Case Study Week 1 Community Acquired Pneumonia 1

Case Study Week #1 (8/17/2020-8/21/2020)
Community Acquired Pneumonia
H.K.’s sister has brought her 71-year-old brother to the primary care clinic because he has had a
fever for 2 days. She says he has shaking chills and a productive cough and he cannot lie down to
sleep because “he can’t stop coughing.” After H.K. is examined, he is diagnosed with
community-acquired pneumonia (CAP) and admitted to your floor at 1130. The resident is busy
and asks you to complete your routine admission assessment and call her with your findings.
1. Name 4 priority areas to include in your assessment.
Priority assessments for this patient would 1st be his vitals and focused respiratory assessment
along with assessing his mental status. I would also, as long as he were not in any severe
respiratory distress, get a past health history mainly focused on his respiratory system as well as
a medication history.
Lewis Medical Surgical Nursing 11th Edition
CASE STUDY PROGRESS
Your assessment findings are as follows: H.K.’s vital signs (VS) are 154/82, 105, 32, 103° F
(39.4 ° C), Spo2 84% on room air. You auscultate decreased breath sounds and coarse crackles in
the left lower lobe anteriorly and posteriorly. His nail beds are dusky on fingers and toes. He has
cough productive of rust-colored sputum and complains of pain in the left side of his chest when
he coughs. He is a lifetime nonsmoker. His medical history includes coronary artery disease and
myocardial infarction with a stent. He is currently on metoprolol, amlodipine, lisinopril, and
furosemide; for his type 2 diabetes mellitus, he is taking metformin and glipizide. He has never
gotten a pneumococcal or flu vaccination. He does report getting “hives” when he took “an
antibiotic pill” a few years ago but does not remember the name of the antibiotic.
2. Which assessment findings are significant? Give your rationale.
All of his vitals are abnormal. His nail beds are dusky on his fingers and toes. Rust colored
sputum. Pain in the left side of his chest when he coughs. Decreased breath sounds and coarse
crackles in the left lower lobe. His fever and rust color sputum are signs of serious infection.
Dusky nail beds show lack of proper oxygenation. Crackles indicate that there is buildup in the
lungs. The pain when he coughs is also a sign of his pneumonia.
Nothing to site here just going off of previous teaching.
Chart View
Admission Orders
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Consistent carbohydrate diet
VS q2h
IV of D5 ½NS at 125 mL/hr
Ceftriaxone 1gram IV every 12 hours
Albuterol 2.5 mg/ipratropium 250 mcg nebulizer treatment STAT, then q4h
Titrate O2 to maintain Spo2 over 90%
Obtain sputum for C&S
STAT blood cultures & sensitivity
Blood glucose ac and hs with sliding scale regular insulin per protocol #2
CBC with differential and basic metabolic panel
CXR now and in the morning
Continue home medications
3. You obtain orders from the resident. Outline a plan of what you need to do in the next 2 to 3
hours.
1. Vital assessment, Chest Xray, Blood work
2. Oxygen administration
3. IV fluid administration
4. Administration of prescribed medication
5. Blood glucose monitoring and insulin administration as per sliding scale
6. Diet consultation
4. Is D5 ½NS an appropriate IV fluid for H.K.? State your rationale.
Yes since this is a hypertonic solution it will help with the removal of unwanted interstitial fluid.
This will also help to thin out out his lung secretions so that he will be able to cough them up
much easier. This is also an effective way to manage his fluid and electrolyte balance.
https://allnurses.com/maintenance-iv-fluids-t390631/
5. What is the rationale for ordering O2 to maintain Spo2 over 90%? 84 is an extremely low Spo2
not correcting this could lead to fatal complications.
6. What is a C&S test, and what role will blood and sputum cultures play in H.K.’s care? Culture
and Sensitivity test are done to determine what types of antibiotics will effectively treat specific
bacteria. Blood and sputum cultures can help to determine the cause of pneumonia as well as if
treatment is working.
https://www.healthhype.com/microbial-culture-lab-test-for-bacteria-fungus.html
7. What would you expect the CXR results to reveal? I would expect Consolidation, Plueral
effusions, lung abscesses.
https://www.med-ed.virginia.edu/courses/rad/cxr/pathology3chest.html
8. You need to follow a specific protocol when obtaining peripheral blood cultures. Place in order
the steps you will perform.
___2__ 1. Select venipuncture site. Cleanse and allow to dry.
____4_ 2. Inject 10 mL of blood into the aerobic bottle.
__3___ 3. Perform venipuncture and collect 20 mL of venous blood.
___1__ 4. Verify patient’s identity and perform hand hygiene.
_6____ 5. Attach identification to specimens and send to laboratory within 30 minutes.
__5___ 6. Inject 10 mL of blood into the anaerobic bottle.
http://a1.mayomedicallaboratories.com/webjc/attachments/72/5658cbf-blood-culture-collection-
procedure.pdf
9. The pharmacy sends the ceftriaxone in 100 mL 0.9% NaCl with instructions to infuse over 40
minutes. At how many milliliters per hour will you regulate the IV infusion pump?
150ml/hr
10. How will you ensure H.K.’s home medication list is accurate? I would contact his pharmacy.
CASE STUDY PROGRESS
The next morning you are again assigned to care for H.K. Your assessment findings are as
follows: VS 154/82, 92, 26, 100° F (37.8° C), Spo2 94% on 2 L O2 per nasal cannula. He appears
to be in no apparent distress and denies any dyspnea. You auscultate decreased breath sounds and
coarse crackles in the left lower lobe anteriorly. His skin is pale, warm, and dry. He has a cough
productive of yellow-colored sputum and complains of pain in the left side of his chest when he
coughs.
11. Is H.K. recovering as expected? Explain your rationale.
Yes. Treatment appears to be working as his fever has came down considerably, his oxygen
saturation is within normal range, and his sputum has gone from rust colored to a yellow color.
12. Based on your evaluation of H.K., write an outcome to achieve by the end of your shift, then
list 6 priority interventions you will perform toward achieving this goal.
Patient will show improved ventilation, gas exchange, and tissue oxygenation
1. Observation of level of consciousness, respiratory status, cyanosis signs every 2 hours.

