of medication such as
amoxicillin or co-trimoxazole, antibiotics used to treat bacterial pneumonia. In the US, a patient
generally requires a prescription to obtain their antibiotics at the local pharmacy without the need
of traveling to different locations. On the other hand, countries such as Bangladesh and Nepal
lack the capacity to treat these individuals, causing their symptoms to worsen. Less than 60% of
healthcare facilities retain access to these antibiotics, raising the mortality rates severely. Overall,
pneumonia remains highly prevalent, especially in developing countries.
Now, we can move onto the actual information. Pneumonia is the infection of the lungs,
and it may result from numerous causes such as a viral, bacterial, or fungal infection. Generally,
when an infection from one of these things reaches the lungs, the body sends out various cells
such as white blood cells, neutrophils, and plasma proteins to attack the foreign bodies. During
this process, the cells create waste that harms both the foreign bodies and the lungs, causing
inflammation to occur. Fluid called pulmonary edema start to build up. Pulmonary, meaning
lungs, and edema meaning a watery liquid in the cavities or tissues of an organ. When excess
fluid fills the lungs, oxygen levels start to lower from the lung’s inability to function smoothly. If
left untreated, the bloodstream will not receive enough oxygen, potentially causing nausea,
coma, and death. Of course, these symptoms may differ between each type of pneumonia, but
they cause the same illnesses.
As for the symptoms and signs, they are like that of the flu. A general patient with
pneumonia has cough, congestion, fever, and chills. The main distinctive symptom may result
from one of these signs such as a nonstop cough and chest pain when coughing or breathing
deeply. Additionally, patients may hear a cracking or crisp like that of feet walking on snow or
hair bristling between each other when listening to their breathing with a stethoscope. Each of
these things are possible signs that the patient may have pneumonia. As shown in this picture
here, there pulmonary edema fills up the alveoli, decreasing the amount of room for oxygen.
To diagnose pneumonia, a doctor needs to first identify the symptoms. A fever represents
an infection while the wheezing and difficulty breathing may result from pneumonia. If a doctor
suspects pneumonia, they will order an x-ray of the chest. The x-ray may take a few days, but the
radiologist will determine both if pneumonia exists and the type of pneumonia present. Once the
findings are printed, the doctor may decide on a plan for the patient’s recovery. As shown here,
there are two types of x-rays. The first one is a clear x-ray of the chest with the diaphragm below
and the spine in the back. In the second, you may notice the whitish cloud appearing on the sides
of the spine. The cloudiness represents the liquid inside of the lungs and since so much of the
edema exists, it is difficult to see through the body. Finally, after the doctor obtains the readings,
they will diagnose the patient with pneumonia and include their treatment options. Also, for
some infections resulting from other sources such as a fungal infection, the doctor may need a
culture test to identify the specific fungus. They may also use a bloodwork test to identify if an
infection exists based on the white blood cell count.
For treatment options, there are different procedures between viral and bacterial
infections. You cannot treat a virus with antibiotics and vaccines provide coverage, not
treatment. To help a patient with a viral pneumonia recover, a provider may treat the symptoms
of the virus rather than remove the actual virus. For example, most viral pneumonia result from
the common flu. To ease this, providers may prescribe Tamiflu or Oseltamivir to reduce
inflammation and ease the stress on the lungs. For bacterial pneumonia, providers must use
antibiotics such as amoxicillin or co-trimoxazole. Antibiotics usually work within three days, so
if a patient does not improve within three days of intaking antibiotics, there may be additional
issues. The bacteria the patient has may be resistant to the antibiotics, and the provider will
provide additional following with different antibiotic treatment. Additionally, there is a
difference between inpatient and outpatient treatment. In earlier times, children used to be
admitted directly to the hospital for inpatient treatment due to the possible risks of the child
dying due to a lack of breathing, but this may cost the family thousands of unnecessary dollars.
The child may also obtain other illnesses due to a proximity with sick individuals. Thus,
inpatient treatments are generally reserved for extremely sick pneumonia patients, and if the
patients need a respiratory machine, they may be admitted into the ICU or intensive care unit.
For outpatient treatment, the patients may receive a list of different antibiotics to take,
and the patient must return to the clinic for close monitoring for either every single day or every
few days. The patient may be prescribed amoxicillin or co-trimoxazole to fight the bacteria. In
both cases, patients are asked to intake lots of fluid while obtaining high levels of bed rest to
allow their body to recover. Other minor forms of medication may be provided such as a netting
pot if the patient has sinus issues or ibuprofen as a pain reducer.
To prevent pneumonia, there are several factors. First, children under the age of five, the
elderly over the age of 65, and all individuals with a compromised immune system have a higher
chance of developing pneumonia. Additionally, those living in unsanitary areas with conditions
such as polluted air or unclean drinking water are at a high risk. For these people, prevention is
key. Prevention first comes from the usage of vaccinations such as the annual flu. Since the flu
may turn into pneumonia, obtaining the flu vaccination will protect against such. Additionally,
proper hygiene such as washing your hands and showering both prevent bacterial infections.
These two small chores have a significant impact on an individual’s chances of contracting
pneumonia. Finally, early recognition of bronchitis or the flu may prevent pneumonia. If the
patient treats the symptoms early, the illness will not develop into pneumonia. Early recognition
may come from annual checkups or tests at a local provider.
Now, we shall talk about the medication for both viral and bacterial pneumonia. To
understand how vaccines impact pneumonia, let us first define what a vaccine is. A vaccine is
generally either a weakened virus or synthetic virus made from recombinant DNA. The vaccine
contains many antigens that, when released into the system, binds with the antibodies to form an
immunity. The antibodies in the bloodstream then have resistances to the virus. For pneumonia,
four prominent vaccinations exist. First Hib, otherwise known as the Hemophilus influenzae type
B vaccine prevents against meningitis, pneumonia, and infection, providers recommend this shot
at 2, 4, and 6 months of age. Next, the annual flu vaccine also prevents against pneumonia. When
someone receives the flu, the infection can spread into the lungs and weaken its capabilities.
