Airway/Breathing (Gas Exchange)
Case Study JoAnn Walker, 84 years old
Pneumonia/Chronic Obstructive Pulmonary Disease
Clinical Reasoning Case Study
Case Study 1
JoAnn Walker, 84 years old
Overview
This case study incorporates a common presentation seen by the nurse in clinical practice:
Community acquired pneumonia with a history of COPD
Concepts
Gas Exchange
Infection
Acid-Base Balance
Thermoregulation
Clinical Judgment
Pain
TB/2018
, Pneumonia-COPD I. Data Collection
History of Present Problem:
JoAnn Walker is an 84-year-old female who has had a productive cough of green phlegm 4 days ago, that continues to
persist. She was started 3 days ago on prednisone 60 mg po daily and azithromycin (Zithromax) 250 mg po x5 days by her
clinic physician. Though she has had intermittent chills, she first noticed a fever last night of 102.0. She has had more
difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement.
Therefore, she called 9-1-1 and arrives at the emergency department (ED) by emergency medical services (EMS) where
you are the nurse who will be responsible for her care.
Personal/Social History:
JoAnn was widowed 6 months ago after 64 years of marriage and resides in assisted living. She is a retired elementary
school teacher. She called her pastor 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, “Yes, this may the beginning of the end for
me.”
Data
Radiology Reports:
Results: Clinical Significance:
Left lower lobe infiltrate. There is a build up of fluid in the patients lung fields
Hypoventilation present Hypoventilation in both lung fields
in both lung fields Possible pneumonia
Laboratory Values
Basic Metabolic Panel (BMP :) Current: High/Low/WNL? Clinical Significance:
Sodium (135-145 mEq/L) 138 Normal
Potassium (3.5-5.0 mEq/L) 5.1 Infection
Chloride (95-105 mEq/L) 98 Normal
CO2 (Bicarb) (21-31 mmol/L) 35 Metabolic alkalosis
Glucose (70-110 mg/dL) 112 Corticosteroid use
Calcium (8.4-10.2 mg/dL) 8.9 Normal
BUN (7 - 25 mg/dl) 32 HR/Sepsis
Creatinine (0.6-1.2 mg/dL) 1.2 Normal
BNP (B-natriuretic Peptide) (<100 97 Normal
ng/L)
Complete Blood Count (CBC :) Current: High/Low/WNL?
WBC (4.5-11.0 mm 3) 14.5 Infection
Hgb (12-16 g/dL) 13.3 Normal
Platelets(150-450x 103/µl) 217 Normal
Neutrophil % (42-72) 92 Prednisone use
Band forms (3-5%) 5 Normal
TB/2018
Case Study JoAnn Walker, 84 years old
Pneumonia/Chronic Obstructive Pulmonary Disease
Clinical Reasoning Case Study
Case Study 1
JoAnn Walker, 84 years old
Overview
This case study incorporates a common presentation seen by the nurse in clinical practice:
Community acquired pneumonia with a history of COPD
Concepts
Gas Exchange
Infection
Acid-Base Balance
Thermoregulation
Clinical Judgment
Pain
TB/2018
, Pneumonia-COPD I. Data Collection
History of Present Problem:
JoAnn Walker is an 84-year-old female who has had a productive cough of green phlegm 4 days ago, that continues to
persist. She was started 3 days ago on prednisone 60 mg po daily and azithromycin (Zithromax) 250 mg po x5 days by her
clinic physician. Though she has had intermittent chills, she first noticed a fever last night of 102.0. She has had more
difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement.
Therefore, she called 9-1-1 and arrives at the emergency department (ED) by emergency medical services (EMS) where
you are the nurse who will be responsible for her care.
Personal/Social History:
JoAnn was widowed 6 months ago after 64 years of marriage and resides in assisted living. She is a retired elementary
school teacher. She called her pastor 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, “Yes, this may the beginning of the end for
me.”
Data
Radiology Reports:
Results: Clinical Significance:
Left lower lobe infiltrate. There is a build up of fluid in the patients lung fields
Hypoventilation present Hypoventilation in both lung fields
in both lung fields Possible pneumonia
Laboratory Values
Basic Metabolic Panel (BMP :) Current: High/Low/WNL? Clinical Significance:
Sodium (135-145 mEq/L) 138 Normal
Potassium (3.5-5.0 mEq/L) 5.1 Infection
Chloride (95-105 mEq/L) 98 Normal
CO2 (Bicarb) (21-31 mmol/L) 35 Metabolic alkalosis
Glucose (70-110 mg/dL) 112 Corticosteroid use
Calcium (8.4-10.2 mg/dL) 8.9 Normal
BUN (7 - 25 mg/dl) 32 HR/Sepsis
Creatinine (0.6-1.2 mg/dL) 1.2 Normal
BNP (B-natriuretic Peptide) (<100 97 Normal
ng/L)
Complete Blood Count (CBC :) Current: High/Low/WNL?
WBC (4.5-11.0 mm 3) 14.5 Infection
Hgb (12-16 g/dL) 13.3 Normal
Platelets(150-450x 103/µl) 217 Normal
Neutrophil % (42-72) 92 Prednisone use
Band forms (3-5%) 5 Normal
TB/2018
