Clinical Assessment and Management of Pneumonia

The assignment details the clinical assessment and management of a 75-year-old man diagnosed with community-acquired pneumonia. The patient presents with symptoms such as relentless coughing, sputum production, pleuritic chest ache, and tachycardia. The nursing care plan requires addressing hypotension, anaphylactic shock, and respiratory distress. The analysis of arterial blood gas (ABG) results indicates acute acidosis in the lungs, indicating a need for oxygen therapy and antibiotic medication.

Running head: CLINICAL ASESSMENT
Clinical Assessment
Name of Student
Name of University
Author Note

1CLINICAL ASSESSMENT
Question 1 (15 marks):
A 75 year old man named Mr. Farouq, came to the high-acuity and was diagnosed with
community acquired pneumonia.. This kind of pneumonia occurs in people who have limited or
no access to healthcare institutions and the condition has been undiagnosed for long time. The
common identified pathogens for this disease are Streptococcus pneumonia and Haemophilus
influenzae or sometimes it can be caused due to bacteria that remain undetected in Gram’s test
like, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella sp., as well as viruses. The
patho-physiology of the bacterial infection enters the lungs and fills them with pus which
accumulates in the airs sacs making it difficult to breathe and induces cough along with sputum
production.
The Patient form the case study shows similar symptoms with the condition and is
suffering from relentless coughing, sputum production, pleuritic chest ache, and tachycardia
along with other clinical symptoms like high fever, high BP, dyspnea and tachypnea, which
indicates that the patient might be undergoing septic shock. The patient suffers difficulty in
breathing and is speaking only single words at a time due to low respiratory rate which is 35
beats per minute and has long expiration rate. His SPO2 or dissolved blood oxygen is 82% which
is mildly low. The analysis of the chest X-ray shows that the patient has crackles on his lower
left lobe base which suggests pulmonary edema or sepsis or accumulation of fluid or pus like
substance in alveoli. This is suggestive of his pneumonic sepsis as well has bronchitis condition.
Electrolytes, urea and creatinine result analysis show that every other component of the report
are normal except Na+ and Cl- due to dehydration. Urea and creatinine are elevated as well,
because the body is not being able to excrete the waste properly, this could lead to a potential

2CLINICAL ASSESSMENT
development of kidney failure that is observed commonly in severe septic shock cases. The
colour of the patient’s urine was found to be very dark in colour, which further supports the
kidney failure hypothesis. The patient’s report for full blood count test shows that the white
blood cell and platelet count is very elevated and his feet are inflated. This kind of signs is an
indicator for patients undergoing anaphylactic shocks in diseased conditions, called thrombosis.
The WBC could also be elevated because of the incidence of bacteria as well as multi-organ
failure due to sepsis in the patient’s body.
Question 2 (5marks):
The nursing care plan management requires a lot of steps to address the condition:
clinical assessment, analysis of diagnostic reports, patient history studying, forming a nursing
care plan, devising a high priority strategy to immediately avoid grave situations, interventional
actions et cetra. Usually in these cases, the patient is given external oxygen supply, external fuild
administration, commencement of antibiotics and physiotherapy to increase air flow in lungs.
Answering to the given question the current requirement is the devising a high priority action
strategy which would include maintaining proper oxygen supply since the patient is losing his
breath.
Nursing Interventions Rationale
Checking and
maintaining a proper
heart rate and
cardiovascular output
 Anaphylactic shocks induce hypotension condition development which
is caused when the pathogen releases endotoxins that starts circulating
in blood. Vascular dilation is induced as well, causing development of
the diseased condition which affects cardiac output. Administration of

3CLINICAL ASSESSMENT
Dopamine controls Hypotension conditions.
 controlling cardiac is necessary to harmonise the cardiac output which
is hampered by electrolytic and ionic components of heart causing
hypotension causing erratic heart rate
 Shallowness while breathing, speech difficulty is induced due to
hindrance in respiratory alleyway and should be controlled.
 Cardiovascular shocks can be synonymous with initialization of
anaphylactic shocks which also elevates, that is why it is essential to
check the cardiac output.
 Improvement of the cardiovascular output can be facilitated by
introduction histamines as well as vasodilators that halt the sepsis
reaction.
 Introduction of external oxygen supply from oxygen concentrator
systems can help the patient’s body balance the amount of CO2-O2.
The hypoxic condition will be controlled.
Question 3 (10 marks):
Analyzing the Arterial Blood Gas (ABG) of the patient, we can observe that the patient
has arterial pH considerably low; about 7.24, whose normal range is 7.35-7.45 generally. The
PaO2 or arterial oxygen pressure is: 55mmHg which is in the normal range of about: 80-

4CLINICAL ASSESSMENT
100mmHg. The pressure of Carbon Dioxide PaCO2 is quite high: 56mmHg, which should be
within 35-45mmHg in normal cases. The HCO3 or bicarbonate content of the patient in his
artery is: 24mmol/L, which within threshold range of 22-32mmol/L. The base excess or BE in
the arterial blood of the patient is: -2mmol/L which is also within normal range of (-2)-(+2)
mmol/L. Finally the Lactate content of the patient’s arterial blood is 5.2mmol/L which is
considerably high: 5.2mmol/L, this suggests that the patient has high lactic acid in his arteries,
meaning the arterial blood is under hypoxic conditions in comparison to the CO2 level.
Analysis of the ABG results interpret that the patient is undergoing acute acidosis in
lungs. This conditions result when the circulatory system cannot get rid of excess amount of CO2
and balance with O2 levels. Excess CO2 causes the pH of the arterial blood to drop down and
lower other fluids indicating acidic conditions, as in case of a pH meter. The balance of pH is
usually lost when there is significant malfunction in the lungs and inability to expire, mostly seen
in patients with respiratory problems and pneumonia. These results indicate that the patient has
respiratory troubles, chronic bronchitis which made it difficult for the patient to expire and
breathe. The lactic acid accumulation in the arterial system of the patient indicates that the
hypoxic conditions created due to the blockage of his alveoli caused by his pneumonia.
Commencement of an alternate antibiotic medicine and maintain the respiration of the patient
with an oxygen mask will stabilize the patient’s condition.