Sample Old Man with Pneumonia Case Study Assignment

Old Man with Pneumonia Case Study Assignment Sample

Question

Task: This assessment task gives you the chance to read extensively about the health status of a critically ill patient. You must choose a case for analysis that either had shock, acute respiratory failure, or heart failure. We are looking for evidence of at least one management strategy that has been presented, as well as a demonstration of a thorough comprehension of the applied pathophysiology that supports the patient's primary condition.

Please be aware that we are not searching for extensive information about the patient. The message can be communicated in one or two sentences (see the example). Since no patient information would be presented in the manuscript, institutional approval is not necessary. It is not sufficient to just list test results if you desire to incorporate them; a list does not express your opinion and does not thus contribute to the grading. Instead, you must offer the test findings in the context of your analysis. You could say, for instance:

The patient's symptoms included hypotension (mean arterial pressure of 48), hypoxia (low oxygen saturations), acidosis (pH of 7.16), and hypocapnia (55 mmol/L of carbon dioxide).

In terms of case selection, if you feel as though you are at a loss for what to choose for review, please speak with your instructor to go over your possibilities. Heart failure is not an acceptable topic choice for cardiovascular students. Positive pressure ventilation cannot be discussed by intensive care students.

Examples of instances and subjects for review

It is not necessary for the subject or case to be complex. Simple examples include
• lowering of blood pressure
• decreased oxygen saturations
• the vasovagal episode
• gastric contents being aspirated
• pneumonia
• hypertension
and so forth

No of the subject, it is your responsibility to describe the compensating processes that are engaged in reaction to the issue. Then you make at least one management strategy a link to the associated physiology.

Answer

1. Introduction:

The pathophysiological issues of James, a gentleman of 57 years old, will be critically discussed in the pneumonia case study. Due to abrupt hypoxemic respiratory failure brought on by severe pneumonia, he was sent to the intensive care unit (ICU) (Mansour et al., 2015). After seeing Japan and New Zealand, James had just returned from a two-week trip abroad. James had been healthy for the 21 days before to admission and had just recently started experiencing modest symptoms. However, two days ago, his condition quickly deteriorated, leaving him with a 39.2-degree fever, shivering, hypoxia, arthralgia, myalgia, and persistent shortness of breath. Since the patient needs some supportive care and has been diagnosed with influenza. Additionally, the acute clinical management strategy for the pneumonia case study will be critically analysed. James will receive additional tests and chest X-rays as his condition worsens in the intensive care unit, and it will be determined whether the clinical management plan is supported by the most recent evidence-based literature.

2. Ethical Use of Patient Healthcare Data:

In terms of ethics, the patient is responsible for allowing the use of their data in research studies. When any type of research is conducted using patient data, ethical problems typically surface. To ensure that patient data is evaluated ethically and that outside assistance is only sought when necessary, it is the patients' and the healthcare department's obligation.

3. Pathophysiology Problem and Treatment Analysis

The human respiratory system typically involves the passage of air through the nose, nasal cavity, pharynx, larynx, trachea, and bronchi after passing through the nose and nasal cavity (Luo, 2016). The Nares is the name of the aperture to the nose. The Nasal cavity has a mucous membrane lining it, along with cilia and blood vessels. The proposed Biology case study shows that there is a cilia where some air filtration is done, warmed by the blood, and moistened by the mucous membranes. A portion of the throat, sometimes known as the pharynx, is where air passes. Williams and Tordoff (2018). The food and air typically go along this route. The air then keeps moving through the larynx. The epiglottis is a flat piece of tissue that is visible on the other side of the larynx and is closed when swallowing anything to keep it from getting into the alveoli. A vocal fold is located in the larynx, or voice box. The bronchial tree and larynx are joined by the windpipe, often known as the trachea. To keep the trachea from collapsing, it features a cartilage ring. The pneumonia case study investigates the fact that the lungs' spongy tissues are also connected to blood capillaries and alveoli in the respiratory system. Human bodies begin to breathe when their lungs dilate and then expand. The smaller bronchi, known as bronchioles, are carried by the air through larger bronchi. At the ends of each bronchiole, there are alveolar sacs. The Alveolar Sacs have blood capillaries that surround them, contain a single layer of millions of alveoli cells, and carry out gas exchange functions. When air is inhaled through the nose, oxygenated air first travels through the pharynx before moving through the larynx, trachea, bronchi, and finally the alveoli. When capillaries process the fusion, oxygen from the air is transferred to the alveoli. In order to exhale carbon dioxide, the capillaries push the gas to the alveoli. Respiration is the name given to such a procedure.

