Clinical Case Study on COPD Pneumonia

Jul 25, 2024

Clinical Case Study on COPD Pneumonia

Introduction

  • Case studies as powerful educational tools for practice-based professions like nursing.
  • Focus on a case study for COPD pneumonia, emphasizing critical thinking and clinical reasoning.

Patient Background

  • Joan Walker: 84-year-old female
  • Symptoms: Productive cough (green phlegm), intermittent chills, fever (102°F last night), increased difficulty breathing, frequent use of albuterol inhaler (every 1-2 hours).
  • Medications: Prednisone (40mg daily), Azithromycin (250mg daily for 5 days).
  • Arrival: Brought to the emergency department after calling 911.

Initial Assessment

  • Age: Higher risk due to being 84 years old.
  • Symptoms: Green phlegm indicating infection, use of prednisone and azithromycin to reduce inflammation, intermittent chills, and high fever (102°F).
  • Breathing difficulties: More shortness of breath, frequent use of albuterol inhaler with no improvement.

Vital Signs

  • Temperature: 103.2°F (febrile response indicates infection/ inflammation).
  • Pulse: 110
  • Respiratory Rate: 30
  • Blood Pressure: 178/96
  • O2 Saturation: 86% on 6 liters per nasal cannula (below the required 92% or 90% for COPD patients).

Clinical Judgement

  • Infection Assessment: High temperature, pulse, respiratory rate meeting SIRS criteria, indicating potential sepsis.
  • Oxygenation Issue: O2 saturation at 86% needs alternative oxygen delivery system.

Nursing Assessment

  • General Appearance: Anxious, distressed, barrel chest present.
  • Respirations: Dyspneic with accessory muscle use, diminished breath sounds bilaterally, expiratory wheezing.
  • Other Observations: Pale, hot, dry skin, intact skin integrity, alert and oriented times four.

Diagnostic Data

  • Basic Metabolic Panel: Normal values except for glucose (112).
  • CBC: White count (14.5), high neutrophils (92%), presence of bands indicating immature neutrophils and aggressive inflammatory response.
  • Lactate: 3.2 (indicating lactic acidosis or anaerobic metabolism due to perfusion issues).
  • ABGs: pH (7.25), PCO2 (68), PO2 (52), bicarbonate (36), O2 saturation (84%). Indicates respiratory acidosis and hypoxia.
  • Chest X-ray: Left lower lobe infiltrate confirming pneumonia, hypoventilation in both lung fields.

Clinical Reasoning Questions

  1. Primary Problem: Pneumonia with systemic inflammatory response (SIRS), potential sepsis.
  2. Medical Plan of Care: Medications to reduce inflammation, dilate bronchioles, and reduce fever (e.g., albuterol, ioperatropium nebulizer, methylprednisolone, levofloxacin, Tylenol).
  3. Nursing Priority: Impaired gas exchange, managing respiratory distress and potential sepsis.
  4. Psychosocial and Holistic Care: Address patient anxiety and stress, provide comfort through touch and communication.
  5. Educational and Discharge Priorities: Teach patient and family about the condition, medications, and follow-up care.

Conclusion

  • Clinical Judgement: Importance of recognizing relevant clinical data and responding appropriately.
  • Active Learning: Use of case studies to prepare students for the NCLEX and clinical practice.
  • Call to Action: Engage in active learning strategies and continuous education.

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