CARING FOR A PATIENT WITH PNEUMONIA, UTI AND
OSTEOARTHRITIS
NURSING CASE ANALYSIS
REPORT
In Partial Fulfillment
Of the Requirements in
NCM 122
Presented by:
Carbon, Jeaneth C.
February 19, 2024
Nursing Case Analysis Study
I. Health History
The subject of my study is M. V. D. is an 82 years old female who was admitted
to Little Hospital Ph on February 9, 2024. Prior to admitting the patient to the hospital, M.
V. D. had been in bed fast state due to Osteoarthritis.
Mrs. V. was diagnosed as having Community Acquired Pneumonia with moderate
risk complicated Urinary Tract Infection. and came in to Little Hospital for check up
however she seek consultation for her present persistent fever. It was managed as UTI
and she received medication of ciprofloxacin but after 5 days her fever persist. Her
antibiotic was shifted to levofloxacin but after 5 days her fever persist hence they decided
to get admitted.
Infectious pneumonia may be due to a variety of microorganisms and can be
community-acquired or hospital-acquired (nosocomial). A patient can inhale bacteria,
viruses, parasites, or irritating agents, or a patient can aspirate liquids or foods. He or she
can also develop increased mucous production and thickening alveolar fluid as a result of
impaired gas exchange. All of these can lead to inflammation of the lower airways.
Organisms commonly associated with infection include Staphylococcus aureus,
Streptococcus pneumoniae, Haemophilus influenza, Mycoplasma pneumoniae,
Legionella pneumonia, Chlamydia pneumoniae (parasite), and Pseudomonas aeruginosa.
She was widowed last year of 2022 and was left to her daughter with her son in
law and two grandson. She has 8 siblings, all of them has hypertension and Diabetes
Milletus but only her was the exemption. Her daughter is her primary care provider and
his other sons and daughters are sending her money for her allowance. She has been
experiencing insomnia for 3 days and takes Benadryl to aid her into sleep. Soon after
three days she experienced persistent fever and now with accompany of chills.
On February 9th, doctor order piperacillin tazobactam for her complicated UTI
that causes her fever and chills and after 2 days of admission and medications her
symptoms did not persist anymore. Patient is also taking trimetazidine and atorvastation
for atherosclerotic aorta but they only provide a medication during their first and second
day and after that they did not comply anymore to the drug regimen.
On February 12th, she was seen with occasional unproductive cough and the
doctor order N-acetyleceistine and was relieved after a day. The patient was not
compliant to the medication regimen since they was admitted. They only provide the
mucolytic medication, vitamins and no more medication until discharge.
II. Diagnostic Measures
When M. V. D. was in the emergency unit the doctor order her for urinalysis,
complete blood count and chest x-ray to confirm her diagnosis. Based on the urinalysis
results showing moderate bacteria, elevated pus cells, protein, blood, leukocytes, and
nitrite. The presence of bacteria along with these other elevated parameters indicates an
infection in the urinary system.and others are also elevated such as pus cells, protein,
blood, leukocytes and nitrite. Her CBC shows that her Hemoglobin decreases, polys
increases this means that her blood count (CBC) results, a decrease in hemoglobin could
suggest anemia, which can sometimes accompany infections or other underlying health
issues. An increase in polys (polymorphonuclear leukocytes) typically indicates an
increase in neutrophils, which are a type of white blood cell involved in fighting
infections. The chest x-ray shows that her both lower lung has hazy opacities which
suggest the presence of abnormal densities or areas of increased opacity in the lower
opacity in the lower regions of both lungs. Hazy opacities can be used by various
conditions including infections such as pneumonia due to accumulation of fluid or pus in
the air sacs of the lungs.
The diagnostic test helped the doctors diagnosed her that she has Community
acquired pneumonia and with moderate complicated urinary tract infection. Community
acquired pneumonia (CAP) refers to an acute pulmonary parenchyma acquired outside of
the hospital. Moderate complicated UTI was a type of UTI that was also an infection that
includes more than one organ in the urinary system (Sachev, 2023).
