Nursing Care Plan Rubric Case Study Chapter 23 Management

Nursing Care Plan Rubriccase Study Chapter 23 Management Of Patients

Assessing and managing patients with pneumonia, especially those with comorbidities such as emphysema, hypertension, and diabetes, requires a comprehensive understanding of the clinical presentation, diagnostic findings, and effective nursing interventions. This case study of Harry Smith, a 70-year-old male admitted with community-acquired pneumonia and underlying lung disease, exemplifies the complexity of respiratory care in older adults. The following discussion addresses core assessment findings, diagnostic support, formulated nursing diagnoses, patient goals, prioritized interventions with rationales, evaluation strategies, and medication considerations pertinent to managing such patients.

Paper For Above instruction

Introduction

Pneumonia remains a leading cause of morbidity and mortality, especially among older adults with pre-existing pulmonary conditions like emphysema. Effective nursing management hinges on thorough assessment, prompt intervention, and continuous evaluation to prevent deterioration. Harry Smith’s presentation illustrates typical symptoms and diagnostic clues that guide clinical decision-making.

Nursing Assessment Findings Supporting Pneumonia Diagnosis

The patient's clinical signs such as fever of 101.5°F, tachycardia (heart rate 101 bpm), tachypnea (respiratory rate 28 breaths/min), and hypoxemia (SpO₂ 85% on room air) suggest an infectious process affecting his respiratory system. His confusion is indicative of hypoxia and possible sepsis, common in elderly pneumonia patients. Auscultation reveals diminished breath sounds and absent sounds at the right base, consistent with consolidation. The weak cough and absence of sputum do not rule out pneumonia, especially in elderly or debilitated patients where sputum expectoration may be minimal.

Diagnostic Findings Supporting Pneumonia

Laboratory results like an elevated white blood cell count (12,500/mm³) indicate an immune response. ABG analysis showing pH 7.30 (acidotic), PaO₂ 55 mm Hg (hypoxemia), and PaCO₂ 50 mm Hg (hypercapnia) reflect respiratory compromise. Chest X-ray showing right lower lobe consolidation confirms pneumonia. Presence of apical bullae and flattened diaphragm relate to underlying emphysema, complicating respiratory function.

NANDA Nursing Diagnoses

• Impaired Gas Exchange related to alveolar-capillary membrane changes secondary to pneumonia
• Risk for Shock related to hypoxemia, hypotension, and systemic infection
• Impaired Breathing Pattern related to hypoxia and lung consolidation
• Impaired Verbal Communication related to fatigue and tachypnea

Prioritized Nursing Diagnoses

1. Impaired Gas Exchange
2. Impaired Breathing Pattern
3. Risk for Shock

Goals and Patient Planning

1. Goal for Impaired Gas Exchange: The patient will maintain SpO₂ > 92% with effective oxygen therapy within 24 hours.

2. Goal for Impaired Breathing Pattern: The patient will exhibit a manageable respiratory rate (

3. Goal for Risk for Shock: The patient will demonstrate stable blood pressure and tissue perfusion with no signs of deterioration during hospitalization.

Interventions and Rationales

1. For Impaired Gas Exchange

• Administer supplemental oxygen as prescribed to maintain adequate oxygenation.
• Monitor ABGs, SpO₂ continuously, and assess lung sounds regularly.
• Position patient in high Fowler’s position to facilitate lung expansion.

Rationale: Supplemental oxygen alleviates hypoxia by increasing arterial oxygen levels. Frequent assessments allow early detection of worsening hypoxia or hypercapnia. Fowler’s position promotes better ventilation and perfusion.

2. For Impaired Breathing Pattern

• Encourage coughing and deep breathing exercises to mobilize secretions and improve ventilation.
• Administer prescribed bronchodilators if indicated to reduce airway resistance.
• Assist with oxygen therapy to reduce work of breathing.

Rationale: Effective coughing removes secretions, reducing airway obstruction. Bronchodilators help open airways, decreasing respiratory effort. Oxygen support minimizes fatigue and prevents hypoxia-induced respiratory distress.

3. For Risk for Shock

• Monitor vital signs closely, especially blood pressure and heart rate.
• Assess skin color, temperature, and capillary refill regularly.
• Administer IV fluids as ordered to maintain perfusion.
• Identify early signs of sepsis or shock for prompt intervention.

Rationale: Early recognition of shock allows rapid intervention, preventing organ failure. Fluid resuscitation restores circulating volume, and vital sign monitoring guides ongoing treatment decisions.

Evaluation

The effectiveness of interventions is evaluated by improvements in oxygenation (SpO₂ > 92%), stabilization of respiratory rate, and absence of hypoxia signs. If goals are not met, interventions are reassessed, including adjusting oxygen therapy, reviewing medication effectiveness, and considering advanced airway management if necessary. Continuous patient monitoring allows modification of plans to optimize outcomes.

Medications: Categories, Usual Dosages, Side Effects, Patient Teaching

• Antibiotics: e.g., Amoxicillin-clavulanate 500 mg/125 mg three times daily. Side effects: Gastrointestinal upset, allergic reactions. Teaching: Complete course, report allergies, and observe for side effects.
• Bronchodilators: e.g., Albuterol inhaler 90 mcg every 4-6 hours as needed. Side effects: Tremors, tachycardia. Teaching: Use inhaler properly, monitor for side effects.
• Antipyretics/Analgesics: e.g., Acetaminophen 650 mg every 4-6 hours. Side effects: Liver toxicity. Teaching: Do not exceed recommended dose, inform about liver health.
• Steroids (if prescribed): e.g., Prednisone 40 mg daily. Side effects: Hyperglycemia, fluid retention. Teaching: Monitor blood glucose, take with food.
• Supportive medications: as per specific patient needs, with monitoring for adverse effects.

Conclusion

Effective management of pneumonia in older adults with comorbidities involves comprehensive assessment, timely diagnostics, well-planned interventions, and patient education. Close monitoring ensures early detection of deterioration, while appropriate medication administration and supportive therapies optimize recovery. Interdisciplinary collaboration and continuous evaluation are essential for improving patient outcomes and preventing complications.

References

1. Hall, J. E., & Guyton, A. C. (2016). Textbook of Medical Physiology (13th Ed.). Elsevier.
2. Gabbay, R. A., & Laipply, R. S. (2019). Pharmacology for Nursing and Health Professions. Elsevier.
3. Lippincott Williams & Wilkins. (2014). Nursing Diagnosis Handbook. Lippincott Williams & Wilkins.
4. McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biological basis for disease in adults and children (8th Ed.). Elsevier.
5. Steinberg, J. (2022). Respiratory Disorders. In D. L. Hickey (Ed.), Advanced Critical Care Nursing Practice (pp. 245–268). Springer.
6. Mandell, L. A., et al. (2019). Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clinical Infectious Diseases, 63(5), e72–e139.
7. Gordon, C., et al. (2020). Pulmonary Nursing and Critical Care. Springer Publishing Company.
8. National Heart, Lung, and Blood Institute. (2021). Pulmonary Disorders. NIH.
9. UpToDate. (2023). Management of community-acquired pneumonia in adults. Retrieved from www.uptodate.com
10. American Lung Association. (2022). COPD Management Strategies. www.lung.org