2. Position in Fowler position or semi-Fowler.
3. Give oxygen according per orders.
4. Monitor blood gas analysis.
5. Create an environment that is quiet and comfortable for the patient.
6. Prevent the occurrence of fatigue in patients.
http://nanda-books.com/2012/10/nursing-plan-for-pneumonia-with.html
13. By the end of your shift, which assessment findings would best indicate that H.K. is
responding to therapy? A
a. Cough productive of yellow sputum; lung sounds clear; Spo2 96% on room air
b. Complaints of dyspnea; respiratory rate of 26 breaths/min on 2 L O2; clear lung sounds
c. Cough productive of white sputum; temperature 100.0° F (37.8° C); Spo2 98% on 2 L O2
d. Coarse crackles in posterior lower lobes; respiratory rate 22 breaths/min; no complaints
of chills
CASE STUDY PROGRESS
After continuing the plan of care for 2 more days, H.K. is recovering from his pneumonia and
preparing for discharge.
14. You know that H.K. is at increased risk for contracting another CAP infection. Describe 4
strategies for preventing CAP infections you will include in H.K.’s discharge teaching plan.
1. Proper and frequent hand hygiene, proper nutrition, adequate rest, and frequent exercise.
2. Avoid others who may be sick as much as possible
3. Flu and pneumonia Vaccination
4. Avoid exposure to smoke
15. H.K. confides in you, “You know, my wife died a year ago, and I live alone now. I’ve been
thinking . . . this pneumonia stuff has been a little scary.” How will you respond? I would explain
to him that by following the teachings in his discharge his risk of contraction will decrease.
16. What are some community resources from which H.K. may benefit? Since he is elderly and
widowed, he may benefit from resources providing meals for seniors, resources for
transportation, pharmacies and clinics that provide free vaccines for flu and pneumonia.
 CASE STUDY OUTCOME
H.K. is discharged in the company of his sister. His plan is to stay with her for a few days. He
thanks you for your care and taking the time to listen and talk with him. He says his sister and he
talked, and they intend to join the local senior center after he is feeling better.
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Case Study Week #1 (8/17/2020-8/21/2020)

Community Acquired Pneumonia

1. Name 4 priority areas to include in your assessment.

Lewis Medical Surgical Nursing 11th Edition

CASE STUDY PROGRESS

2. Which assessment findings are significant? Give your rationale.

Nothing to site here just going off of previous teaching.

1. Vital assessment, Chest Xray, Blood work

4. Administration of prescribed medication

5. Blood glucose monitoring and insulin administration as per sliding scale

4. Is D5 ½NS an appropriate IV fluid for H.K.? State your rationale.

Lewis Medical Surgical Nursing 11th Edition

___2__ 1. Select venipuncture site. Cleanse and allow to dry.

____4_ 2. Inject 10 mL of blood into the aerobic bottle.

__3___ 3. Perform venipuncture and collect 20 mL of venous blood.

___1__ 4. Verify patient’s identity and perform hand hygiene.

_6____ 5. Attach identification to specimens and send to laboratory within 30 minutes.

CASE STUDY PROGRESS

11. Is H.K. recovering as expected? Explain your rationale.

1. Observation of level of consciousness, respiratory status, cyanosis signs every 2 hours.

CASE STUDY PROGRESS

2. Avoid others who may be sick as much as possible

3. Flu and pneumonia Vaccination

4. Avoid exposure to smoke

 CASE STUDY OUTCOME

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_2 1. Select venipuncture site. Cleanse and allow to dry.

3_ 3. Perform venipuncture and collect 20 mL of venous blood.

_1 4. Verify patient’s identity and perform hand hygiene.