Each year, a patient should schedule their shot to prevent themselves, first from getting the flu,
and secondly from contracting any additional diseases. The PCV13 otherwise known as Prevnar
13 routinely protects against a few stains of Streptococcus pneumonia. Patients receive this shot
and 2, 4, and 5 months with a bolster shot at 12-15 months. Lastly, pneumovax 23 or the
pneumococcal polysaccharide vaccine provide additional protection against the Streptococcus
bacteria. Individuals recommend this for adults over the age of 65. Additionally, second dosages
are recommended after five years. In total, each of these vaccinations provides protection against
either a specific strain or other possible infections.
As witnessed here, this is a general history for viral pneumonia. Unfortunately, I do not
retain the same level of medical knowledge as the doctors or nurses in this room, but this
provides the basic notes that a student could write. To read it, the sides represent the subjective,
objective, assessment, and plan. This is a 13-year-old Hispanic female here c/o fever of 102
degrees, headaches, chills, congestion, and cough for a week. The patient also complains of chest
pain when coughing heavily. No history of family illnesses. The vitals are as following with the
weight, height, temperature, respiratory rate, blood pressure, and heart rate. The objective
follows the main observations such as the general, HEENT representing the head ears eyes nose
and throat. CARD represents the heart palpitations and the RESP represents what the provider
notices when they listen to the lungs. The assessment regards to what the patient may have, and
the plan follows the treatment. Since this is a viral infection, the patient will need flu medication
such as Tamiflu, otherwise labeled as Oseltamivir, bedrest, and fluids. By reducing the severity
of the symptoms, patient’s body will have higher capabilities of functioning and fighting against
the virus. The follow-up ensures that the patient will recover. If the patient does not recover, then
the provider may admit the patient for a different treatment option or into the hospital.
Lastly, I will mention the antibiotics that treat pneumonia. The prevalence of antibiotics
first started with Alexander Fleming, who I mentioned at an earlier time. When he looked
through some growing mold in a tray, he noticed the mold fighting against a common bacterial
strain. And from there, as you have heard before, started the revolution for new antibiotics.
Antibiotics work by breaking the cell wall of a bacteria and destroying the bacteria cell.
Currently, many types of antibiotics such as amoxicillin or co-trimoxazole. Both chemical
structures strongly represent that of penicillin with a few changes in the molecule structure.
However, some bacteria are resistant against these two medications, so doctors may prescribe
levofloxacin. Of course, there are other specific medications that I am unaware of due to a lack
of medical knowledge. This brings up an additional issue though. Many bacterial strains are
developing resistances against antibiotics. This occurs when a patient obtains a specific
bacterium in their system and start to take antibiotics. However, the patient may not finish their
prescriptions as advised, and when that occurs, some of the bacteria lives and replicates at a high
rate. The bacteria may then mutate to develop a code that could bypass the specific antibiotics.
Countries with a lack of prescriptions lead to this severe issue in which patients may buy
antibiotics over a counter without a prescription. The patient may then improperly use the
prescription, leading to additional resistances. The importance of this comes from the need for
future research in antibiotics and developing anti-resistant strains. Thus, this may seem like an
interesting research project if I ever choose to follow this route.
Finally, to go over my research, pneumonia is the infection of the lungs and to prevent
such, individuals should obtain their required and recommended vaccinations such as PCV 13,
the annual flu shot, and the Hib. Annual checkups may help detect signs of an infection early-on,
and to prevent bacterial infections, simple hygiene can make a huge difference. Antibiotics
resistances should be prevented by following a doctor’s prescription. Providers should also
prevent themselves from overprescribing medications to reduce the usage of antibiotics.
Throughout this entire research process, I entered most of the information into a 12-page
research paper and cited the information at the end. This represents my collegiate-level work and
during my internship, Dr. Nguyen would provide additional information that I could include in
my research such as recombinant DNA for flu vaccines. Other minor worries that I had
throughout this project involve time-management. On the average school day, I do not arrive
home until 8 dues to my tutoring job. Additionally, I have other things such as club activities on
Fridays and volunteering on Sundays while maintaining my grades. As such, I often had
difficulties dedicating enough time to both my research and product. In the end, though, I
prevailed and completed my research.
Now for the product. Essentially, I have my research paper directed towards the general
population. The explanations in the paper are not the level of medical students due to a lack of
knowledge. However, the paper has decent clarifications on different aspects of pneumonia. In
addition to that, I created a handout as you can see here. Each of the flaps represent a different
aspect. There are also two different versions: an English and a Spanish version. Since many of
Dr. Nguyen’s patients are Hispanic, a Spanish version would provide a broader range of
individuals with information. The purpose of this handout follows the need to spread
information, especially on what exactly pneumonia is and how people may prevent themselves
from contracting the disease. The following are two images of my research and product in
process. I made my research paper in a word document and my handout on publisher.
In conclusion, pneumonia represents a large percent of deaths for children under the age
of five, and as such, we must continue to reiterate the importance of prevention and treatment for
such diseases. Following this, I would like to express my appreciation for the staff such as the
receptionist, Marlin, and the nurse Gloria. Following Gloria around has been an amazing
experience as she has a very vibrant personality. I would also like to thank Dr. Nguyen
specifically for his hard work and present him a thank-you card. At the end of all the
presentations, the interns have a gift they would like to present to him, so I will hold off on that
until the end. Nonetheless, thank you all for sitting through this long presentation. Here is my
work cited and do you have any questions or comments?