Question

write a nursing care plan with the case study following the rubric

Case Study, Chapter 23, Management of Patients With Chest and Lower Respiratory Tract Disorders

1)Harry Smith, 70 years of age, is a male patient who is admitted to the medical-surgical unit with acute community-acquired pneumonia. He was diagnosed with paraseptal emphysema 3 years ago. The patient smoked cigarettes one pack per day for 55 years and quit 3 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: blood pressure 90/50 mm Hg, heart rate 101 bpm, respiratory rate 28 breaths/min, and temperature 101.5°F. The pulse oximeter on room air is 85%. The CBC is as follows: WBC 12,500, platelets 350,000, HCT 30%, and Hgb 10 g/dL. ABGs on room air are pH 7.30, PaO2 55, PaCO2 50, HCO3 25. Chest x-ray results reveal 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.

RUBRIC( please follow the rubric while using the numbers)

Do not write the NCP using a grid format... use an essay format/ bullet point using the numbers of this rubric.

All NCP will be graded according to the following rubric.

1) Definition of the medical diagnosis __________10

etiology/pathophysiology

2) Common signs and symptoms ___________5

3) Potential complications ___________5

4) Head to toe physical assessment you are to write one....use the data in the case if there is none you create it as if this was your patient. ____________10

5) Diagnostic and lab studies ___________5

normal values

expected abnormalities

6) ALL NANADA Nursing diagnoses __________10

7) Develop 3 NANDA priority nursing diagnoses __________10

8) State a patient plan AND goal for each of the __________10

priority nursing diagnosis

9) Write interventions for each of __________10

priority nursing diagnosis

10) Write scientific rationales for you you ___________5

interventions

11) Write evaluation of your interventions __________10

your plan or make changes

12) List of typical medications __________10

category

usual dosage

side effects

patient teaching

Answer 1

1. Community acquired pneumonia is one of the types of pneumonia which is acquired from the community .

#. Pathogenesis

Community-Acquired Pneumonia

• Microorganisms gain access to the lower

respiratory tract via:

- Inhaled as aerosolized particles

- Enter via bloodstream from an extra-pulmonary site of infection

- Aspiration of oropharyngeal contents

- Commensal bacteria in respiratory tract

become pathogenic

• When pulmonary defenses are functioning optimally, aspirated organisms are cleared via the mucociliary

transport system, coughing, and alveolar macrophages

• Factors that promote aspiration include altered MS (stroke, seizure), neuromuscular dz, ETOH and medications

• Lung infections w/viruses can suppress antibacterial activity of the lungs by impairing alveolar macrophage

fxn and mucociliary clearance

• Mucociliary clearance is reduced by diseases, ETOH, and drugs (narcotics)

• Defects in cellular and humoral immune function

#. Etiology

• The causative organism is only identified in 30- 50% of cases of CAP

• S. pneumoniaeis most common cause

• Underlying lung disease (i.e. COPD)

-H. influenzae, Moraxella catarrhalis

• s/p respiratory viral infxn (i.e. influenza)

-S. aureus

• Chronic oral steroids/severe underlying

bronchopulm dz, ETOH, frequent abx use

- Enterobacteriaceae, P. aeruginosa

#. Signs/Symptoms

• Abrupt onset of:

- Fever

- Chills

- Dyspnea

- Cough

• Productive vs nonproductive

- Chest pain

- Mental status changes

- Fatigue

- Headache

#. Physical Examination :-

• Tachypnea, tachycardia

• Lung examination

- Dullness to percussion

- Diminished breath sounds

- Inspiratory crackles

- Rales, rhonchi

- Tactile fremitus, egophony

- Chest wall retractions

#. Diagnostic and laboratory investigations :-

Chest Radiograph

• Lobar consolidation

• Dense lobar or

segmental infiltrate

• Patchy consolidation

• Diffuse, alveolar pattern

#. Laboratory Examination

• WBC with differential

- May be elevated

- Look for left shift

• Sputum gram stain and culture

• Blood cultures

- May help identify the presence of bacteremia and of a

resistant pathogen (low yield ~ 11%)

• Oxygen saturation

- Hypoxia on arterial blood gas (ABG) or pulse oximetry.