Pneumonia case study
Adapted from the Evolve case study guide page 273
CB is a 75 year old married female who presents to the outpatient clinic complaining of a severe cough, left sided chest pain that has become progressively worse over the past several days. She appears anxious and her face is flushed. The physician suspects pneumonia. Her vitals are as follows:
Temp: 102.6 F
RR: 32 shallow
1. What is pneumonia and what are the major complications of this disorder? See Iggy page 659
2. What causes pneumonia? (see etiology page 659)
3. What are your concerns about the patient? (Think biopsychosocial being)
4. What is the cause of the concern?
5. What information do you need? Lets review the pneumonia algorithm
- How could risk factor analysis help to distinguish between CAP and HAP (see table 33-2 page 659)
You learn that your client never seeks regular health examinations, has not received any vaccinations and hedged when asked about alcohol and cigarette smoking use.
- Howe does that impact her risks?
- What clinical manifestations would alert you to the presence of pneumonia in this client? See table 33-3 page 662
- How could this type of infection be prevented? See chart 33-4 page 660)
- What would yo advocate for the physician to order to diagnosed pneumonia and why?
- Pulse oximetry:
- What are you going to do about it? Check the NCP in the chart (plan of care for Pneumonia) & review the practice guidelines
- Based on what you understand about this disorder, what is the client experiencing?
The physician prescribed Ceclor and discharges the client home.
- What concerns to have regarding the treatment regimen in view of the evidence?
- How should you communicate your concerns?
- What instructions should you provide to the client?
Following several days on Cefaclor (Ceclor) to which she did not respond, she required hospitalization for pneumonia and was started on IV Moxifloxacin in the emergency department. Review standard MD orders. What do you expect to be included in the plan of care?
· Oxygen therapy
- What outcomes would you set for each potential complication?
b. Ineffective breathing pattern
c. Ineffective airway clearance
g. Activity intolerance
You are scheduled to care for CB on the medical surgical unit two days later. You perform an initial assessment.
- Which of the following findings found on initial assessment would alarm you and which are expected? (Select all that apply)
a. Drowsy, but arousable and cooperative
b. Chest soreness
c. Productive cough
d. 6 degree F decline in temperature
e. Urine output 200 mL over 8 hours
g. Pulse oximetry 88%
You review the client’s laboratory reports:
Lab reports: Pneumonia client
CBC and bleeding times
Complete Blood Count
Specimen: Blood Released 1/11/2010 0500
Organism: P aeruginosa
How do you interpret these labs?
- Review the standard MD orders. What additional data should you collect? Based on your findings what would be your next best action?
The rapid response team responds to stabilize the client.
- How do you think you responded to the client’s situation?
- What could you do differently?