ETOH Withdrawal/Pneumonia
UNFOLDING Reasoning Case Study
Elena Acosta, 54 years old
Primary Concept
Addiction
Interrelated Concepts (In order of emphasis)
• Infection
• Intracranial Regulation
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23% ✓
• Safety and Infection Control 9-15% ✓
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
• Basic Care and Comfort 6-12% ✓
• Pharmacological and Parenteral Therapies 12-18% ✓
1
, • Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
History of Present Problem:
Elena Acosta is a 54-yr. old Hispanic woman with hypertension managed with hydrochlorothiazide. She is 63” (160.2 cm)
and weighs 175 pounds (79.3 kg-BMI 31.0). She felt “crummy” and weaker the last 24 hours and called 911 when she
began to have mid-sternal chest pain that increased with coughing and developed a harsh productive cough with green
phlegm with difficulty breathing.
Initial lab results: WBC 14.5, neutrophils 92%, Hgb 12.9, potassium 3.5, creatinine 1.1, total bili 0.9, ALT 42, chest x-
ray revealed RLL infiltrate consistent with pneumonia, blood and sputum cultures collected and pending. Smell of ETOH
present on her breath. Blood alcohol level 0.04, urine drug screen negative. She is admitted to the medical unit with a
diagnosis of pneumonia. You are the nurse responsible for her care.
Personal/Social History:
Ms. Acosta works in a mid-level management position for a corporate finance company. She describes her job as quite
stressful. She drinks 4-5 cups of coffee every day and to least 1-2 alcoholic drinks most days. She states that she
shouldn’t smoke and has cut down to about ½ a pack per day. She reports drinking more and sleeping poorly following
her father’s death over a year ago. She takes alprazolam as needed for sleep or when she feels more anxious. She is
hesitant to be admitted because she has a high deductible insurance plan and doesn’t know how she will be able to afford
it.
1. What data from the histories are RELEVANT and have clinical significance to the nurse? (Reduction of Risk
Potential) (worth 5 points)
RELEVANT Data from Present Problem: Clinical Significance:
-Hypertension -Hypertension puts the patient at risk for many other conditions such as
-BMI 31 MI and Stroke.
-Mid-sternal chest pain -Being overweight put the patient at greater risk for multiple health
-Harsh productive cough with green phlegm conditions. It also can prevent the lungs form fully expanding.
-Blood alcohol level -Mid-sternal chest pain is likely caused by the pneumonia but an ECG
-RLL infiltrate/diagnosis of pneumonia will be needed to rule out any cardiac causes.
-WBC 14.5 and Neutrophil 92% -A harsh productive cough with green phlegm indicates an infection is
present in the lungs.
-Blood alcohol level of 0.04 indicates the patient has had a drink
recently. The patient should be assessed for alcohol addiction.
-Right lower lobe infiltration indicates this area of the lungs is filled with
fluid and is infected.
-An increased WBC count indicates an infection is present. Neutrophils
are the body’s first line of defense against an acute infection and
elevated levels further indicate the presents of an infection.
RELEVANT Data from Social History: Clinical Significance:
-Stressful job -Constant increased stress can lead to an impaired immune system,
-1-2 alcoholic drinks most days cardiovascular diseases, and mental health problems.
-1/2 pack per day smoker - Frequent alcohol consumption can weaken the immune system,
-Sleeping poorly decrease absorption of nutrients, and cause liver damage. Also
-High deductable indicates patient has unhealthy coping mechanisms.
- Smoking weakens the lungs and impairs the lungs natural defenses
against infections.
-Impaired sleeping is likely due to stress and can lead to cognitive
impairment and weakened immunity.
-A high deductible could have delayed the patient in seeking medical
attention. This will also increase the patient’s stress levels.
2
UNFOLDING Reasoning Case Study
Elena Acosta, 54 years old
Primary Concept
Addiction
Interrelated Concepts (In order of emphasis)
• Infection
• Intracranial Regulation
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23% ✓
• Safety and Infection Control 9-15% ✓
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
• Basic Care and Comfort 6-12% ✓
• Pharmacological and Parenteral Therapies 12-18% ✓
1
, • Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
History of Present Problem:
Elena Acosta is a 54-yr. old Hispanic woman with hypertension managed with hydrochlorothiazide. She is 63” (160.2 cm)
and weighs 175 pounds (79.3 kg-BMI 31.0). She felt “crummy” and weaker the last 24 hours and called 911 when she
began to have mid-sternal chest pain that increased with coughing and developed a harsh productive cough with green
phlegm with difficulty breathing.
Initial lab results: WBC 14.5, neutrophils 92%, Hgb 12.9, potassium 3.5, creatinine 1.1, total bili 0.9, ALT 42, chest x-
ray revealed RLL infiltrate consistent with pneumonia, blood and sputum cultures collected and pending. Smell of ETOH
present on her breath. Blood alcohol level 0.04, urine drug screen negative. She is admitted to the medical unit with a
diagnosis of pneumonia. You are the nurse responsible for her care.
Personal/Social History:
Ms. Acosta works in a mid-level management position for a corporate finance company. She describes her job as quite
stressful. She drinks 4-5 cups of coffee every day and to least 1-2 alcoholic drinks most days. She states that she
shouldn’t smoke and has cut down to about ½ a pack per day. She reports drinking more and sleeping poorly following
her father’s death over a year ago. She takes alprazolam as needed for sleep or when she feels more anxious. She is
hesitant to be admitted because she has a high deductible insurance plan and doesn’t know how she will be able to afford
it.
1. What data from the histories are RELEVANT and have clinical significance to the nurse? (Reduction of Risk
Potential) (worth 5 points)
RELEVANT Data from Present Problem: Clinical Significance:
-Hypertension -Hypertension puts the patient at risk for many other conditions such as
-BMI 31 MI and Stroke.
-Mid-sternal chest pain -Being overweight put the patient at greater risk for multiple health
-Harsh productive cough with green phlegm conditions. It also can prevent the lungs form fully expanding.
-Blood alcohol level -Mid-sternal chest pain is likely caused by the pneumonia but an ECG
-RLL infiltrate/diagnosis of pneumonia will be needed to rule out any cardiac causes.
-WBC 14.5 and Neutrophil 92% -A harsh productive cough with green phlegm indicates an infection is
present in the lungs.
-Blood alcohol level of 0.04 indicates the patient has had a drink
recently. The patient should be assessed for alcohol addiction.
-Right lower lobe infiltration indicates this area of the lungs is filled with
fluid and is infected.
-An increased WBC count indicates an infection is present. Neutrophils
are the body’s first line of defense against an acute infection and
elevated levels further indicate the presents of an infection.
RELEVANT Data from Social History: Clinical Significance:
-Stressful job -Constant increased stress can lead to an impaired immune system,
-1-2 alcoholic drinks most days cardiovascular diseases, and mental health problems.
-1/2 pack per day smoker - Frequent alcohol consumption can weaken the immune system,
-Sleeping poorly decrease absorption of nutrients, and cause liver damage. Also
-High deductable indicates patient has unhealthy coping mechanisms.
- Smoking weakens the lungs and impairs the lungs natural defenses
against infections.
-Impaired sleeping is likely due to stress and can lead to cognitive
impairment and weakened immunity.
-A high deductible could have delayed the patient in seeking medical
attention. This will also increase the patient’s stress levels.
2
