NCM 112 RLE

BSN LEVEL 3

Case Scenario 1
Care of client with alterations in Oxygenation
Pneumonia

This is a case of a 58 year old male named Mr. Roque who came in the ER per wheelchair accompanied
by his wife with chief complaint of high grade fever and chills and difficulty of breathing. Vital signs
shows a temperature of 38.5ºC, pulse rate 85 bpm, respiratory rate of 28 cpm, blood pressure of
130/80mmHg. Oxygen saturation 90% in room air. Weight -65 kg. Physical examination performed
with the patient in upright position. His findings revealed that there were decreased breath sounds and
with rales/crackles on the left lower lung segments upon auscultation. Occasional productive cough with
yellowish sputum; rapid and shallow breathing. He appears to look restless and pale. Swollen and
inflamed throat was noted. Abdomen, HEENT, skin and extremities are essentially normal. Seen and
examined by Resident on Duty.

1 week prior to admission the patient had cough associated with back pain and has poor appetite. Took
over the counter drugs to relieve his pain/discomfort. Sought consult and was requested a chest x-ray.
Advised admission due to left lung field infiltration. Admission care rendered by ER Nurse.

Past medical history reveals he is hypertensive. He has been a smoker since he was in highschool at an
early age of 18 years old. Consumes 2 sticks of cigarettes per day. Has pollen allergies and frequently
suffers from rhinitis. He works in an office as a consultant and often works overtime. Due to his nature
of work, he is occasionally sent by the manager as a representative of the company to travel places for
any work related activities.

His laboratory results shows: Chest x-ray PA view- left lower lobe infiltration, Sputum culture and
sensitivity positive for Streptococcus Pneumoniae, Hematology result- WBC count: 23.84; RBC count:
4.98; Hemoglobin 150; Hematocrit 0.45; Platelet- 200,000; Neutrophils 0.83; Lymphocytes 0.09;
Monocytes 0.01; Eosinophils 0.01; Basophils 0.1; Urinalysis- Color: Straw; Transparency: Hazy; pH:
5.0; Sp Gravity: 1.015; Albumin: Negative; Sugar: Negative.

Impression: CAP-MR, left lower lung considered

Mr. Roque was treated with IV fluids, antibiotics and oxygen therapy. The following doctor’s order: IVF
of PNSS 1L at 80cc per hour. Paracetamol 500mg tablet, 1 tab rtc every 4 hrs for 24 hours then prn for
fever. Azithromycin 500mg OD for 7 days. Piperacillin + Tazobactam 4.5G IV 1 vial via solulet Q8H
ANST. Losartan K 50mg/tab 1 tab OD. Sodium ascorbate + zinc 500mg/10mg tab OD after breakfast.
Acetylcysteine 600mg 1 effervescent tablet to dissolve in 30ml of water OD HS. Oxygen Inhalation at 2
liter/min. PAI with Salbutamol sulfate 1mg/ml 1 nebule TID, then chest physiotherapy thereafter.
Monitor vital signs; increase fluid intake; activity as tolerated.

After medical and respiratory treatments Mr Roque’s condition improved. Intravenous antibiotics and
oxygen inhalation were discontinued after 7 days. Vitals signs were stable and within normal limits.
There were occasional non-productive cough and less rales noted upon auscultation by ROD and
consultant. He was oriented and instructed of going home medications and care. The following meds:
Paracetamol 500mg 1 tab Q8H PRN for fever, Acetylcysteine 600mg 1 effervescent tablet to dissolve
in 30ml of water OD at bedtime, Azithromycin 500mg/tab for 7 days more. He was advised to have a
follow-up check up after 3 weeks in the doctor’s office. He was grateful for all the nurses and doctors
that attended his care.

Questions:

1. List the possible complications that may arise if the condition is left untreated and briefly describe
each.

2. Differentiate the HAP and CAP.

3. What is reverse isolation, quarantine and isolation.

4. Differentiate bronchopneumonia and covid 19.

5. What are the different microorganisms that causes pneumonia?