Case Study #2: Pneumonia

Day 1: Medical Ward

Day: 1
Time: 10h30
Place: Medical Ward (Seventh Floor)

As the elevator doors open, Erin is greeted with a view that overlooks the city. Erin sighs, “Oh, I so wish I could be out there rather than here. I wonder if my room will have this view.” Glen grunts as he pushes the stretcher over the gap between the elevator and the door. Alexa follows him as he weaves past visitors and other professionals waiting for the elevators.

At the nurses’ station, Glen announces that Erin is the patient from Emergency. Tracie, a new BSN graduate, stands up from the computer screen. This is just her tenth shift on the seventh floor. “Hi Glen. Mrs Johns is going to be my patient. I have prepared Room 712 for her and she will be next to the window, in Bed 1.”

“Awesome. Okay Mrs. Johns, let’s get you into your room.”

Glen, with Alexa and Tracie following him, pushes the stretcher part-way down the hall to Room 712. Sliding it easily past the patient in Bed 2 he maneuvers the stretcher right beside the bed and locks the wheels. Alexa and Tracie go to the other side of the bed and all three assist Erin to move across to her new bed.

“Oh my. I can’t. Catch my. Breath. Help. Me.”

Alexa steps towards the bed and moves the oxygen tubing from the portable tank to the wall outlet. “Mrs. Johns, I want you to try to take some deep breaths through your nose and blow out through your mouth. Slightly close your lips together like you are whistling.”

Erin takes a deep breath in through her nose and breathes out through her partially closed mouth.

“Very good, Mrs. Johns. Keep going. Another breath. Excellent.” Alexa watches the SpO2 monitor move from 88% to 93% with Erin taking slow deep breaths.

“How do you feel now?”

“Really tired but I can. Catch my breath now. Thank you.” Erin reaches her hand out and gently touches Alexa’s hand. Alexa smiles back and pats Erin’s hand a couple of times.

“Mrs. Johns, my name is Tracie and I will be the nurse caring for you. I am going to step outside and review your chart so I can plan your care and then I will be back in a few minutes. Do you need anything right now?”

“No, but can my dog visit me here?”

“Yes, we do allow pets during the evening visiting hours as long as your roommate in the bed beside you is okay with your dog coming in. I will check with him and see if there are any patients with allergies to pets on the unit.”

“Very good, thank you.”

Tracie and Alexa step outside the room, followed by Glen pulling the stretcher out, only banging the wall lightly as he pulls it around the corner of Bed 2.

Alexa speaks. “Okay Tracie? I have placed Mrs. Johns on opti-flow and her Sats are pretty good when she does not exert herself. Orders are to keep Sats above 93%. I will talk with the RT covering this floor so they can come by and see her frequently.”

Tracie flips through the papers from Emergency including the transfer form. “Looks good. I do have one question though. Why did you ask her to breathe through closed lips like whistling?”

“That is called pursed lip breathing. Some patients with COPD do it naturally. It helps keep the alveoli open and prevents them from collapsing and making her oxygenation worse.”

“Oh, I sort of remember that from school. I will have to look that up. Thank you.”

“Okay, if you need anything, please call the floor RT and they will come and help out.”

“Will do.” Tracie moves back to the desk to review the chart, lab work and other tests. She notes that the antibiotics have started and the next dose according to the transfer form is in four hours.

“Ok, everything looks fine right now. I need to start the admission assessment.”

Tracie gathers the vital sign machine and her stethoscope and heads to Erin’s room.

“Hi Mrs. Johns, I would like to have a closer look at you and take your vital signs. Is that ok?”

“Yes, I have nothing else to do. I am feeling better.”

Tracie attaches the blood pressure cuff to Erin’s arm, places the pulse oximeter on her finger and then inserts the temperature probe under her tongue. While the machine is humming, she looks critically at Erin and thinks to herself: It looks like she is breathing a bit faster than normal, chest expansion seems symmetrical, she has a bit of nasal flaring.

The vital signs machine beeps and Tracie records all the vitals onto the admission assessment.

Day: 1 Pulse Rate Blood Pressure Respiratory Rate Temperature O2 Saturation
 Time: 18h00 96 180/90 28 36.5° C 85% on Optiflow

“Mrs. Johns, I need to lift up your gown a bit and listen to your heart and lungs.”

Erin sighs and pulls her gown out from under her. Tracie systematically listens to Erin’s heart and lungs, and records her findings along with the respiratory rate onto the admission assessment form.

“Thank you Mrs. Johns. I am almost done. Can you tell me your birth date, day of the week, and who is prime minister?”

Erin answers each of the questions and tells Tracie she knows she is in the hospital. Tracie goes on to fully assess Erin and record her findings on the admission assessment form.

“Ok, thank you. I’m all done right now. Do you need anything?”

“When is lunch?”

“It should be coming up anytime now. I think I heard the lunch cart in the hallway so you should be getting it soon.”

“Thank you. I don’t need anything right now.”

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