CAP Case Study

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.
Four priority areas to include in my assessment of H.K are, breathing patterns and
oxygen,, lung sounds, color of skin and nails, all vitals and orientation.
Lewish’s Medical-Surgical Nursing Assessment and Management of

Clinical Problems 11th Edition pg 507, Table 27.4
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), Spo 84% on room air. You auscultate decreased breath sounds and
2
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.
The assessment findings that are most significant are his oxygen saturation, nail beds
being dusky, history of Coronary artery disease and myocardial infarction with a stent
and being diabetic. The reasons for this are because patients with heart or artery
diseases are more likely to have a hard time fighting off an infection such as
pneumonia. Since he is not smoker and has never smoked his oxygen saturation is
alarming along with his nail beds being dusky. Also, he is diabetic and they are also at
risk patients for being immunodeficient.
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Clinical Problems 11th Edition
Chart View
Admission Orders
Consistent carbohydrate diet
VS q2h
IV of D ½NS at 125 mL/hr
5
Ceftriaxone 1gram IV every 12 hours

Albuterol 2.5 mg/ipratropium 250 mcg nebulizer treatment STAT, then q4h
Titrate O to maintain Spo over 90%
2 2
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.
In the next 2-3 hours I would start off by administering oxygen and
making sure his oxygen level is above 90% and take vitals every 2
hours. Also administer his STAT nebulizer treatment. I would also call
lab and get a CBC with differential and basic metabolic panel also
obtain a sputum sample for C&S. and start educating him about
medications how to take at home when he is discharged.

Clinical Problems 11th Edition Chapter 26
4. Is D ½NS an appropriate IV fluid for H.K.? State your rationale.

5
D5 ½ NS is appropriate for H.K. because of his diagnosis of

Pneumonia which is an infection and his fever he will need fluid
replacement. Although D5 ½ NS is not good for pts with heart
conditions such as coronary artery disease and myocardial infarction with a
stents as long as he is stable it should be okay to use, possibly a
cardiac monitor for monitoring during the infusion of D5 ½ NS.
Clinical Problems 11th Edition Chapter 26
https://allnurses.com/appropriate-iv-pneumonia-t473861/
5. What is the rationale for ordering O to maintain Spo over 90%?

2 2
Maintaining Spo2 over 90% with oxygen is so that blood flow and circulation keep
his vital organs and limbs from dying.
6. What is a C&S test, and what role will blood and sputum cultures play in H.K.’s
care?
C&S test is a Culture and Sensitivy Test. The culture will determine whether it is
bacterial or fungal. The Sensitivy test will show which antibiotics will help. In H.K’s
case the C&S test will help show why he has pneumonia.

7. What would you expect the CXR results to reveal?

I would expect the CXR results to reveal abscesses or pleural effusions due to H.K’s
pneumonia.

https://www.mayoclinic.org/tests-procedures/chest-x-rays/about/pac-20393494
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.
9. The pharmacy sends the ceftriaxone in 100 mL 0.9% NaClwith instructions to

infuse over 40 minutes. At how many milliliters per hour will you regulate the IV
infusion pump?
100/40 x 60 = 150ml/hr
Didn’t cite this from anywhere, used my dimensial analysis math
10. How will you ensure H.K.’s home medication list is accurate?
I would ask H.Ks daughter if she had a list or if she could bring his medication in
from home. If H.Ks daughter was unable I would ask HK if he was coherent the name
of his pharmacy to see if they had an updated reliable list.

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), Spo 94% on 2 L O per nasal 2 2
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, his recovering is as expected and the productive couch of yellow colored sputum
means his body is fighting the infection off, he is also not showing any signs of
distress and his VS are stable aong with his 94% on 2L. He is not out of the woods
yet, HK still needs plenty of fluids IV and Oral along with good nutrition, plenty of
rest and continuing antibiotics .

1. Assess HK thoroughly and give medications when due
2. Encourage Ambulation
3. Keep HOB elevated
4. Teach deep breathing exercises
5. Have HK demonstrate how to use an incentive spirometer
6. Maintain adequate fluids while setting goals for fluid intake
https://nurseslabs.com/pneumonia/
Lewish’s Medical-Surgical Nursing Assessment and
Management of Clinical Problems 11 th Edition
13. By the end of your shift, which assessment findings would best indicate that H.K.
is responding to therapy?
a. Cough productive of yellow sputum; lung sounds clear; Spo 96% on room air 2
b. Complaints of dyspnea; respiratory rate of 26 breaths/min on 2 L O ; clear lung 2
sounds
c. Cough productive of white sputum; temperature 100.0° F (37.8° C); Spo 98% on 2 L 2
O 2
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.
4 strategeies for preventing CAP infections to include in HKs dishcharge teaching
plan would be 1. Get pneumonia and flu vaccine every year. 2. Wash hands often. 3.
Stay away from people who are sick and running a fever, Disinfect high traffic areas
like door knobs, sofas, toilets etc.
https://www.drugs.com/cg/community-acquired-pneumonia.html
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 first apologize for the loss of his wife and agree that it is scary but I would
also then educate him on ways to prevent CAP. I would then clarify any questions or
concerns he had regarding CAP or anything that is concerning him.

16. What are some community resources from which H.K. may benefit?
Some community resoures from which HK may benefit from would be Home Heath
Agencies, Community Transportation, Health Department all for dealing with his
illness and preventing it from happening again like pneumonia and flu vaccination.

• 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

Lewish’s Medical-Surgical Nursing Assessment and Management of

CASE STUDY PROGRESS

Ceftriaxone 1gram IV every 12 hours

Obtain sputum for C&S

Lewish’s Medical-Surgical Nursing Assessment and Management of

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

D5 ½ NS is appropriate for H.K. because of his diagnosis of

5. What is the rationale for ordering O to maintain Spo over 90%?

Lewish’s Medical-Surgical Nursing Assessment and Management of

7. What would you expect the CXR results to reveal?

Lewish’s Medical-Surgical Nursing Assessment and Management of

9. The pharmacy sends the ceftriaxone in 100 mL 0.9% NaClwith instructions to

Lewish’s Medical-Surgical Nursing Assessment and Management of

CASE STUDY PROGRESS

cannula. He appears to be in no apparent distress and denies any dyspnea. You

Lewish’s Medical-Surgical Nursing Assessment and Management of

b. Complaints of dyspnea; respiratory rate of 26 breaths/min on 2 L O ; clear lung 2

d. Coarse crackles in posterior lower lobes; respiratory rate 22 breaths/min; no

Lewish’s Medical-Surgical Nursing Assessment and Management of

Lewish’s Medical-Surgical Nursing Assessment and Management of

• CASE STUDY OUTCOME

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