University of Scranton Nursing 350

Dr. Margarete Lieb Zalon, PhD, RN, CS

Community-Acquired Pneumonia in the Elderly Case Study

Mrs. Green a 84 year old white female. She lives in her own home and has a caretaker who is a 63 year old retired state worker who decided to work as aide for a home health agency. Currently, Mrs. Green is able to walk with walker. She takes a daily walk around the block with the aide. She is able to perform most activities of daily living with the exception of meal preparation and washing her feet and back. Medications include a diuretic for hypertension, digoxin and a stool softener. Mrs. Green has recently become more fatigued. Last night she was unable to complete her walk around the block. The caregiver reports that she had one episode of falling while going to the bathroom last week. Last night she was incontinent and confused. Although Mrs. Green has voiced no specific complaints, the caregiver has become concerned by her inability to "get rid of her cold." The caregiver has brought her to a walk-in clinic for evaluation. Mrs. Green is well-groomed and neat. She answers all questions appropriately. Her BP = 100/60, P = 100, R = 24, temperature = 99 F. Her EKG shows normal sinus rhythm. The chest x-ray shows previous scarring and small infiltrates in the right and left lower lobes. Her skin is warm and dry. Nose and throat have inflamed and irritated mucous membranes. Her breath sounds are bronchial; percussion is normal and resonant. Her blood sugar is 134 and her white count is 15, 600. She has not been eating well. The physical examination reveals that her chest expansion is diminished. The nurse hears crackles over the lower posterior lobes and bronchial breath sounds.

What most likely accounts for Mrs. Green's lethargy?
What complicates the diagnosis of pneumonia in the elderly?

The nurse-practitioner decides to have Mrs. Green admitted to the hospital.

What nursing diagnoses would you select?
What are the outcomes for the nursing care plan?
What are the highest priority nursing interventions for each of the nursing diagnoses?
What should be included in an ongoing assessment of Mrs. Green?
Is it permissible to begin antibiotics before cultures are obtained? Why or Why not? What factors should be considered in making your decision?

Mrs. Green's arterial blood gases are drawn with the following results: O2 saturation = 89, PCO2 = 48, PO2 = 70, HCO3 = 27, pH = 7.34.

What is the significance of these results?

Mrs. Green is placed on oxygen via nasal catheter at 4 L minute. He will be receiving Proventil nebulizer treatments q 4 h.

Does the oxygen delivery system need to be humidified?

Identify the percentage of oxygen delivered in the following methods and their use:

Oxygen Delivery System	Percentage of Oxygen Delivered	Uses
Nasal cannula at 4 liters/minute
Simple face mask
Non-rebreather mask
Partial rebreather mask
T-piece

The nurse walks into the room and notices that Mrs. Green is very dusky in color and she seems irritable. The pulse oximeter came off and when the nurse placed it back on her finger, the reading was an 86.

What would be the most appropriate actions?

Eventually, with meticulous respiratory care, Mrs. Green makes a gradual recovery and is sent to a personal care home before returning home.

What should be done to minimize her likelihood of developing pneumonia again?

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