Pneumonia Case Study PDF

Preview

Summary

Pneumonia case study...

Description

KEISER UNIVERSITY Pneumonia Case Study HS is 70 years of age and a male patient who is admitted to the medical-surgical unit with acute Community Acquired Pneumonia. He was diagnosed with paraseptal emphysema three years ago. The patient smoked cigarettes 1 pack per day for 55 years and quit three years ago. The patient has a history of hypertension, and diabetes controlled with oral diabetic agents. The patient presents with confusion as to time and place. The family stated that this is a new change for the patient. The admission vital signs are as follows: BP 90/50, P 101, R 28, and T 101.5 °F. The pulse oximeter on room air is 85%. The CBC is: WBC 12,500, platelets 350,000, HCT 30%, and Hgb 10 g/dL. ABGs on room air are: pH 7.30, PaCO 2 50, HCO3 25, PaO2 55. Chest x-ray reveals right lower lobe consolidation, presence of apical bullae, flattened diaphragm, and a small pleural effusion in the right lower lobe. Lung auscultation reveals severely diminished breath sounds in the right lower lobe and absence of breath sounds at the base. The breath sounds in the rest of the lungs are slightly decreased. The patient complains of fatigue and shortness of breath and cannot finish a short sentence before the respiratory rate increases above the baseline and his nail beds and lips turn a bluish tinge and the pulse oximetry decreases to 82%. The patient is diaphoretic and is using accessory muscles. The patient coughs weakly, but he does not raise any sputum. 1. What nursing assessment findings support the diagnosis of pneumonia? (At least 3 examples – 8 points)

    

Confusion of time and place Decreased oxygen saturation of 85% Shortness of breath and diminished breath sounds Tachycardia Hypotension

2. What diagnostic test findings support the diagnosis of pneumonia and why? (At least 3 examples – 8 points)

  

X-RAY of chest indicates right lower lobe consolidation Elevated WBC of 12,500 - CBC PaO2 of 55 – ABGs

3. What nursing diagnoses should the nurse formulate for the patient? (At least 3 examples – 8 points)

  

Activity intolerance r/t impaired respiratory function Ineffective airway clearance r/t nonproductive cough and oxygen saturation Impaired gas exchange r/t impaired respiratory function

4. What goals should the nurse develop for the patient?

(At least 3 examples – 8 points)

   

Improvement of ABGS within normal limit by end of shift Absence of symptoms such as confusion, shortness of breath Improvement of lung function through use of deep breathing exercises, positioning and incentive spirometer Improvement of CBC within normal limit by end of shift

5. What overall interventions should the nurse provide? (At least 3 examples – 8 points)

  

ADMINISTER OXYGEN THERAPY – promote improvement in vitals and ABGs Encourage deep breathing exercises and use of incentive spirometer to prevent atelectasis Encourage positioning that helps aid in ventilation improvement such as high-fowler or

6. Develop a list of medications that may be prescribed for this disease process. (At least 3 examples – 8 points)

  

Bronchodilators – Albuterol Anti-inflammatory agents - Methylprednisolone Antibiotics - Azithromycin

7. What psychosocial components should the nurse consider for this client? (At least 3 examples – 8 points)

   

Depression r/t hospitalization and isolation Anxiety r/t condition and debilitation of health Inability to cope due to health condition worsening Death anxiety r/t worsening of condition

8. What potential complications could HS develops based on his pneumonia diagnosis? (At least 3 examples – 8 points)

    

Respiratory failure Atelectasis Sepsis/septic shock/super infection Continuation of symptoms post therapy Pleural effusion

True/False (2 points each)

1. Pneumonia and influenza are the most common causes of death from infectious disease in the United States. TRUE 2. Hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA) require isolation. TRUE 3. Tuberculosis medication should be taken with meals to minimize gastric irritation. FALSE 4. A pulmonary embolism is a life-threatening emergency. TRUE 5. More than 80% of lung cancers are caused by inhaled carcinogens. TRUE 6. The pathophysiology of emphysema involves destruction of alveoli leading to impaired oxygen diffusion. TRUE 7. Administering high levels of oxygen to patients with COPD may result in suppressing their drive to breath. TRUE 8. The strongest predisposing factor for asthma is allergy. TRUE 9. Daily peak flow monitoring is recommended for all patients with moderate to severe asthma. TRUE Fill-in-the-Blank (2 points each) 10. Patients with pleural effusions are at increased risk for atelectasis. 11. Ventilation-perfusion ratio is the ratio between ventilation and perfusion in the lungs. 12. The most common cause of pulmonary edema is abnormal cardiac function. 13. A pulmonary embolism is most commonly caused by a thrombus originating in the deep veins of the calf/thigh 14. Purse-lip breathing helps the patient with COPD to slow expiration and feel more relaxed. 15. Patients who have difficulty coordinating inspiration with activation of their metered dose inhaler can be helped by use of a spacer 16. Smoking is the major risk factor for emphysema. 17. Pharmacologic management options available to assist patients to stop smoking involves nicotine replacement. 18. Manifestations of pneumonia include: a. Pleuritic chest pain

b. mental status change - confusion c. tachypnea, SOB...