Question

Case Study 30 Class/Group Name x's sister has brough skina chills and a productive cough and Scenario HKS sister has brought her 71-year-old broth 2 days She says he has shaking chills and a productive "he can't stop coughing." After H.K. is examined, he is die (CAP) and admitted to your floor at 1130. The admission assessment and call her with your findings a brother to the primary care clinic because he has had a fever for productive cough and he cannot lie down to sleep because ined, he is diagnosed with community acquired pneumonia 1130. The resident is busy and asks you to complete your routine hic because he has hadas 1. Name 4 priority areas to include in your assessment. CASE STUDY PROGRESS Your assessment findings are as follows: H.K's vital signs (VS) are 154/82, 105, 32, 103°F (39.4*. Spo,849 on room air. You auscultate decreased breath sounds and coarse crackles in the left lower lobe anterion and posteriorly. His nail beds are dusky on fingers and toes. He has cough productive of rust colors sputum and complains of pain in the left side of his chest when he coughs. He is a lifetime nonsmoke history includes coronary artery disease and myocardial infarction with a stent. He is cum metoprolol, amlodipine, lisinopril, and furosemide; for his dipine, lisinopril, and furosemide: for his type 2 diabetes mellitus, he is taking me and glipizide. He has never gotten a pneumococ when he took an antibiotic pill' a few years ago but doe Jotten a pneumococcal or flu vaccination. He does report getting does not remember the name of the antibiotic 2. Which assessment findings are significant? Give your ratio are significant? Give your rationale. 7.

Answer 1

1.The priority area for assessment for Mr.HK are

• Physical examination
  • Inspection :any sort of respiratory illness will lead to changes in the color ,shape or nature of the nail like cyanosis, clubbing ,etc.,The skin can be examined for the dryness, tone, turgor.,etc.,Then the breathing pattern has to be noted. In simple vital signs can be measured to get the basic knowledge about the changes in the
  • Auscultation: In CAP the lung sounds has to be assessed for any crackles, fruits, fluid accumulation, etc.,
• History collection:
  • Medical and surgical history
  • For any food and drug allergy
  • Previous admission
  • Lifestyle for alcohol, smoking, exercise
• Vaccination history for pneumonia
• Use of any active medication
• Elimination pattern to ruke out any fluid accumulation

2.The assessment findings which are significant are

• Abnormal vital signs
  • Increased temperature is because of infection
  • Increased blood pressure is because of increased heart rate secondary to tachycardia
  • Decreased oxygen saturation because of decreased oxygen supply to lungs.
• Secretion in the lungs has lead to decreased breath sounds and crackles
• Dusky nail beds due to hypoxia
• Vaccination history provides a clear knowledge about the way to diagnose CAP
• Pain at chest due to pressure in the respiratory system to enable gaseous exchange.
• Allergy assessment cautions the healthcare to start antibiotics after test dose only

3.Ths plan of action which has to be done on next two to three hours are

• To monitor vital signs every second hourly
• Insert IV line and collect blood sample and send to laboratory for investigations
• Administer antibiotics(after test dose observations) and IV fluids to the patient
• Simultaneously start the nebulization for the patient to enhance breathing
• Once patient is stabilised chest X ray can be done

Titration of oxygen can be done only when patient starts to maintain normal saturation at room air

Blood glucose will be done at bed time and in the morning

Sputum can be obtained for culture testing

4.In pneumonia the tonicity of the blood is altered in order to stabilize this and maintain the fluid and electrolyte balance a collois is necessary .The D 5 1/2 NS can be very effective in doing this,Morever the diabetic medication cam lead to hypoglycemia in order to prevent and maintain a dectrose solution will be helpful.The blood pressure is so elevated so a 0.9%NS cannot be administered if done ot will further elevate blood pressure. This cam be prevented if 1/2% NS is administered.