ETOH Withdrawal-Pneumonia
UNFOLDING Reasoning Case Study 2022-
2023.
Elena Acosta, 54 years old
Primary Concept
Addiction
Interrelated Concepts (In order of emph
• Infection
• Intracranial Regulation
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items
Category/Subcat
Safe and Effective Care Environment
• Management of Care 17-23%
• Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
• Basic Care and Comfort 6-12%
• Pharmacological and Parenteral Therapies 12-18%
1
,• Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
History of Present Problem:
Elena Acosta is a 54-yr. old Hispanic woman with hypertension managed with
hydrochlorothiazide. She is 63” (160.2 cm) and weighs 175 pounds (79.3 kg-BMI
31.0). She felt “crummy” and weaker the last 24 hours and called 911 when she
began to have mid-sternal chest pain that increased with coughing and developed
a harsh productive cough with green phlegm with difficulty breathing.
Initial lab results: WBC 14.5, neutrophils 92%, Hgb 12.9, potassium 3.5,
creatinine 1.1, total bili 0.9, ALT 42, chest xray revealed RLL infiltrate consistent
with pneumonia, blood and sputum cultures collected and pending. Smell of
ETOH present on her breath. Blood alcohol level 0.04, urine drug screen negative.
She is admitted to the medical unit with a diagnosis of pneumonia. You are the
nurse responsible for her care.
Personal/Social History:
Ms. Acosta works in a mid-level management position for a corporate finance
company. She describes her job as quite stressful. She drinks 4-5 cups of coffee
every day and to least 1-2 alcoholic drinks most days. She states that she
shouldn’t smoke and has cut down to about ½ a pack per day. She reports
drinking more and sleeping poorly following her father’s death over a year ago.
She takes alprazolam as needed for sleep or when she feels more anxious. She is
hesitant to be admitted because she has a high deductible insurance plan and
doesn’t know how she will be able to afford it.
1. What data from the histories are RELEVANT and have clinical significance to the
nurse? (Reduction of Risk Potential) (worth 5 points)
RELEVANT Data from Present Problem: Clinical Significance:
-Hypertension -Hypertension puts the patient at risk for many other conditio
such as
-BMI 31 MI and Stroke.
-Mid-sternal chest pain -Being overweight put the patient at greater risk for
multiple health -Harsh productive cough with green phlegm conditions. It also
can prevent the lungs form fully expanding. -Blood alcohol level -Mid-sternal
2
, chest pain is likely caused by the pneumonia but an ECG -RLL
infiltrate/diagnosis of pneumonia will be needed to rule out any cardiac
causes.
-WBC 14.5 and Neutrophil 92% -A harsh productive cough with green phlegm
indicates an infection is present in the lungs.
-Blood alcohol level of 0.04 indicates the patient
has had a drink recently. The patient should be
assessed for alcohol addiction.
-Right lower lobe infiltration indicates this area of
the lungs is filled with fluid and is infected.
-An increased WBC count indicates an infection is
present. Neutrophils are the body’s first line of
defense against an acute infection and elevated
levels further indicate the presents of an
infection.
RELEVANT Data from Social History: Clinical Significance:
-Stressful job health problems. - Frequent alcohol
-1-2 alcoholic drinks consumption can weaken the immune system,
most days decrease absorption of nutrients, and cause
-1/2 pack per day liver damage. Also indicates patient has
smoker unhealthy coping mechanisms.
-Sleeping poorly - Smoking weakens the lungs and impairs the
-High deductable lungs natural defenses against infections.
-Constant increased -Impaired sleeping is likely due to stress and can
stress can lead to an lead to cognitive impairment and weakened
impaired immune immunity.
system, -A high deductible could have delayed the
cardiovascular patient in seeking medical attention. This will
diseases, and mental also increase the patient’s stress levels.
Patient Care Begins: Initial Assessment Medical Unit
Current VS: P-Q-R-S-T Pain Assessment:
T: 101.2 F/38.4 C (oral) Provoking/Palliative: nothing
3
UNFOLDING Reasoning Case Study 2022-
2023.
