Pneumonia Case Study Discussion
Hello! This is a pathophysiology class case study. The number of pages/words is only 2 pages because there are a lot of questions and some questions only require a few words. There are marks based on the question, please try to explain them as much as you can based on nursing. If you have the book on Gould\’s pathophysiology for the health professions 6th edition and Lewis Medical surgical nursing in Canada books, feel free to use that as resource, and if not, a reliable one and please include it in the references. I will add the document for you to see. Thank you so much for the help! Take care.
Jaspreet Patel is an 80 year old widowed female who has been in hospital for three weeks following an ischemic stroke. She has significant left sided weakness and cannot mobilize or reposition herself in bed. She has been on nasogastric feeds for the past two weeks but they have been slow to advance and have been stopped and started intermittently due to diarrhea.
The client has no family. Past medical history is unclear except for hypertension. Speech is garbled with word finding difficulties since the stroke.
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The client’s usual VS are T 36.5C P 80 bpm R 22 bpm BP 138/84 O2 sat 91% on room air
Assessment Findings this morning.
- Increased fatigue over the past 3 days
- Alert and oriented X 2-disoriented to place this morning
- Anxious and distressed Pneumonia Case Study Discussion
- Dyspnea and SOB
- Accessory muscle use
- Breath sounds diminished to bases bilaterally
- Productive cough with green blood-tinges sputum—difficulty expectorating
- Expiratory wheeze bilaterally
- Barrel chest
- Skin is pale, hot and dry
- Strong peripheral pulses
- Urine is clear and concentrated with U/O 100 cc overnight
- Intermittent chills
- Fingernails are yellow with clubbing present
- Explain the rationale for each of the VS findings below. (10 marks)
| T 37.4 C
Existing conditions such as high blood pressure are associated with fever. |
HR 110/bpm
A heart rate of 110 pm is above normal. A normal heart rate fall within 60-100 bpm. |
| BP 105/80
Usually, the client has a BP of 138/84, which is classified as high normal blood pressure. The reduced BP is a complication of pneumonia. Presence of pneumonia in the blood causes the blood pressure to drop significantly. |
O2 sat 85%
Low oxygen levels are indicative of pneumonia. Oxygen saturation below 88 percent is considered dangerously low. |
| RR 30/min
The client has increased breathing rate. The breathing rate of a normal person is 8 to 16 beats per minute. Respiratory problems are known to increase the respiration rate. |
- What are the risk factors for pneumonia for this client? (6 marks)
For this client, risk factors for pneumonia are advanced age, being hospitalized, and having a chronic illness.
- What type of pneumonia might you speculate that this client has? Why? (2 mark)
It is likely that this patient has bacterial pneumonia. The patient is presenting with symptoms that resemble those of bacterial pneumonia. They include fatigue, productive cough, loss of appetite, rapid heart rate, fever, and intermittent chills.
- What diagnostic test(s) would confirm a diagnosis of pneumonia? (1 mark)
Chest X-rays, blood tests such as complete blood count (CBC), and pulse oximetry.
What assessment findings suggest an underlying respiratory disease that is not pneumonia? (2 marks)
The patient assessment has findings indicative of respiratory illnesses such as chronic obstructive pulmonary disease. These include barrel chest, wheezing during normal breathing, decreased breath sounds.
- What is it and how might it increase her risk for pneumonia? (3 marks)
COPD is a chronic inflammatory lung disease that obstructs airflow the lungs. Patients with COPD are more susceptible to pneumonia as COPD increase the risk of respiratory failure. With COPD, there is presence of pathogenic bacteria in the airways, which increase the risk of bacterial pneumonia.
- Explain the pathophysiology and significance of the wheezing and the green blood-tinged sputum? (2 marks) Pneumonia Case Study Discussion
Green Blood-tinged sputum occurs when sputum has visible blood streaks. It is common in patients with respiratory diseases such as asthma COPD, or pneumonia. In patients with pneumonia, the infection of the lungs causes them to fill with fluid which obstructs the airways, causing wheezing.
- Explain the significance of each of the findings. (7 marks total)
| Lab test | Findings | Normal Findings | Marks |
| Arterial Blood Gases (ABGs) | pH 7.32 PaCO2 54 PaO2 62
HCO3– 24 Low ph (respiratory acidosis) occurs in patients with disorders that affect the lungs. A high PCO2 is associated with respiratory acidosis. Lower Pa02 than normal shows patient is not getting enough oxygen. The patient’s HCO3 is normal. |
pH 7.35-7.45
PaCO2 35-45 mmHg PaO2 80-100 mmHg HCO3– 21-28 mmol/L |
3 |
| Leukocytes (WBC) | 14.8
High leucocytes in the blood are indicative of an infection. |
3.5-12 x 109/L | 1 |
| Hemoglobin (Hb) | 100
The patient’s hemoglobin levels are low, indicating that she is not getting enough oxygen. |
120-160 g/L (F) | 1 |
| Hematocrit (Hct) | 0.48
High hematocrit levels are common in patients with pneumonia. Such patients have a hypodynamic circulatory response characterized by increased hematocrit. |
0.37-0.47 | 1 |
| Sodium (Na+ ) | 147
High sodium levels in patients with pneumonia result from the imbalance in the electrolytes. |
135-145 mmol/L | 1 |
- Which assessment findings may be different in the elderly? Explain why this may occur. (3 marks)
Cognitive assessment findings may be different among the elderly. Cognitive impairment among older adults results from the interplay of factors such as medications side effects, dementia, and delirium.
- What assessment findings suggest the possibility of sepsis. What further diagnostic testing would help confirm this? (4 marks)
High leucocytes in the blood, electrolyte imbalance, and increased body temperature are assessment findings that suggest the possibility of sepsis. However, further tests such as X-rays, MRIs, CT scans, and Pneumonia Case Study Discussion