Case Study #2 Pneumonia

Question 1

Discuss predisposing factors to respiratory problems in the elderly

Answer 1

Chest wall deformities affecting lung compliance causing increase work of breathing

lung parachyma loses supporting structure causing dilatation of airspaces

respiratory muscle decrease

impaired effective cough

aging lungs become stiffer and less able to expand and contract

Question 2

Identify and describe the components of a comprehensive respiratory assessment

Answer 2

• Onset and symptoms of cough and SOB
• Vital signs
• Respiratory rate, rhythm and depth (shallow, normal or deep)
• use of accessory muscles
• patient’s position (tripod)
• airway, breathing, circulation
• O2 Saturation

Auscultation

• absence of breath sounds
• adventitious sound such as wheeze, crackles

Circulation

• skin condition
• cap refill
• chest expansion
• fremitus

Question 3

Identify manifestation of pneumonia

Answer 3

• Vary, depending on age
• fever, malaise, chills
• rust colored sputum
• decreased air entry
• pleuritic pain
• elderly may not have temp change, loss of appetite, change in mental status

Question 4

Identify the diagnostic assessments for pneumonia

Answer 4

Chest X-rays to confirm the presence of pneumonia and the extend and location f the infection

Blood tests to confirm the presence of infection and to identify the type of organism causing the infection. And to rule out bacteremia

Sputum test to confirm the type of organism

CBC and Diff may show an elevated of white blood count indicating the presence of an infection

Question 5

Describe the pharmacological treatment of pneumonia

Answer 5

Antibiotic or antiviral medication

Cefuroxime -effective for COPD and those who had antibiotics in the past
MOA - binds to bacterial cell wall, causing cell death
AE - allergy, liver and kidney function

Azithromycin
MOA - inhibits protein synthesis at the level of the 50S bacterial ribosome
AE - liver and kidney function, hypersensitivity,

Question 6

Describe the nursing management of a person with pneumonia

Answer 6

• effective airway
• monitor respiratory status
• o2 supplementation
• position patient in comfortable position (high semi fowler
• create a comfortable environment
• hydrate
• LOC, signs of cyanosis
• assist patients in activities, physical tolerance