Pneumonia
Introduction
In this unfolding case study that simulates the complexities of clinical practice, you will assume the role of a nurse in an emergency
department or level 3 trauma center. You will use a holistic approach to provide safe care by making correct clinical judgments for a
patient with pneumonia or respiratory concerns. You will need to apply essential knowledge to notice and interpret the most crucial
assessment findings and lab values to properly establish care priorities and recognize a developing complication before it needlessly
progresses.
_____________________________________________________________________________________
Preparation for Care Activity
Recognizing Clinical Relationships
Review the medical history and home medications of this patient. For each home medication, identify the pharm. classification and
expected outcome for this patient, and its most common side effect (SE). Finally, draw a line to determine which medication treats
what condition.
Medical History Home Medication Pharm Expected Outcome Common Side Effects (SE)
Classification
• COPD/asthma Fluticasone/salmeterol
• Hypertension diskus 250/50 mcg 1 puff
• Hyperlipidemia every 12 hours
• Cor-pulmonale
• Anxiety Albuterol MDI 2 puffs
• 1ppd smoker x40 every 4 hours prn
years; quit 10 years
ago Lisinopril 10 mg PO daily
Atorvastatin 40 mg PO
daily
Escitalopram10 mg PO
daily
HCTZ 12.5 mg PO daily
Part I: Developing Noticing and Interpreting Skills
Present Problem
Debbie Ryan is a 69-year-old female with a persistent productive cough with green phlegm that started four days ago. She was
started on prednisone 40 mg PO daily, Augmentin XR 2000 mg 1 PO BID, and azithromycin 500 mg PO on day one, then 250 mg PO
daily after that by her primary care provider. Though she has had intermittent chills, she had a fever of 102.0 F/38.9 C last night. She
has had more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement.
Hence, 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
Debbie is a retired convenience store manager. She is also the primary care provider for her 13-year-old grandson with severe
autism. Her grandson is 250 pounds and has a violent temper at times. Due to his behavior, she has trouble finding anyone to watch
him. She is hoping to get some different antibiotics. She insists that she must be home by the time he gets off the school bus at 3:30
This study source was downloaded by 100000898960505 from CourseHero.com on 05-15-2025 20:19:54 GMT -05:00
https://www.coursehero.com/file/235546679/UNRS-107-PNA-Case-Studydocx/
, pm. Debbie appears very anxious. She tells you her husband died of pneumonia three years ago. A family friend works as a hospital
chaplain at this facility. She wondered if someone could call him and ask if he could come to say a prayer with her for a speedy
recovery.
Contextual Factors
You are a new nurse in a Level III trauma center. You completed your 12-week new employee orientation two weeks ago. You are
working one nurse short, and it is already 1:30 pm. The patient typically seeks primary care at a local Indian Health Center Clinic. The
only medical records available for review are from Debbie's ED visit two years ago when she was evaluated for a syncopal episode.
1. Which findings from the present problem are most important and noticed by the nurse as clinically significant?
Most Important Findings Clinical Significance
2. Which data from the social history is most important and noticed by the nurse as clinically significant?
Most Important Findings Clinical Significance
3. Which findings from the contextual factors are most important and noticed by the nurse as clinically significant?
Most Important Findings Clinical Significance
Patient Care Begins
Temperature Heart Rate Blood Pressure Respirations SpO2 MAP
39.6 C 110 178/96 30/min on 6L NC 86% 123
5. Which current vital sign findings are most important and noticed by the nurse as clinically significant?
Most Important Data Clinical Significance
Current Assessment:
This study source was downloaded by 100000898960505 from CourseHero.com on 05-15-2025 20:19:54 GMT -05:00
https://www.coursehero.com/file/235546679/UNRS-107-PNA-Case-Studydocx/
Introduction
In this unfolding case study that simulates the complexities of clinical practice, you will assume the role of a nurse in an emergency
department or level 3 trauma center. You will use a holistic approach to provide safe care by making correct clinical judgments for a
patient with pneumonia or respiratory concerns. You will need to apply essential knowledge to notice and interpret the most crucial
assessment findings and lab values to properly establish care priorities and recognize a developing complication before it needlessly
progresses.
_____________________________________________________________________________________
Preparation for Care Activity
Recognizing Clinical Relationships
Review the medical history and home medications of this patient. For each home medication, identify the pharm. classification and
expected outcome for this patient, and its most common side effect (SE). Finally, draw a line to determine which medication treats
what condition.
Medical History Home Medication Pharm Expected Outcome Common Side Effects (SE)
Classification
• COPD/asthma Fluticasone/salmeterol
• Hypertension diskus 250/50 mcg 1 puff
• Hyperlipidemia every 12 hours
• Cor-pulmonale
• Anxiety Albuterol MDI 2 puffs
• 1ppd smoker x40 every 4 hours prn
years; quit 10 years
ago Lisinopril 10 mg PO daily
Atorvastatin 40 mg PO
daily
Escitalopram10 mg PO
daily
HCTZ 12.5 mg PO daily
Part I: Developing Noticing and Interpreting Skills
Present Problem
Debbie Ryan is a 69-year-old female with a persistent productive cough with green phlegm that started four days ago. She was
started on prednisone 40 mg PO daily, Augmentin XR 2000 mg 1 PO BID, and azithromycin 500 mg PO on day one, then 250 mg PO
daily after that by her primary care provider. Though she has had intermittent chills, she had a fever of 102.0 F/38.9 C last night. She
has had more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement.
Hence, 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
Debbie is a retired convenience store manager. She is also the primary care provider for her 13-year-old grandson with severe
autism. Her grandson is 250 pounds and has a violent temper at times. Due to his behavior, she has trouble finding anyone to watch
him. She is hoping to get some different antibiotics. She insists that she must be home by the time he gets off the school bus at 3:30
This study source was downloaded by 100000898960505 from CourseHero.com on 05-15-2025 20:19:54 GMT -05:00
https://www.coursehero.com/file/235546679/UNRS-107-PNA-Case-Studydocx/
, pm. Debbie appears very anxious. She tells you her husband died of pneumonia three years ago. A family friend works as a hospital
chaplain at this facility. She wondered if someone could call him and ask if he could come to say a prayer with her for a speedy
recovery.
Contextual Factors
You are a new nurse in a Level III trauma center. You completed your 12-week new employee orientation two weeks ago. You are
working one nurse short, and it is already 1:30 pm. The patient typically seeks primary care at a local Indian Health Center Clinic. The
only medical records available for review are from Debbie's ED visit two years ago when she was evaluated for a syncopal episode.
1. Which findings from the present problem are most important and noticed by the nurse as clinically significant?
Most Important Findings Clinical Significance
2. Which data from the social history is most important and noticed by the nurse as clinically significant?
Most Important Findings Clinical Significance
3. Which findings from the contextual factors are most important and noticed by the nurse as clinically significant?
Most Important Findings Clinical Significance
Patient Care Begins
Temperature Heart Rate Blood Pressure Respirations SpO2 MAP
39.6 C 110 178/96 30/min on 6L NC 86% 123
5. Which current vital sign findings are most important and noticed by the nurse as clinically significant?
Most Important Data Clinical Significance
Current Assessment:
This study source was downloaded by 100000898960505 from CourseHero.com on 05-15-2025 20:19:54 GMT -05:00
https://www.coursehero.com/file/235546679/UNRS-107-PNA-Case-Studydocx/
