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We would probably bring this patient back to a negative pressure room, even though the history is not highly suggestive of tuberculosis. The initial step would be to complete a history and physical examination.  It would be important to inquire about the patient’s past medical history as well as that of her immediate family (parents and siblings). Additionally, it would be important to make sure that the blood did not come from her stomach by asking questions that would differentiate the 2 areas, as many patients are confused when describing whether they “vomited” or “coughed up” blood.  Since aspirin is the only medication listed, we would inquire why that was ordered and consider discontinuation of the medication at this time due to increased bleeding. We would review the patient’s possible risk factors that could be contributing to symptoms: hx smoking, alcohol consumption, and the year the library was built for possible asbestos exposure.  During the physical exam we would be assessing breathing patterns, pulsoximetry, presence of cyanosis on the mucous membranes, swallowing difficulties, N/V, issues with heartburn and indigestion, recent infections and reassessing pain levels.   The patient will receive IVF due decrease PO intake and possible dehydration.
Laboratory testing would need to be conducted to provide more of a comprehensive picture.   The following are some initial lab test that would be needed:
 
  		CBC & BMP:  to check WBC count (temp = 99.2F), HgB and HCT (anemia due to 				bleeding), and electrolyte levels.

Type & Screen:  from determining blood compatibilities, if possible blood transfusion will need.  

		PT/PTT/INR:  checking bleeding time and clotting factors as patient presents w/ bright
 red sputum and history of aspirin use.

		AST/SGOT&:  checking possible liver damage due to alcohol intake.
		ALT/SGPT
		
		TB testing: hemoptisis, weight loss and fatigue are s/s of active TB.

		Cardiac Enzymes:  possible changes in cardiac function

		CEA:  increase in levels can indicate varying types of cancer

		CXR PA and Lateral – R/O infiltrates and masses

	The patient will then undergo CT scan of the chest and upper abdomen to assess possible tumors.  CT scan may reveal suspicious areas in the chest and abdominal region, but more testing would be required in order to determine if the areas are cancerous.   The MRI will be ordered in conjunction with the CT-scan.  MRI will provide images that can detect tiny changes in the structure of the body.  Once the patient is admitted from the ED to main floor, further testing (bronchoscopy, etc) will be required based on the results of the initial testing.