Case Study 1 Client Profile: Mrs. Harriet Is A 68-Year-Old W

Case Study 1client Profilemrs Harriet Is A 68 Year Old Woman Who Is A

Discuss additional assessment data that would help gain a more thorough understanding or Mrs. Harriet's symptoms.

Discuss the causes, pathophysiology, and symptoms of acute bronchitis.

Discuss the pathophysiology and causes of pneumonia in general.

Compare the defining characteristics of community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and viral pneumonia.

Discuss the factors that place Mrs. Harriet at greater risk for the development of pneumonia.

Mrs. Harriet asks the nurse to explain what the HCP saw on her chest X-ray. She asks, "The doctor said something about a 'trate' he saw on my lung, What did he mean by that?" How would the nurse explain what an infiltrate is?

Briefly explain the pathophysiology and identify at least five clinical manifestations of the respiratory diagnosis that is being ruled out for Mrs. Harriet by administering the Mantoux test.

While awaiting test results to confirm if Mrs. Harriet has TB, what precautions should be taken when assigning her to a room and providing nursing care?

Discuss the measurement of induration that would indicate a positive Mantoux test for Mrs. Harriet. If she tested positive for exposure to TB but did not have assessment findings consistent with active disease, what medication could be prescribed, and what is the benefit of this treatment?

The nurse asked Mrs. Harriet if she has been using her incentive spirometer. Mrs. Harriet states, "I tried to use it a couple of times but I think it is broken. When I blow into it, the ball does not go up like I was told it should." How should the nurse intervene?

Briefly discuss the significance of each of the following laboratory results: (a) WBC 12,200 (b) 72% seg neutrophils, (c) left shift of 11% bands, (d) BNP 50.9 (e) results of sputum culture show S. pneumoniae, (f) CPK WNL, (g) CPK-MB WNL, and (h) troponin WNL.

Analyze Mrs. Harriet's ABG results. Determine whether each value is high/low or within normal limits: interpret the acid-base balance; determine if there is compensation, and indicate whether the client has hypoxemia.

The nurse calls the HCP to request a change in the medications that have been prescribed for Mrs. Harriet. Discuss which medication the nurse is concerned about being unsafe for this client.

Provide a rationale for each of the following prescribed components of Mrs. Harriet's treatment plan: oxygen to keep the client's oxygen saturation ≥95%, Ceftriaxone sodium, Albuterol, Acetaminophen, bed rest, 1800 calorie diet, increased oral fluid intake to 2-4 liters/day, coughing and deep breathing exercises, and use of the incentive spirometer (IS).

Mrs. Harriet was taking Dextromethorphan at home to help manage her cough. The HCP did not prescribe continued use of the Dextromethorphan during hospitalization. Explain this omission.

If it was learned that Mrs. Harriet has a past medical history of COPD, how would the HCP's prescription that oxygen is delivered to keep the client's oxygen saturation ≥95% be changed?

Identify three priority nursing diagnoses that should be included in Mrs. Harriet's plan of care.

You are the nurse providing discharge teaching to Mrs. Harriet. Briefly discuss what you will recommend to her regarding seeking follow-up care, lifestyle considerations, and how to help prevent pneumonia in the future.

Paper For Above instruction

Mrs. Harriet's case highlights the complex nature of respiratory illnesses, including pneumonia and acute bronchitis, particularly in elderly patients with comorbid conditions. A thorough assessment considers not only symptoms and vital signs but also additional data that could illuminate her clinical picture more clearly. For example, obtaining a detailed history of her recent exposures, prior respiratory infections, smoking history, medication adherence, and previous hospitalizations can help refine diagnosis and management strategies. Observing her overall respiratory effort, assessing for signs of cyanosis, use of accessory muscles, and auscultation findings such as wheezes or rhonchi can further detail her pulmonary status. Additionally, measuring her functional status, nutritional state, and checking for comorbid conditions like COPD or heart failure are essential.

Acute bronchitis typically results from viral infections, but bacterial pathogens can also cause it. It is characterized by inflammation of the bronchi, leading to cough, sputum production, and sometimes wheezing. The pathophysiology involves infection-triggered inflammation causing increased mucus production, airway narrowing, and impaired airflow. Symptoms include cough lasting more than five days, exporatory wheezes, chest discomfort, malaise, and low-grade fever. Pathogenic viruses such as influenza, parainfluenza, and adenoviruses are common etiologic agents. When bacteria are involved, similar symptoms are present, but with a higher likelihood of purulent sputum and elevated WBCs.

Pneumonia, whether community-acquired, hospital-acquired, or viral, involves infection-induced inflammation of the pulmonary parenchyma. The causes vary: bacteria like Streptococcus pneumoniae are predominant in CAP, whereas HAP often involves multidrug-resistant organisms such as Pseudomonas or MRSA. Viral pneumonia is frequently caused by influenza viruses, respiratory syncytial virus, or coronaviruses. The bacteria reach the lungs via aspiration, inhalation of droplets, or hematogenous spread, leading to alveolar filling with exudate, consolidation, and impaired gas exchange. The immune response results in symptoms such as cough, fever, dyspnea, hypoxemia, and pleuritic chest pain.

Distinguishing features exist among types of pneumonia. Community-acquired pneumonia (CAP) occurs outside hospital settings, often presenting suddenly with cough, fever, pleuritic chest pain, and lobar consolidation on imaging. Hospital-acquired pneumonia (HAP) develops 48 hours or more after admission, often involving resistant organisms and requiring different antibiotic approaches. Viral pneumonia, characterized by diffuse infiltrates and less productive cough, may be accompanied by systemic viral symptoms such as myalgia and malaise. The management approach depends on the setting, etiology, and severity of illness.

