Question

Sarah is a 69-year old female that presented to the emergency department with shortness of breath. Her past medical history includes heart failure and COPD. Her pulse oximetry on room air is 82%. You notify the provider, and he orders oxygen at 4 L via nasal canula NC. Sarah’s chest x-ray reveals bilateral pneumonia. Her arterial blood gas result are below:

pH	7.30
PaCO2	58 mm Hg
PaO2	78 mm Hg
HCO3	26 mEq/L

Sarah is admitted to a general medical floor. You are the nurse assigned to Sarah.

1. What potential problems can occur based on the above findings?
2. How would you provide multidimensional care for Sarah?
3. Describe the roles of other departments in Sarah’s treatment plan.

Answer 1

First of all let's look at the medical conditions that Sarah has:-

1. Heart Failure

2. COPD

3.Bilateral pneumonia

4.Hypoxia as seen on pulse oximetry

5. Increased paCO2- 58mmHg (normal=35- 45)

6. Decreased pO2- 78mm Hg (normal=80-100)

So Sarah can face following problems -

LUNGS

1. Bacteremia in future due to infection from lunga to blood. Check for Fever, tachycardia, tachypnea if reported by Sarah.

2.Pleural Efusion seen when chest pain is increased on breathing, cough , sneezing.  

3. Lung Abscess  

4. Respiratory failure due to pleural efusion and pleurisy.

HEART

1.Heart Failure- 20% of pneumonia is related to heart diseases and in this case sarah already is suffering from heart failure.

Kidney Failure can be seen due to septicaemia.

Multidimensional care of Sarah:-

1.​​​​​​Further Investigation for confirmation of cause of the pneumonia must be done

a. CMP test (Comprehensive Metabolic Panel)

-This will let us know the level of ALT AST which will tell about the status for liver from volume overload

- Creatinine level and GFR which will lets us know about the kidney functions.

- ABG which is already done.

b.ECG to know the underlying heart condition.

c.CT to know the exact condition of chest

2. Cough - give cough suppressants.

3 Maintain good hydration

4.Monitor her for diarrhea which is side effect of antibiotics.

5. Monitor very closely during the initiation of therapy of patient.

6. Encourage good hand washing techniques.

7. Encourage adequate rest.

8. Asses depth and rate of chest movement.

Speacial attention during Covid 19 pandemic:-

Special care must be given to Sarah during the pandemic time period as she is suffering from Pneumonia and has history of heart disease and COPD so she is a high risk patient.

She must be properly taken care by regular hand sanitizing and proper use of mask and PPE kit when and where required.

Role of other Departments:-

1. Medicine Department-

The main role is of medicine department only as it will diagnose and start the preliminary treatment for sarah.

2. Radiology-

After her initial treatment she will be investigated ny radiologist for confirmation of diagnosis by XRay CT .

3. Surgery

If she develops any complication which can be abscess aur pleural effusion it is surgery department which will drain the fluid.

4. Pathology

Once the fluid is drained it will be sent to Pathology for evaluation.

5. Microbiology

Fluid drained and blood samples will be evaluated here for any infection aur septicemia.

6.Biochemistry

She will be evaluated here for Irine sugar levels, it creatinine, AST, ALT .