Management of Patients With Chest and Lower Respiratory Tract Disorders (Case Study)

Management of Patients With Chest and Lower Respiratory Tract Disorders (Case Study)
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 101.5°F. The pulse oximeter on room
air is 85%. The CBC is as follows: WBC 12,500, platelets 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 increases 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. (Learning Objective 3)
What nursing assessment findings support the diagnosis of pneumonia?
What diagnostic findings support the diagnosis of pneumonia?
What NANDA nursing diagnoses should the nurse formulate for the patient?
What goals should the nurse develop for the patient?
What overall interventions should the nurse provide?
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 100°F, and her blood pressure is 90/50 mm Hg. She complains of
feeling anxious and having stabbing chest pain which gets worse with inspiration. She complains
that she feels like she is going to pass out or possibly die.
(Learning Objective 7)
What could possibly be going on with the patient and what measures should the nurse provide
immediately?
What risk factors does the patient have for a pulmonary embolus?
What measures are appropriate to manage a pulmonary embolism?
What measures are appropriate to help the patient in this case study prevent the reoccurrence of
a pulmonary embolism?