The exchange of gases between the bodily cell and the atmosphere occurs during respiration. In it, numerous things happen, one of which is breathing. The Alveolar Sacs transport air to the Alveoli, where gas exchange is processed and easily absorbed (De Giacomi et al., 2018). Alveoli perform the gas exchange between epithelia capillaries and alveoli when they are filled with air during an inspiration. The blue gas over here is the carbon dioxide that has been exhaled, and the white gas over here is inspired oxygen. Red blood cells ultimately change colour after a gas exchange is completed. The red blood cells are altered in the capillaries such that the alveoli release carbon dioxide before binding oxygen.

An inflammation in the lower respiratory tract and a deadly infection were discovered in a case study of a patient with pneumonia. This infection is brought on by pneumococcus streptococcus pneumonia, which is a combination of a virus, bacteria, mycoplasma, and pathogens that can be breathed. The infection increases the amount of fluid that is secreted, and this extra fluid pools and gathers in the lungs' air sacs (Dumas et al., 2019). Pneumonia is associated with the air space in the lungs when excaudate is present, which produces coughing, acute chest discomfort, shortness of breath, and a high temperature. When the patient was first admitted to the hospital, the same situation was seen in him as well (Dickson et al., 2017).

The next day, an x-ray of the chest revealed pneumonia in the left upper lobe. Due to his acute hypoxemic respiratory failure, the patient was prescribed an albuterol inhaler and azithromycin. He also received an intravenous stat dose of ceftriaxone and azithromycin before being discharged and allowed to return home (Ramos-Rossy et al., 2018). After two days, the patient began to have chronic symptoms, for which cough syrup and prednisone were recommended. The patient from the pneumonia case study reported exhaustion. His temperature had risen to 38.8°C. Since he took acetaminophen, he was unable to fall asleep. He also had a persistent cough that occasionally produced blood-tinged sputum, as well as pleuritic chest pain. He had dyspnea when I was assessing his health (Kazzaz et al., 2017). As a nurse, I evaluated the patient's vital signs and discovered that their blood pressure was 148/72 mm Hg, their breathing rate was about 26 breaths per minute, their pulse rate was 88 beats per minute, and their oxygen saturation level was 94%. Some crackles had been observed in the left axillary region and left lung base (Serota et al., 2018). A significant infiltration is visible on the left side of the chest radiograph.

The left upper lobe of the chest was observed to have a severe consolidation on the lateral and posteroanterior chest radiographs, whereas the right upper lobe had a mild consolidation and a faint left pleural effusion. Lymphadenopathy was absent, nevertheless.

Prior to admission, a portable anteroposterior via the chest radiograph was taken to check for more lung opacification. The left upper lobe showed the most involvement, and the right upper lobe of the right lung showed multifocal consolidation (Sanz-Herrero et al., 2016).

The doctor started a Vancomycin therapy on the third day, and on the fifth day, he started an imipenem therapy. However, the patient developed hypoxemia on the sixth day, for which he required four litters of oxygen therapy delivered through nasal prongs. Around 270 mg per deciliter of?1-antitrypsin was present (Kawakami et al., 2019). IgM, IgG, and total bilirubin levels in the blood as well as their anion gaps were all within normal ranges.

According to the readings generated in this case study on pneumonia, the patient was transferred to the intensive care unit (ICU) for additional assessment and maintained there for two days. A bronchoscopy was performed, and the results showed a purulent discharge without any mucous plugs. The left ventricular's ejection fraction ranged from 60 to 65%. The cultures of the sputum samples were unfavourable (Kushwah et al., 2018). It was discovered that the echocardiography had biventricular function and wall motion.

By the ninth day, the airway pressure that was prescribed to have positive bi-level had gradually improved. Methylprednisolone was given at the precise moment the trachea was intubated voluntarily on the same day. The sputum cultures had produced species of candida while the blood cultures came back negative (Park et al., 2016).

The patient needs to be admitted to the ICU once more on day ten. Norepinephrine, fentanyl, and midazolam intravenous infusions, as well as moxifloxacin, vecuronium, vancomycin, imipenem, ondansetron, sodium succinate, acetaminophen, pantoprazole, enoxaparin, ondansetron, albuletrol, nystatin suspension, and fluticasone nasal spray, were among the medications the doctor The patient also had indomethacin for his gout and received an influenza vaccination. The administration of drugs revealed no allergy symptoms in his body, nonetheless. He informed me about himself and the places he had lived and worked as I was watching him. He also revealed that he used to smoke 40 packs of cigarettes every two weeks, but for the past six months, he had quit before falling ill and being brought to the hospital (Ivanick et al., 2019). He doesn't use any illegal substances, and he used to drink alcohol very infrequently or on special occasions.