III. Diet
When M.V.D. was admitted her diet was low in salt and low in fat. She is allowed
to eat only those with low salt and fat such vegetable dishes and other cafeteria dishes.
She has atherosclerosis aorta that causes her chest pain sometimes and that is why the
doctor order for her diet is the low fat and low sodium diet. The patient was instructed to
eat vegetables more often and to limit or if necessary to avoid meat and chicken to avoid
too much fat intake to control other underlying complications that will eventually help
the other symptoms to subside.
IV. Drug Therapy
Their are almost fifteen drugs for the patient but the patient is not compliant to the
treatment regimen. The SO of the patient only allow her to take the mucolytic drug and
antibiotic for two days. The other drug for her osteoarthritis and other vitamins was not
available in the patient’s stock since the Significant others are not complying to the
medications regimen they only make an argument to the nurses who are reminding them.
Her first day, she taken piperacillin+tazobactam 4.5g the only antibiotic the
patient was taking used for any infections which is indicated to treat her moderate
complicated UTI. She has also a PRN medication for her fever and chills which was
Paracetamol 500mg. She was also taking Restor F a multivitamins and minerals for
supplementation for vigor and stamina since the patient is too weak to move due to her
conditions. She has also a Calcium+Vitamin D which was to help her bone to become
more stronger as possible. Since her Hemoglobin was low the doctor ordered her to take
ferrous sulfate to increase her hemoglobin level.Any medication such as trimetazidine,
atorvastatine, azithromycin, n-acetylcysteine, diphenhydramine, prednisone, febuxostat,
pantoprazole and glucosamin was not given. The significant others were adviced to
comply to e medication regimen they only argue that they gave their medication in the
nurse’s station but truly they did not submit any other medication.
On February 13, the patient had a arthrocentesis at her right knee with
intraarticular steriod injection was the last procedure she had and no other procedure
followed.
V. Other Therapy
The patient has no other therapy ordered but the Significant others were advised
to help their mother to have a passive range of motion exercises at least divided 30
minutes in a day depending on the tolerance of their patient since their mother was not
able to move her right leg due to chronic pain in her knee due to osteoarthritis. Turning
the patient side-to-side was also emphasize and given importance to make sure the patient
will not develop any friction shear or lesion. Other like clean linens, clothing, and regular
proper hygiene was emphasized to avoid any other infection or any caused of other
infection.
VI. Nursing Care Plan
During first day of care the patient has occasional non-productive cough, she got
her nebulization during the night shift and was not able to give any medication during
morning shift since they do not have any supply anymore. The list of Nursing care plan
was listed below in narrative form.
The patient’s SO stated that she has been coughing but there is no phlegm
expectorated. Patient status has an oxygen saturation level of 98%, without Oxygen, use
of accessory muscle, and sleeping in Moderate high back rest. The formulated nursing
diagnosis was Ineffective airway clearance related to secretions in the bronchi as
evidence by observed sputum production in the chest x-ray results stating hazy opacities
in the upper part of the lungs and Ineffective breathing pattern related to cough due to
pneumonia as evidence by use of accessory muscle while breathing. This plan of care was
intended for the patient to demonstrate appropriate airway clearance at least at the end of
the shift and to demonstrate patent airway at the end of the week’s duty. Patient was
monitored for respiratory changes, and her ability and effectiveness of cough to watch out
for any exacerbation of her cough and difficulty of breathing. The care plan also
encourage the patient to increase the fluid intake since their was no restriction to facilitate
hydration and lubricate the phlegm. Positioning the patient was also significant also help
the patient to have a adequate ventilation. At the end of the shift the patient display no
exacerbation of cough and patient demonstrated a patent airway and good expectoration.
Due to patient’s osteoarthritis, she has been experiencing pain during the first and
second day shift and the next care plan has helped her manage her osteoarthritis.
The patient’s folks verbalized that patient stays only in one position because it is
very painful in the affected part. Patient’s right knee was swollen and warm to touch and
every time her right knee was move in a very slight movement she will complain of pain.
