Pneumonia Case Study
Nursing 380
Meet Aunt Lydia
PART 1
Aunt Lydia is brought to the emergency room from Gilead Skilled Nursing Facility by the
paramedics. She is complaining of severe dyspnea and shortness of breath. She has been
experiencing cold-like symptoms for the past 2 days and has been lying in bed continually. She
has a productive cough with thick greenish sputum. When Aunt Lydia woke up, she was short of
breath, even after using her albuterol metered-dose inhaler (MDI). She appears very anxious and
confused. A CXR, labs, a blood culture, a sputum for culture and sensitivity are ordered.
HISTORY
Aunt Lydia is 71 years old. Her history includes chronic obstructive pulmonary disease (COPD)
related to smoking 2 packs of cigarettes per day since she was 15 years old. She has been
incontinent of stool and urine for the past 2 years. She takes high dose oral estrogen for
menopausal symptoms. Her pneumonia and flu vaccinations are not up-to-date because Aunt
Lydia does not trust the U.S. government and believes vaccinations are a scam.
VITAL SIGNS
BP 154/90
HR 108
RR 24
Pulse ox 94%
Temp 101.8F
ASSESSMENT DATA:
Clubbing of fingers S3 heart sound Crackles in all lobes
Fatigued in the afternoon Tenting of skin Wet undergarments
Pale mucous membranes 1+ edema Dark yellow urine
1
Pc 1.19
, 1. When assessing Aunt Lydia, which one of the six assessments, listed above requires
your immediate intervention? Why?
Pulse ox of 94%This is an indication of hypoxia. She is not getting enough oxygen in
through her lungs.
2. What are four possible priority interventions for the problem you selected?
You can administer oxygen, sit her up in high fowler’s position, you can help her cough
up secretions, and you can offer her suctioning of her phlegm.
3. Calculate the number of pack years Aunt Lydia has been smoking.
The number of pack years for A. Lydia is: 56 (years smoking) x Packs/day (2) = 112pack
years.
4. Which of the following duties can be delegated to CNA to assist with Aunt Lydia’s
care?
First: Select all that apply.
Second: Circle ONE intervention priority intervention (a-e) that should be
done right away.
a. Raise head of bed up to promote lung expansion
Record pulse ox
c. Assess level of consciousness
d. Auscultate lung sounds
. Change clothing
5. What is the CDC’s current recommendation of when pneumonia and influenza
vaccinations should be given to an 88-year-old?
The CDC recommends getting these two shots at the same time that your provider
recommends.
6. Is confusion a common or uncommon symptoms of pneumonia in an older adult?
Confusion is very common in older adults as a sign of hypoxia and pain.
7. Organize these common pathophysiologic stages of pneumonia in order. Number
the first stage with 1 and the last stage with 4:
4. a. Macrophages lyse the debris and normal lung tissue and function is restored
3. b. Mucous production increases and can obstruct airflow and further decrease gas
exchange.
1.c. Inflammatory response in the lungs with neutrophils is activated to engulf and kill
the offending organism.
2. d. Increased capillary permeability contributes to alveolar filling with organisms and
neutrophils leading to hypoxia.
PART 2
2
Pc 1.19
Nursing 380
Meet Aunt Lydia
PART 1
Aunt Lydia is brought to the emergency room from Gilead Skilled Nursing Facility by the
paramedics. She is complaining of severe dyspnea and shortness of breath. She has been
experiencing cold-like symptoms for the past 2 days and has been lying in bed continually. She
has a productive cough with thick greenish sputum. When Aunt Lydia woke up, she was short of
breath, even after using her albuterol metered-dose inhaler (MDI). She appears very anxious and
confused. A CXR, labs, a blood culture, a sputum for culture and sensitivity are ordered.
HISTORY
Aunt Lydia is 71 years old. Her history includes chronic obstructive pulmonary disease (COPD)
related to smoking 2 packs of cigarettes per day since she was 15 years old. She has been
incontinent of stool and urine for the past 2 years. She takes high dose oral estrogen for
menopausal symptoms. Her pneumonia and flu vaccinations are not up-to-date because Aunt
Lydia does not trust the U.S. government and believes vaccinations are a scam.
VITAL SIGNS
BP 154/90
HR 108
RR 24
Pulse ox 94%
Temp 101.8F
ASSESSMENT DATA:
Clubbing of fingers S3 heart sound Crackles in all lobes
Fatigued in the afternoon Tenting of skin Wet undergarments
Pale mucous membranes 1+ edema Dark yellow urine
1
Pc 1.19
, 1. When assessing Aunt Lydia, which one of the six assessments, listed above requires
your immediate intervention? Why?
Pulse ox of 94%This is an indication of hypoxia. She is not getting enough oxygen in
through her lungs.
2. What are four possible priority interventions for the problem you selected?
You can administer oxygen, sit her up in high fowler’s position, you can help her cough
up secretions, and you can offer her suctioning of her phlegm.
3. Calculate the number of pack years Aunt Lydia has been smoking.
The number of pack years for A. Lydia is: 56 (years smoking) x Packs/day (2) = 112pack
years.
4. Which of the following duties can be delegated to CNA to assist with Aunt Lydia’s
care?
First: Select all that apply.
Second: Circle ONE intervention priority intervention (a-e) that should be
done right away.
a. Raise head of bed up to promote lung expansion
Record pulse ox
c. Assess level of consciousness
d. Auscultate lung sounds
. Change clothing
5. What is the CDC’s current recommendation of when pneumonia and influenza
vaccinations should be given to an 88-year-old?
The CDC recommends getting these two shots at the same time that your provider
recommends.
6. Is confusion a common or uncommon symptoms of pneumonia in an older adult?
Confusion is very common in older adults as a sign of hypoxia and pain.
7. Organize these common pathophysiologic stages of pneumonia in order. Number
the first stage with 1 and the last stage with 4:
4. a. Macrophages lyse the debris and normal lung tissue and function is restored
3. b. Mucous production increases and can obstruct airflow and further decrease gas
exchange.
1.c. Inflammatory response in the lungs with neutrophils is activated to engulf and kill
the offending organism.
2. d. Increased capillary permeability contributes to alveolar filling with organisms and
neutrophils leading to hypoxia.
PART 2
2
Pc 1.19
