Ricelito D.

Zamora, RN

Respiratory System Case Study

October 15, 2017

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 101.5F. The pulse oximeter on room air is 85%. The CBC is as follows: WBC
12,500, platelet 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 increase 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.

a. What nursing assessment findings support the diagnosis of pneumonia?

Nursing findings that support his diagnosis of pneumonia based on the details that was
reveal during assessment are as follows; His medical history when he was diagnosed with
paraseptal emphysema 3 years ago and a history of hypertension, and diabetes could be a
risk factors that could lead to develop pneumonia. Harry mentioned that he smoked
cigarettes one pack per day for 55 years and quit 3 years ago, and presents with confusion
as to time and place during interview could also be a precipitating factor. Shotness of
breath is also noted as evidenced by respiratory rate 28 breaths/min,pulse oximeter on
room air is 85%, he complains of fatigue and shortness of breath and cannot finish a short
sentence before the respiratory rate increase 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. Fever is also noted when temperature taken and shows a result
of 101.5F. a presence of fluid in the lungs was also exhibit upon auscultation as it heard a
severely diminished breath sounds in the right lower lobe and absence of breath sounds at
the base. . The patient coughs weakly, but he does not raise any sputum was also disclose.

b. What diagnostic findings support the diagnosis of pneumonia?

Diagnostic findings reveals a presence of infection as evidenced by a WBC of 12,500

after his CBC result which can support this diagnosis. Result of ABGs could also support this
diagnosis based on the data of pH 7.30, paO2 55, PaCO2 50, HCO3 25 as it is interpreted as
respiratory acidosis as the lungs do not expel carbon dioxide adequately (inadequate
ventilation). Chest x-ray can confirmed diagnosis as a results reveal right lower lobe
consolidation, presence of apical bullae, flattened diaphragm, and a small pleural effusion
in the right lower lobe.

c. What nursing diagnoses should the nurse formulates for the patient?

Nursing diagnosis that should formulate for this patient can be a impaired gas exchange
related to altered delivery of oxygen as evidenced by the results of ABG of pH 7.30, paO2
55, PaCO2 50, HCO3 25, shotness of breath also noted as evidenced by respiratory rate 28
breaths/min,pulse oximeter on room air is 85% and a use of accessory muscles when
breathing.

d. What goals should the nurse develop for the patient?

Goals that are appropriate for the patients conditions includes improving airway
patency, rest to conserve energy, maintenance of proper fluid volume, maintenance of
adequate nutrition, understanding of treatment protocol and preventive measures and the
preventions of complications.

e. What overall interventions should the nurse provide?

Overall interventions for this patient includes supportive measures like humidified
oxygen therapy for hypoxemia, mechanical ventilation for respiratory failure, a high calorie
diet and adequate fluid intake. Interventions should include bed rest and analgesic to
relieve pleuritic chest pain.

2. Marie Perez, a 53 year-old patient, is day 1 after a gastric bypass. She complains of
shortness of breath; her respiratory rate is 30 breaths/min, heart rate is 110 bpm, pulse
oximetry 89% on room air, temperature is 100F, and her blood pressure is 90/50 mm
Hg. She complains that she feels like she is going to pass out or possibly die.

a. What could possibly be going on with the patient and what measures should the
nurse provide immediately?
 Shortness of breath after surgery can be very scary and, in some cases, life-
threatening. It may involve such sensations as feeling unable to take a big breath,
tightness in the chest or difficulty breathing. Shortness of breath can have numerous
causes, including airway blockage, lack of activity, pain or even underlying heart and
lung conditions. Feeling short of breath after surgery should never be ignored. Advised
patient to take a deep breath and release the air slowly, administration of oxygen
therapy can also done as per doctors order.