Chronic pain joint stiffness, degeneration and inflammatory processes evidenced by
hesitancy to move joint. The patient was assessed with her pain scale and the factors that
exacerbate the pain. Application of warm compress during morning was suggested to the
SO and if pain persist they are also instructed to put a cold compress on the affected area
at least every 30 minutes each day to minimize the swelling and pain. Patient was
encourage to do ADLs with assistance and in schedule manner or breaks in between.
Reminded about her maintenance and to reduce the pain and degeneration of the soft
tissues.
The patient’s BP has increased to 140/80 and it is in hypertension stage 1. Her
next nursing care plan with diagnosis of Knowledge deficit related to ineffective health
management of increased blood pressure. This care plan helped the client to lower her
BP and how to maintain in the tolerable level. The patient was encouraged to eat more
fruits and vegetables to help the BP maintain its current level. Introduced to relaxation
techniques because when her right knee was in intolerable pain it can make her calm thus
maintaining her blood pressure. Also, advised to comply with her medication regimen.
The patient was not able to do her activities of daily living due to her chronic pain
her right leg and right hand. The nursing diagnosis was Altered activities of daily living
related to acute pain as evidenced by limited range of motion. The patient was encourage
to ask for assistance for any movement she wish to allow her move to her extent tolerable
pace. The family and caregivers were involved through giving them instruction on how
will they help the patient to accomplish her task, incorporating the family will promotes
commitment and understanding of each person’s value. They are instructed to rest
between movement to regain energy and to continue. Caregivers and family are
instructed to anticipate the need of the patient because the patient are shy to ask for help
and she just lie on the bed.
In addition, the patient developed pneumonia due to the fact that she cannot able
to go outside the house and their house has different bacterias that she might be able to
intake that causes her to have a pneumonia. She has been with pneumonia in her past
history. Exacerbation and frequent occurrence of pneumonia was due to the patient’s
inability to breath fresh air. If only she can have a better air and good ventilation, she
might not have a frequent occurrence of pneumonia. The SO stated that, since the time
she was diagnosed with osteoarthritis, she has been in bed lying almost all the time and
she was easy to get sick. She also develop urinary tract infection because of unsafe usage
of diaper, as the patient verbalizes that she cannot urinate well in the diaper and she will
just hold her urge until she cannot longer hold the urge then she can urinate.
After being in bed for how many hours a day the patient might be able to have
pressure ulcer. Another nursing care plan was about Risk for impaired skin integrity
related to alteration of physical movement. The SO was instructed to turn the patient
from side-to-side every 2 hours to avoid any warmness in the sacral area or any area
which is warmed and heated for how many hours of lying down. Encouraged to use
lotion for moisturizer and make sure temperature was in enough to cool down every areas
in accordance to patients’ preference. Reminded to always change lines and other
bedding when already dirty or soaked with fluids.
VII. Teaching Plan
The patient and the significant others were thought proper hygiene such proper
hand washing that pneumonia can also be from anything that was taken by the mouth and
bacteria goes down to the lungs. Hand washing technique was the every first and at home
mitigation to avoid any high risk for any kind of diseases. The Significant others are also
thought for proper ventilation most especially for the patient so the negative air in their
room will exit from the window and fresh air will enter and adequate exposure to healthy
sunlight may also give some vitamins for them and which is also best for the patient.
Turning the patient from side-to-side was also emphasize since their patient was almost a
bedridden due to her illness, friction ulcer was a high risk Appropriate cleaning of the
house, eliminating dust and possible bacteria in any areas in the room of the patient such
as spraying Lysol but making sure when spraying the patient is wearing mask or
transported to the other room. Encouraged to eat more vegetables and fruits, less fats and
salts will also make the patient’s BP and/or maintained. Proper hygiene, most especially
genital care since the patient has a UTI, infection due to hygiene related bacteria can also
be a cause of UTI. Encouraged the SO to change the diaper of the patient every time it is
already wet because it might cause discomfort, rashes and itchiness to the patient.