Question

D.T. is an 88-year-old woman who lives alone. She has been feeling weaker over past 2 days. Last night became confused and disoriented. Her housekeeper notified her daughter, who brought D.T. to the clinic. She complains of coughing over the past 3 days. She has a history of mild heart failure that is treated medically but has no other significant health disorders. She last saw her health care provider 4 months ago. What are D.T.’s risk factors for pneumonia? (underline or highlight) Based on her history, what type of pneumonia would you suspect D.T. has?

2. What clinical manifestations of pneumonia is D.T. displaying?

3. For what other clinical manifestations would you assess D.T. ?

4. What diagnostic tests would you expect the nurse practitioner in the clinic to order?

5. Because of her age and altered mentation, the health care provider admits her to the hospital for treatment. On admission, D.T. has bronchial breath sounds with dullness of the left lower lobe and egophony. Her O2 saturation is 87%. What is your priority of care for D.T.? (think whole patient)

6. It has been 4 days since D.T. was admitted for pneumonia. She is hemodynamically stable and neurologically intact. She has been switched from IV antibiotics to oral antibiotics and is ready for discharge. What important teaching should you provide to the patient and family? (think whole patient

Answer 1

1. The patient possess risk factors are

• She may have weakened immune system as her age is 88 years ( older adult)
• She has a history of mild heart failure (chronic disease). That may be one of risk factor.

The pneumonia may categorized as bacterial pneumonia. Because the patient gets better by antibiotic treatment. Sputum culture may used to identify the type of pneumonia.

2. Clinical manifestation related to pneumonia are chest pain, coughing for 3 days.

3. Other clinical manifestation have to consider and evaluate are disorientation, confusion.

4. Diagnostic tests to find out and confirm pneumonia are chest x ray, sputum culture, bronchoscopy, CT chest.

Other diagnostic test to evaluate the altered mental status are MRI brain/ CT brain

5.For this situation the priority to be given for breathing difficult, oxygen saturation. At first have to treat lung infection, stablize breathing pattern.

6. Discharge teaching : Healthy diet, breathing exercise, not expose to unhealthy environment, if symptoms appear immediately come to hospital.