His mother and sister both had a?1 - antitrypsin deficiency, and his mother also had chronic obstructive lung disease, it was discovered when he spoke about his family history (Hirai et al., 2017). At the age of 63, his father passed away from a myocardial infarction. He was afebrile, sedated, and intubated as the patient studied for the case study on pneumonia was being examined. His heart rate was 50 beats per minute, his respiratory rate was 38 breaths per minute, and his blood pressure was measured at 89/22 mm Hg. He received ventilator assistance during this stage (Orsini et al., 2020). It had normal heart and bowel sounds, but there was considerable swelling in the limbs and legs indicative with 2+ edoema, as well as bilateral breathing noises. Plasma anion gap and serum protein electrophoresis were both found to be within normal ranges. hazy looking urine After urine examination, it revealed that there was 1+ albumin and 2+ urobilinogen (Yoshimi, Satou and Mori, 2018). Additionally, according to his report, he has 3 to 5 white cells, 5 to 15 red blood cells, very few renal tubular cells per high power field, few squamous cells, few reparative cells, 30 to 90 granular casts per low-power field, 20 to 100 hyaline cast, and mucus (Mangioni et al., 2019).

It is necessary to insert the esophagogastric and endotracheal tubes in the chest radiography that was shown in the pneumonia case study scenario. Additionally, there was a significant rise in bilateral multifocal consolidation without pleural effusion and pneumothorax. The oxygen inspired has a proportion of oxygen growing toward 1, the arterial partial pressure of oxygen (PaO2) rises to 93 mm Hg, and the oxygen saturation is 95%. (Wang et al., 2018). He received infusions of fentanyl, propofol, vasopressin, meropenem, and methylprednisolone. Later, I discontinue delivering imipenem. When the sputum sample was stained with gram's solution, it became apparent that the polymorphonuclear leukocyte count was moderate. The test came back negative for adenovirus, respiratory syncytial virus, and parainfluenza antigens (Furumido et al., 2019). Nucleic acid testing was done for the influenza A and B viruses.

A two-drug antifungal chemotherapy regimen is necessary for the patient's treatment. As part of the treatment, corticosteroids will be given. Exercise-induced hypoxemia and restrictive ventilator dysfunction continue a year after therapy is finished.

4. What conclusions were drawn from the investigation on the pneumonia case study?

Pneumonia is quite common in people between the ages of 66 and 88, and it's more likely to be acquired in the community, according to one of the research taken into account when creating this case study on pneumonia (Sonaglioni et al., 2019). Another study indicated that approximately 14,069 Medicare recipients older than 65 who had a severe case of community-acquired pneumonia were admitted to the hospital. The geriatric age group difference was between 78 and 8 years, according to a different study used to construct this case study on pneumonia (Kwon et al., 2018). This could be as a result of the varying older population's hospitalisation rate and access to healthcare. Most cases of pneumonia in elderly patients are brought on by the lungs' loss of elastic recoil, the mechanical clearing of the airways, the weakening of the respiratory muscles that cause coughing, the aging-related decline in mucociliary clearance, the cumulative effects of coexisting chronic diseases, defects in cell-mediated immunity, and humoral immunity (Prendki et al., 2018).
When analysing the cases with sex distribution to support the pneumonia case study scenario, it is found that more males than females are affected, with the percentage of females being around 30% (lès-Nancy and Vandoeuvre-lès-Nancy, 2019). The fact that smoking and drunkenness are more prevalent among men may be to blame for this. Additionally, it could be a result of worsening COPD or heart failure.

5. Conclusion

According to the critical examination of the case study on pneumonia, the condition is a major issue for older individuals and is frequently encountered in clinical settings. The most typical signs of pneumonia in older patients include respiratory symptoms, gastrointestinal symptoms, tachypnea, tachycardia, and crepitation. When collecting sputum from an old patient, it is frequently difficult to pinpoint the etiological agents. The process of isolating the responsible microbes might occasionally be complex. Empirical therapy may therefore be required in this situation. The results of the pneumonia case study show that environmental factors, such as climate, play a major role in raising the risk of pneumonia, which affects the respiratory system and causes inflammation and infection of the alveolar spaces in the lungs.

References

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2. Immunocompromised Pneumonia, 2017 by R.P. Dickson. The Critical Care Evidence-Based (pp. 215-220). The Springer, Cham.

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24. 2018; Yoshimi, M., Satou, Y., and Mori, M. sputum cytodiagnosis revealed a case of herpes simplex virus pneumonia. Case report on a case of pneumonia, Clinical Case Reports, 6(1), p.