Case Study : Adult Geriatric Pneumonia

Mr. HS is a 78-year-old retired male, who presented to the emergency room at Northeast Methodist Hospital initially on February 11, 2011, with complaints of shortness of breath and coughing. He was diagnosed as having a COPD Exacerbation and was placed on antibiotic therapy and was released home. He was also advised at that time to complete the entire course of antibiotics and return to his primary treating physician if his condition did not improve.

EH is a 68-year-old male who comes into the clinic complaining of a fever with a temperature of 103 °F. He has had a cough for the last three days that is producing some thick green brown mucous. The MD feels he most likely has bacterial pneumonia. He also has a history of having rheumatoid arthritis, and being immune compromised as he is on an immunosuppressant methotrexate. He has noted that over the last year he has lost weight unintentionally and feels he is underweight.

Jane’s asthma was acute severe. Initially to alleviate some of Jane’s breathlessness she was sat up right in the bed and supported with pillows to improve air entry. Due to her low oxygen saturations she was placed on 40% oxygen via Hudson mask (BTS 2006), as Jane was mouth breathing the mask was the appropriate device to use to ensure adequate oxygenation (Walsh 2002). According to Inwald et al (2001) hypoxemia is frequently a primary cause in numerous asthma related deaths. By administering oxygen promptly, for acute severe asthma, serious hypoxemia

D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years. He has had pneumonia yearly for the past 3 years, and has been a 2-pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is an acute

This paper explores Pneumonia and the respiratory disease process associated with bacterial and viral pathogens most commonly located in the lung. The paper examines the process, symptoms and treatments most commonly viewed in patient cases of Pneumonia. My goal is to educate the reader and to warn of the

History of Present Illness: Ms. Manock is a very pleasant 60-year-old woman with a history of severe COPD. She was previously seen by Elvira Aguila, MD. Her last office visit was in February 2015. Since that time, she states that over the last few weeks, she feels her dyspnea has worsened which is a result of increased humidity, which is normal for her. She has had a stable cough over the last six months, which is intermittently productive of sputum. She is using her supplemental oxygen at 2 L/minute with exertion and with sleep. She also notes postnasal drip, which is related to seasonal allergies.

B.T. has a nursing diagnosis of ineffective airway clearance that requires nurse management with prescribed beta 2 adrenergic agonists, and teaching effective coughing and breathing techniques. The respiratory therapist will assist by performing nebulizer treatment and teaching the patient about home nebulizer. The nurse will emphasize on the importance of adhering to medication regimen and taking the right medication at the right time.

The patient may have a hard time breathing because she is in pain after having surgery. Since they patient doesn’t want to breath due to the pain it can cause atelectasis and later sepsis if not treated in time. It would be important to teach the patient about splinting and to use an incentive spirometry in order to help her be able to breath. Another risk factor for the patient not being able to oxygenate would be hypovolemia since there is less blood volume which can also lead to less oxygen being able to travel in the blood or able to perfuse throughout the body.

The clinical manifestations of pneumonia will be different according to the causative organism and the patient’s underlying conditions and/or comorbidities (Smeltzer, et al). Some of the manifestations are

Patient outcome consisted of performing 10 deep breaths per hour. We have reviewed details that were difficult for the patient to remember, such as breathing out before placing the lips on the mouthpiece, and holding breath for 3 to 5 seconds at the top of each inhalation. With empathy, I provided understanding that being hospitalized is never easy due to sensory overload, pain and lack of privacy. Additionally, we have discussed the basic pathophysiology of lung inflammation and what it can do to a person. So overall, the outcome included enhanced disease knowledge with effective use of incentive spirometer.

Pneumonia is described in Tabers cyclopedia medical dictionary, “as inflammation of the lungs, usually due to an infection with bacteria, viruses, or other pathogenic organisms” (p.1833)

There were even times when the nurse asked us some of the medications and what they do, which we gladly answered. The nurse was very open-minded, and contributed to the conversation really well, without overshadowing the pharmacists. After discussing, we briefly split the questions that we wanted to ask among the three of us. Up until this point, I believed that our team would do well since we prepared ourselves. However, to our surprise, we were not prepared when the patient continuously complained about feeling dizzy, and not being able to breathe. All three of us were not knowledgeable enough to help the patient with his symptoms that he kept complaining about. At first, we attempted to adjust the bed, however, that did not help and made it worse. Not knowing what to do, we tried to persuade the patient to try to focus on the questions that we were about to ask in order to help with his symptoms. When the patient complied, the nurse started asking very general questions about his health and lifestyle. It was a great start until the nurse started asking questions that we were going to ask the patient. In the end, she asked all the questions that we planned to

Presently, experiencing a cough, fatigue, fever of 100°F, and increased shortness of breath with activity for the past 5 days. Patient reports productive, “cough is a large amount of thick, tan sputum occurring day, and night, worse at night when lying on my back”. In the mornings John K has a thick, productive cough of “whitish sputum” for the last 18 months. Admits to sleeping with two pillows at night for comfort. John K, has difficulty breathing with climbing one flight of stairs and intercourse. In evaluating John K, presented sitting in tripod position with active mild respiratory distress, physically fatigued, oxygen saturation of 92% room air, respirations 24 (shallow), and temperature 99.8°F. Further physical findings identify early finger nail clubbing, moderate use of the abdominal muscles as evidence in compensating to breath, bilateral tympany on percussion, diffuse coarse crackles and few scattered end expiratory wheezes throughout bilateral lung fields. Electrolyte lab values within normal limits (no evidence of infection), ruling out pneumonia and chronic bronchitis. Chest x ray results COPD confirmed, ruling out pneumonia and chronic bronchitis. Sputum sample results normal flora congruent to COPD with no evidence to bacteria growth or pathogens identified, ruling out pneumonia and chronic bronchitis. Diagnostic

This is a case of a 74 year old woman who was diagnosed with Community Acquired Pneumonia.

The patient's overall symptoms and lab work suggest that she is suffering from hospital acquired pneumonia. Currently the patient is presenting a moist chesty cough. Additionally, her heart rate is elevated, her oxygenation is low, and her RR is high. She has a raised white blood cell count, which indicates infection. Finally, the patient is acting confused and disoriented, which can be the direct result of a lack of oxygenation to the brain. All of these symptoms point to pneumonia (Torres, 1999).