Factors increasing Mrs. Harriet's pneumonia risk include advanced age, obesity, reduced immune response, comorbidities such as cardiovascular disease, and smoking history. Her decreased mobility and possible impaired airway clearance due to excess mucus production further elevate her risk. Central cyanosis and diminished lung sounds indicate significant ventilation-perfusion mismatch, which worsens her prognosis without prompt intervention.

Explaining an infiltrate to Mrs. Harriet involves describing it as an area on her lung image where normal air-filled spaces are replaced with fluid, pus, or other material due to infection or inflammation. This appears as a cloudy or opaque region on the chest X-ray, indicating an area of lung consolidation. Such infiltrates typically signify pneumonia or other inflammatory processes within the lung tissue.

The Mantoux test assesses for latent TB infection by measuring the induration (swelling) at the injection site 48-72 hours after administration. A positive test indicates prior exposure to TB bacteria, not necessarily active disease. Clinical manifestations that the test helps rule out include persistent cough, hemoptysis, weight loss, night sweats, and fever—symptoms of active TB. An induration of ≥15 mm in a healthy individual typically signifies significant exposure, warranting further diagnostic evaluation and possible prophylactic therapy.

If Mrs. Harriet tests positive for TB exposure but shows no active symptoms, medications like Isoniazid can be prescribed as chemoprophylaxis. The benefit of this treatment is the prevention of reactivation of latent infection into active TB disease, thereby reducing transmission risk and protecting her lung health.

Regarding her incentive spirometer use, the nurse should first verify whether the device is indeed malfunctioning or if Mrs. Harriet is not performing the technique correctly. Demonstrating proper use again, troubleshooting the device (checking for blockages or damage), and providing encouragement or alternative methods to ensure adequate lung expansion are essential. Ensuring she understands the purpose and proper technique can improve compliance and respiratory function.

Laboratory results provide insight into her infection and cardiac status. Elevated WBC indicates infection or inflammation. A neutrophil percentage of 72% with a left shift of bands suggests an acute bacterial infection, consistent with pneumonia. A BNP of 50.9 pg/mL, within normal limits, suggests no significant heart failure. The sputum culture revealing Streptococcus pneumoniae indicates the causative bacterial pathogen, guiding targeted antibiotic therapy. Normal CK, CK-MB, and troponin levels are reassuring, indicating no myocardial injury.

Analysis of her ABG results shows a pH of 7.44, indicating slight alkalosis; PaCO2 at 39 mmHg, within normal limits; bicarbonate of 26.9 mEq/L, also normal, indicating no immediate acid-base disturbance. Her PaO2 is 58 mmHg, which demonstrates hypoxemia, despite oxygen therapy. The overall picture suggests respiratory alkalosis with hypoxemia, requiring supplemental oxygen and ventilatory support until gas exchange improves. The absence of compensation indicates her renal system has not yet adapted to this imbalance, consistent with an acute process.

Concern about medication safety involves reviewing potential drug interactions and adverse effects. For Mrs. Harriet, the main concern might be the use of erythromycin, which interacts with other medications and can cause QT prolongation, especially in older adults. Careful assessment of her medication list and renal function is necessary before administering antibiotics to avoid adverse reactions.

The prescribed treatments aim to stabilize her condition, prevent further hypoxia, and treat underlying infection. Oxygen therapy maintains adequate saturation, which is critical for tissue oxygenation. Ceftriaxone targets bacterial pneumonia effectively, given its broad-spectrum coverage, including Streptococcus pneumoniae. Albuterol relieves bronchospasm, improving airflow; acetaminophen alleviates fever and discomfort. Bed rest minimizes energy expenditure and promotes recovery. A high-calorie diet supports immune function and tissue repair. Increased oral fluids help thin mucus, facilitating clearance. Coughing and deep breathing exercises, along with incentive spirometry, prevent atelectasis, improve ventilation, and promote lung expansion.

The omission of Dextromethorphan during hospitalization is based on concerns that suppressing cough might impede airway clearance of mucus, risking accumulation and worsening infection. Also, nonproductive cough may be a sign of worsening respiratory status or adverse effects that need close monitoring.

If Mrs. Harriet has COPD, oxygen therapy needs careful titration. In COPD, overly high oxygen saturation targets (≥95%) can suppress her hypoxic drive to breathe, leading to CO2 retention and respiratory acidosis. In such cases, her oxygen saturation should be maintained around 88-92%, with close monitoring of arterial blood gases to prevent hypercapnia.

Prioritized nursing diagnoses include: impaired gas exchange related to alveolar-capillary membrane inflammation, risk for activity intolerance due to fatigue and dyspnea, and knowledge deficit regarding disease management and prevention of future respiratory infections. These focus on ensuring oxygenation, promoting rest and activity tolerance, and educating Mrs. Harriet to prevent recurrence.

Discharge teaching should emphasize the importance of follow-up care with her healthcare provider, smoking cessation if applicable, vaccination updates (pneumococcal and influenza), proper medication adherence, nutrition, hydration, and respiratory exercises. She should be advised to seek immediate care if symptoms worsen, such as increased dyspnea, chest pain, or new fevers. Lifestyle modifications like maintaining good hygiene, avoiding sick contacts, and managing comorbidities are vital for preventing future pneumonia episodes. Reinforcing the need for regular health screenings and vaccination schedules will help safeguard her lung health and enhance her quality of life.

References

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• American Lung Association. (2020). Pneumonia. Retrieved from https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia
• Marini, J. J., & Gattinoni, L. (2014). Management of Acute Respiratory Distress Syndrome. New England Journal of Medicine, 370(10), 856–868.
• McGraw-Hill Education. (2018). Pathophysiology, 6e. Elsevier.
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