Elena Acosta, 54 years old
Primary Concept
Addiction
Interrelated Concepts (In order of emph
• Infection
• Intracranial Regulation
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items
Category/Subcat
Safe and Effective Care Environment
• Management of Care 17-23%
• Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
• Basic Care and Comfort 6-12%
• Pharmacological and Parenteral Therapies 12-18%
1
,• Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
History of Present Problem:
Elena Acosta is a 54-yr. old Hispanic woman with hypertension managed with
hydrochlorothiazide. She is 63” (160.2 cm) and weighs 175 pounds (79.3 kg-BMI
31.0). She felt “crummy” and weaker the last 24 hours and called 911 when she
began to have mid-sternal chest pain that increased with coughing and developed
a harsh productive cough with green phlegm with difficulty breathing.
Initial lab results: WBC 14.5, neutrophils 92%, Hgb 12.9, potassium 3.5,
creatinine 1.1, total bili 0.9, ALT 42, chest xray revealed RLL infiltrate consistent
with pneumonia, blood and sputum cultures collected and pending. Smell of
ETOH present on her breath. Blood alcohol level 0.04, urine drug screen negative.
She is admitted to the medical unit with a diagnosis of pneumonia. You are the
nurse responsible for her care.
Personal/Social History:
Ms. Acosta works in a mid-level management position for a corporate finance
company. She describes her job as quite stressful. She drinks 4-5 cups of coffee
every day and to least 1-2 alcoholic drinks most days. She states that she
shouldn’t smoke and has cut down to about ½ a pack per day. She reports
drinking more and sleeping poorly following her father’s death over a year ago.
She takes alprazolam as needed for sleep or when she feels more anxious. She is
hesitant to be admitted because she has a high deductible insurance plan and
doesn’t know how she will be able to afford it.
1. What data from the histories are RELEVANT and have clinical significance to the
nurse? (Reduction of Risk Potential) (worth 5 points)
RELEVANT Data from Present Problem: Clinical Significance:
-Hypertension -Hypertension puts the patient at risk for many other conditio
such as
-BMI 31 MI and Stroke.
-Mid-sternal chest pain -Being overweight put the patient at greater risk for
multiple health -Harsh productive cough with green phlegm conditions. It also
can prevent the lungs form fully expanding. -Blood alcohol level -Mid-sternal
2
, chest pain is likely caused by the pneumonia but an ECG -RLL
infiltrate/diagnosis of pneumonia will be needed to rule out any cardiac
causes.
-WBC 14.5 and Neutrophil 92% -A harsh productive cough with green phlegm
indicates an infection is present in the lungs.
-Blood alcohol level of 0.04 indicates the patient
has had a drink recently. The patient should be
assessed for alcohol addiction.
-Right lower lobe infiltration indicates this area of
the lungs is filled with fluid and is infected.
-An increased WBC count indicates an infection is
present. Neutrophils are the body’s first line of
defense against an acute infection and elevated
levels further indicate the presents of an
infection.
RELEVANT Data from Social History: Clinical Significance:
-Stressful job health problems. - Frequent alcohol
-1-2 alcoholic drinks consumption can weaken the immune system,
most days decrease absorption of nutrients, and cause
-1/2 pack per day liver damage. Also indicates patient has
smoker unhealthy coping mechanisms.
-Sleeping poorly - Smoking weakens the lungs and impairs the
-High deductable lungs natural defenses against infections.
-Constant increased -Impaired sleeping is likely due to stress and can
stress can lead to an lead to cognitive impairment and weakened
impaired immune immunity.
system, -A high deductible could have delayed the
cardiovascular patient in seeking medical attention. This will
diseases, and mental also increase the patient’s stress levels.
Patient Care Begins: Initial Assessment Medical Unit
Current VS: P-Q-R-S-T Pain Assessment:
T: 101.2 F/38.4 C (oral) Provoking/Palliative: nothing
3
