​Pneumonia-COPD Case study basic (week 2)

Joan Walker, 84 years old Primary Concept Gas Exchange Interrelated Concepts (​In order of emphasis) 1. Infection 2. Acid-Base Balance 3. Thermoregulation 4. Clinical Judgement 5. Pain History of Present Problem: Joan Walker is an 84-year-old female who has had a productive cough of green phlegm that started four days ago that continues to persist. She was started three days ago on prednisone 40 mg PO daily and azithromycin (Zithromax) 250 mg PO x5 days by her clinic physician. Though she has had intermittent chills, she had a fever last night of 102.0 F/38.9 C. She has had more difficulty breathing during the last night and has been using her albuterol inhale every 1-2 hours with no improvement so she called 9-1-1 and is brought to the emergency department (ED) where you are the nurse who will be responsible for her care. Personal/Social History: Joan was widowed six months ago after 64 years of marriage and resides in assisted living. She is a retired elementary school teacher. She called her pastor before coming to the ED 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 to her pastor, “Yes please, I feel that this may be the beginning of the end for me!” What data from the histories is RELEVANT andRELEVANT Data from Present Problem Productive cough of green phlegm four days ago that persists. Started three days ago on prednisone 60 mg PO daily and azithromycin 250 mg PO x5 days by her clinic physician. Fever last night of 102.0 More difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement RELEVANT Date from Social History 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!” has clinical significance to the nurse? Clinical Significance: Productive cough is a clinical manifestation. Sputum in shades of yellow- green indicates bacterial infection. This respiratory infection was treated by an antibiotic and steroids. Nurse determine if treatment was effective, Response to bacterial infection. Inflammatory response. Recurrent pneumonia is a common complication of COPD and a frequent cause of COPD exacerbation Clinical Significance Joan values spirituality. Spirituality is important to patient and the nurse must be sensitive Emotional support will be a priority for disease