Case Study #1
Student Name:________________________
For the homework assignments, the student must complete the questions on
their own accord (thus not a group project or splitting). By signing your name on
your homework assignment you have agreed that the work presented is of your
own accord and is not completed with any collaboration with other instructors,
students and healthcare workers. The answers provided cannot be copied
word for word from a book or plagiarized and must demonstrate critical thinking,
prioritization and decision making. Points will be deducted based on the answers
provided.
Mrs. Harriet is a 68 year old woman who is alert and oriented. She presents to
the emergency department with complaints of chest tightness, shortness of
breath, cougn and congestion. She states, “I have been having these symptoms
for three days now. I have been taking Maximum Strength Robitussin for my
cough but is has not helped very much. When I woke up this morning, I felt very
weak so I came in to be checked out.” Her vital signs are blood pressure 110/70,
pulse 94, respiratory rate of 28 and a temperature of 102.7 °F. Her oxygen
saturation on room air if 92%. He is placed on 2 liters of oxygen by nasal
cannula. The physician prescribes a 12 lead electrocardiogram and chest x-ray.
Laboratory test prescribed include CBC, BMP, BNP, CPK, CPK-MB, and
troponin. The physician will also assess blood cultures x2, ABGs on room air,
sputum culture and sensitivity, and asks that the client have a Mantoux test.
Ethnicity: Black American
Preexisting condition: Allergy to erythromycin and aspirin
Socioeconomic: Retired, lives at home with her husband, volunteers as a
receptionist at a local adult community center, smokes a half of a pack of
cigarettes per day, positive tobacco use for 54 years.
Mrs. Harriet’s EKG, shows normal sinus rhythm with a heart rate of 98 beats per
minutes. The CXR reveals a right lower lobe infiltrate, Lab tests include the
following results, WBC: 12,200 cells/mm³, 72% seg neutrophiles with a left shift
of 11 % bands, and a BNP of 50.9 pg/ml. ABG’s on room air are pH 7.44,
PaCO2 39 mm/Hg HCO3 26.9 mEq/L, Pa02 is 58 mmHg, and oxygen sat is
92%. Results of the sputum culture show Streptococcus pneumonia. The CPK,
CPK-MB,and troponin are all within normal limits. Mrs. Harriet is five feet three
inches tall and weights 224 pounts. On assessment, the nurse hears expiratory
wheezes and rhonchi bilaterally with diminished lung sounds in the right base.
Her thoracic expansion is equal but slightly decrease on inspiration. Accessory
muscle retraction is not noted, and she does not exhibit central cyanosis.
Capillary refill of the client’s nail beds is four seconds.
Mrs. Harriet is admitted with acute bronchitis and pneumonia. The physican
prescribes oxygen via nasal cannula to keep the client’s oxygen saturation ≥
95%, ceftrizxone sodium, erythromycin, albuterol, acetaminophen every four
hours as needed, bed rest, increased oral fluid intake to 2-4 liters per day,
coughing and deep breathing exercises, and use of an incentive spirometer.
1) Discuss the pathophysiology and symptoms of acute bronchitis.
2) Discuss the pathophysiology and causes of pneumonia in general
3) Compare the defining characteristics of community-acquired pneumonia,
hospital acquired pneumonia and viral pneumonia.
4) Discuss the factors that place Mrs. Harriet at greater risk for the
development of pneumonia
5) The nurse asks Mrs. Harriet if she has been using her incentive
spirometer. Mrs. Harriet states, “I tried to use it a couple of times but I
think it is broken. When I blow into it, the ball does not go up like I was
told it should.” How should the nurse intervene?
6) Analyze Mrs. Harriet’s ABG results. Determine whether each value is
high, low, or within normal limits; interpret the acid base balance;
determine if there is compensation; and indicate whether the client has
hypoxemia.
7) Provide a rationale for each of the following prescribed components of
Mrs. Harriet’s treatment plan: oxygen saturation ≥ 95%, ceftrizxone
sodium, erythromycin, albuterol, acetaminophen every four hours as
needed, bed rest, increased oral fluid intake to 2-4 liters per day, coughing
and deep breathing exercises, and use of an incentive spirometer.
Taken from: Ankner, G. Delmar’s Case Study Series: Medical Surgical Nursing; 2008,
Thomson Delmar.