Case Study
Airway/Breathing (Oxygenation) Pneumonia/Chronic
Obstructive Pulmonary Disease Clinical Reasoning
Case Study
STUDENT Worksheet
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 causing an acute exacerbation. Principles of spiritual care are also naturally situated in
this scenario to provide rich discussion of “how to” practically incorporate this into the nurse’s practice.
Concepts (in order of emphasis)
I. Gas Exchange
II. Infection
III. Acid-Base Balance
IV. Thermoregulation V. Clinical Judgment VI. Pain
VII. Patient Education
VIII. Communication
IX. Collaboration
Pneumonia-COPD
I. Data Collection
,Case Study
History of Present Problem:
, Case Study
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.”
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
Green phlegm These vital signs clinically show signs of infection. With the
Chills difficulty breathing I would think about possible respiratory infection
Fever (102.0)
Difficulty Breathing (no improvement with
albuterol)
RELEVANT Data from Social History: Clinical Significance:
84 years old Her social history is clinically significant because with her age and
Live in assisted living facility being in close quarters with quite a few people could increase her
Religious preference risk for the spread of infection. Also we need to keep in mind her
religious preference during her stay.
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
• COPD/asthma 1. Fluticasone/salmeterol 1. corticosteroid, beta 1. prevent symptoms of
• Hypertension (Advair) diskus 1 puff every 2 adrenergic agonist asthma/COPD
• Hyperlipidemia 12 hours 2. Sympathomimetic 2. treats asthma,
• Cor-pulmonale 2. Albuterol (Ventolin) MDI bronchodilator bronchodilator, allows
• Anxiety disorder 2 puffs every 4 hours prn 3. ACE inhibitor for better gas exchange
• 1ppd smoker x40 years. 3. Lisinopril (Prinivil) 10 mg 4. Peroxisome 3. used to treat
Quit 10 years ago po daily Proliferator Receptor hypertension, lowers blood
4. Gemfribrozil (Lopid) 600 alpha Agonist pressure
5. Benzodiazepine 4. helps treat hyperlipidemia,
mg po bid 6. Potassium Sparing lowers cholesterol and
5. Diazepam (Valium) 2.5 Diuretic triglycerides
mg po every 6 hours as 5. Treats anxiety, little to no
needed anxiety
6. Triamterene-HCTZ 6. Increased urination without
(Dyazide) 1 tab daily affecting potassium
One disease process often influences the development of other illnesses. Based on your knowledge of
pathophysiology, (if applicable), which disease likely developed FIRST that then initiated a “domino effect” in
their life?
• put in bold what PMH problem likely started FIRST
• Underline what PMH problem(s) FOLLOWED as domino(s) (anxiety could have happened at any part of her
life span)
II. Patient Care Begins:
Airway/Breathing (Oxygenation) Pneumonia/Chronic
Obstructive Pulmonary Disease Clinical Reasoning
Case Study
STUDENT Worksheet
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 causing an acute exacerbation. Principles of spiritual care are also naturally situated in
this scenario to provide rich discussion of “how to” practically incorporate this into the nurse’s practice.
Concepts (in order of emphasis)
I. Gas Exchange
II. Infection
III. Acid-Base Balance
IV. Thermoregulation V. Clinical Judgment VI. Pain
VII. Patient Education
VIII. Communication
IX. Collaboration
Pneumonia-COPD
I. Data Collection
,Case Study
History of Present Problem:
, Case Study
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.”
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
Green phlegm These vital signs clinically show signs of infection. With the
Chills difficulty breathing I would think about possible respiratory infection
Fever (102.0)
Difficulty Breathing (no improvement with
albuterol)
RELEVANT Data from Social History: Clinical Significance:
84 years old Her social history is clinically significant because with her age and
Live in assisted living facility being in close quarters with quite a few people could increase her
Religious preference risk for the spread of infection. Also we need to keep in mind her
religious preference during her stay.
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
• COPD/asthma 1. Fluticasone/salmeterol 1. corticosteroid, beta 1. prevent symptoms of
• Hypertension (Advair) diskus 1 puff every 2 adrenergic agonist asthma/COPD
• Hyperlipidemia 12 hours 2. Sympathomimetic 2. treats asthma,
• Cor-pulmonale 2. Albuterol (Ventolin) MDI bronchodilator bronchodilator, allows
• Anxiety disorder 2 puffs every 4 hours prn 3. ACE inhibitor for better gas exchange
• 1ppd smoker x40 years. 3. Lisinopril (Prinivil) 10 mg 4. Peroxisome 3. used to treat
Quit 10 years ago po daily Proliferator Receptor hypertension, lowers blood
4. Gemfribrozil (Lopid) 600 alpha Agonist pressure
5. Benzodiazepine 4. helps treat hyperlipidemia,
mg po bid 6. Potassium Sparing lowers cholesterol and
5. Diazepam (Valium) 2.5 Diuretic triglycerides
mg po every 6 hours as 5. Treats anxiety, little to no
needed anxiety
6. Triamterene-HCTZ 6. Increased urination without
(Dyazide) 1 tab daily affecting potassium
One disease process often influences the development of other illnesses. Based on your knowledge of
pathophysiology, (if applicable), which disease likely developed FIRST that then initiated a “domino effect” in
their life?
• put in bold what PMH problem likely started FIRST
• Underline what PMH problem(s) FOLLOWED as domino(s) (anxiety could have happened at any part of her
life span)
II. Patient Care Begins:
