Student Pneumonia-COPD Fundamental Reasoning

Pneumonia-COPD
Joan Walker, 84 years old
Primary Concept
Gas Exchange
Interrelated Concepts (In order of emphasis)
1. Infection
2. Acid-Base Balance
3. Thermoregulation
4. Clinical Judgment
5. Pain
FUNDAMENTAL Reasoning: STUDENT
History of Present Problem:
Pneumonia-COPD
Joan Walker is an 84-year-old female who has had a productive cough of green phlegm that started four days ago that
persists. She was started three days ago on prednisone 40 mg PO daily and azithromycin (Zithromax) 250 mg PO x5 days
© 2016 Keith Rischer/www.KeithRN.com
by her clinic physician. Though she has had intermittent chills, she had a fever last night of 102.0 F/38.9 C. She has had
more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement
so she called 9-1-1 and was brought to the emergency department (ED) where you are the nurse who will be responsible
for her care.
Personal/Social History:
Joan was widowed six months ago after 64 years of marriage and resides in assisted living. She is a retired elementary
school teacher. She called her pastor before coming to the ED and he has now arrived and came back with the patient. The
nurse walked in the room when the pastor asked Joan if she would like to pray. The patient said to her pastor, “Yes please,
I feel that this may the beginning of the end for me!”
What data from the histories are RELEVANT and have clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
84 years old- elderly
ZithromaxPrednisoneFever of 102
Increased difficulty breathing
As people get older, their immune systems become less able to fight off
infection
With this medication, the infection should be beginning to fight off, an
temperatures would lower; there is a chance the doctor prescribed the
wrong medication for this infection
Prednisone is used to reduce inflammation, but at the same time, it can
decrease the immune system, therefore increasing the risk of infection
Fever is a good indicator of infection or inflammation
Patient is having a hard time breathing, it is important to monitor her
oxygen saturation and ABG to determine if she is having enough tissue
perfusion
RELEVANT Data from Social History: Clinical Significance:
Widowed
Stated “this is the beginning of the end”
Stress hormones can cause physiological changes to the body; some of
these changes can cause a weakened immune system
Sometimes patient can identify that there is indeed something wrong with
them, it is important to take these statements seriously; also this is a sign
that the patient may be giving up or feeling depressed

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