Name: ______________________________________________ Date: _________________

KEISER UNIVERSITY
Pneumonia Case Study
Basic Adult Healthcare – NUR1211C

HS is 70 years of age and a male patient who is admitted to the medical-surgical unit with acute
Community Acquired Pneumonia. He was diagnosed with paraseptal emphysema three years ago. The
patient smoked cigarettes 1 pack per day for 55 years and quit three years ago. The patient has a history
of hypertension, and diabetes controlled with oral diabetic agents. The patient presents with confusion as
to time and place. The family stated that this is a new change for the patient. The admission vital signs
are as follows: BP 90/50, P 101, R 28, and T 101.5 °F. The pulse oximeter on room air is 85%. The CBC
is: WBC 12,500, platelets 350,000, HCT 30%, and Hgb 10 g/dL. ABGs on room air are: pH 7.30,
PaCO2 50, HCO3 25, PaO2 55. Chest x-ray reveals right lower lobe consolidation, presence of apical
bullae, flattened diaphragm, and a small pleural effusion in the right lower lobe. Lung auscultation
reveals severely diminished breath sounds in the right lower lobe and absence of breath sounds at the
base. The breath sounds in the rest of the lungs are slightly decreased. The patient complains of fatigue
and shortness of breath and cannot finish a short sentence before the respiratory rate increases above the
baseline and his nail beds and lips turn a bluish tinge and the pulse oximetry decreases to 82%. The
patient is diaphoretic and is using accessory muscles. The patient coughs weakly, but he does not raise
any sputum.

• What nursing assessment findings support the diagnosis of pneumonia?

(At least 3 examples – 8 points)

• What diagnostic test findings support the diagnosis of pneumonia and why?
(At least 3 examples – 8 points)

• What nursing diagnoses should the nurse formulate for the patient?
(At least 3 examples – 8 points)

• What goals should the nurse develop for the patient?

(At least 3 examples – 8 points)
• What overall interventions should the nurse provide?
(At least 3 examples – 8 points)

• Develop a list of medications that may be prescribed for this disease process.
(At least 3 examples – 8 points)

• What psychosocial components should the nurse consider for this client?
(At least 3 examples – 8 points)

• What potential complications could HS develops based on his pneumonia diagnosis?

(At least 3 examples – 8 points)

True/False (2 points each)

• Pneumonia and influenza are the most common causes of death from infectious disease in the
United States.

• Hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA) require isolation.

• Tuberculosis medication should be taken with meals to minimize gastric irritation.

• A pulmonary embolism is a life-threatening emergency.

• More than 80% of lung cancers are caused by inhaled carcinogens.

• The pathophysiology of emphysema involves destruction of alveoli leading to impaired oxygen

diffusion.

• Administering high levels of oxygen to patients with COPD may result in suppressing their drive
 to breath.

• The strongest predisposing factor for asthma is allergy.

• Daily peak flow monitoring is recommended for all patients with moderate to severe asthma.

Fill-in-the-Blank (2 points each)

• Patients with pleural effusions are at increased risk for _____________.

• Ventilation-perfusion ratio is the ratio between ventilation and perfusion in the _____________.

• The most common cause of pulmonary edema is abnormal _____________ function.

• A pulmonary embolism is most commonly caused by a thrombus originating in the deep veins of
the _____________.

• _____________ breathing helps the patient with COPD to slow expiration and feel more relaxed.

• Patients who have difficulty coordinating inspiration with activation of their metered dose inhaler
can be helped by use of a _____________.

• _____________ is the major risk factor for emphysema.

• Pharmacologic management options available to assist patients to stop smoking involves

_____________ replacement.

• Manifestations of pneumonia include:

• _______________ b. _______________ c. _______________