Pneumonia-COPD
Joan Walker, 84 years old
Primary Concept
Gas Exchange
Interrelated Concepts (In order of emphasis)
1. Infection
2. Acid-Base Balance
3. Thermoregulation
4. Clinical Judgement
5. Pain
...
Pneumonia-COPD
Joan Walker, 84 years old
Primary Concept
Gas Exchange
Interrelated Concepts (In order of emphasis)
1. Infection
2. Acid-Base Balance
3. Thermoregulation
4. Clinical Judgement
5. Pain
History of Present Problem:
Joan Walker is an 84-year-old female who has had a productive cough of green phlegm that started four days ago that continues to persist. She was started three days ago on prednisone 40 mg PO daily and azithromycin (Zithromax) 250 mg PO x5 days by her clinic physician. Though she has had intermittent chills, she had a fever last night of 102.0 F/38.9 C. She has had more difficulty breathing during the last night and has been using her albuterol inhale every 1-2 hours with no improvement so she called 9-1-1 and is brought to the emergency department (ED) where you are the nurse who will be responsible for her care.
Personal/Social History:
Joan was widowed six months ago after 64 years of marriage and resides in assisted living. She is a retired elementary school teacher. She called her pastor before coming to the ED and he has now arrived and came back with the patient. The nurse walked in the room when the pastor asked Joan if she would like to pray. The patient said to her pastor, “Yes please, I feel that this may be the beginning of the end for me!”
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem Clinical Significance:
• Productive cough
• Green phlegm
• Condition is Persistent
• Albuterol is not working effectively
• High fever The patient is presenting with an infection of the respiratory system, this needs to be addressed and treated quickly as it could result in respiratory failure.
RELEVANT Date from Social History Clinical Significance
• Lost her husband 6 months ago
• She finds comfort in her pastor and prayer
• She fears this is the end for her
• Resides in assisted living home The patient may feel depressed and lonely since losing her husband. She may also lose her will to survive if she fears or believes this is the end for her, this could cause additional issues and stress.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment (5th VS):
T: 103.2 F/39.6 C (oral) Provoking/Palliative: Deep breath/Shallow breathing
P: 110 (regular) Quality: Ache
R: 30 (labored) Region/Radiation: Generalized over right side of chest with no radiation
BP: 178/96 Severity: 3/10
O2 sat: 86% 6 liters n/c Timing: Intermittent-lasting a few seconds
What VS data is RELEVANT and must be recognized as clinically significant by the nurse?
RELEVANT VS Data Clinical Significance:
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-7. What nursing assessments will identify this complication EARLY if it develops?
• Focused respiratory assessment
• Breath sounds
• O2 saturation
• Blood pressure
• Pulse
8. What nursing interventions will you initiate if this complication develops?
Nurse labs
Oxygen through nasal canula, incentive spirometer, fluids to stay hydrated (watch for overflow especially in the lungs), a steroid for inflammation, afebrile medication.
9. What psychosocial needs will this patient and/or family have that will need to be addressed?
Fear that this is the end for her that she will be dying, fear of her current health situation in general, and loneliness and possible depression after losing her husband.
10. How will the nurse address these psychosocial needs?
Take the time to talk with her about what she is feeling, possibly pray with her since she finds that comforting, explain her condition and the treatment plan so she understands what is happening, invite her pastor for future visits and possibly suggest a psychiatrist.
Caring and the “Art” of Nursing
1. What is the patient likely experiencing/feeling right now in this situation?
The patient is likely scared and panicking, problems with the respiratory system can be especially hard to handle. She is having difficulty breathing and is not getting enough oxygen and that can be very frightening to go through. She has also just lost her husband and is still grieving and believes this is going to be the end for her.
2. What can you do to engage yourself with this patient’s experience and show that she matters to you as a person?
Address and treat her problem immediately. Once this patient is getting better oxygen flow taking the time to talk to your patient can really help them, explaining to them what is happening and what you are doing to help them can help decrease their fears. Inviting her pastor to come into the room and sit and pray with her since she asked for him when she arrived. Praying with your patient if invited to can also help with their fears and help build a trust.
Use Reflection to THINK Like a Nurse
Reflection-IN-action (Tanner, 2006) is the nurse’s ability to accurately interpret the patient’s response to an intervention in the moment as the events are unfolding to make a correct clinical judgement.
1. What did you learn from this scenario?
I learned a lot about treating respiratory patients and the importance of acting fast and precisely. I learned about reading different lab values and what they can mean for a patient with impaired gas exchange and this was also my first time interpreting an EKG.
2. How can I use what has been learned from this scenario t improve patient care in the future?
I definitely will be focusing on the ABC’s of nursing with all patients but especially in patients with respiratory problems. I have a better understanding of lab value that I can definitely learn more on and carry with me through all areas of nursing.
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