Nursing Assignment: Analysis of Pneumonia Case Study and Nursing Care

This nursing assignment analyzes a case study of a 56-year-old female patient, Mrs. Carole Kennedy, admitted with pneumonia, focusing on clinical reasoning and nursing care. The assignment explores the patient's medical history, including ischemic heart disease and previous surgeries, and the changes in her clinical presentation, such as increased vital signs and chest pain. It delves into the pathophysiology of pneumonia and related cardiovascular issues. The report outlines nursing priorities, including airway management, breathing assessment, and circulation support, while also addressing psychosocial issues such as patient isolation and family support. The assignment emphasizes the importance of patient-centered care and the integration of clinical knowledge with practical nursing interventions to improve patient outcomes. The patient's history of smoking and its impact on her condition, along with the importance of family support, are also discussed.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the student
Name of the University
Author note

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Introduction
The clinical reasoning, which is also known as clinical judgment, is the method which the
clinicians follow for assessing the patient. This method has several steps- at first, the signs and
the symptoms are collected, and then the information is processed. After that, the medical
conditions of the patients need to be understood, and finally, the planning, implementation and
evaluation of the outcomes are done (Hunter & Arthur, 2016). This assignment is dealing with
the reasoning of the clinical issues of a patient suffering from pneumonia. Any subjective and
objective clinical problems are related to the past medical disease that the patient had suffered
from. In the given case study, the patient was suffering from pneumonia and chest pain. The
clinical issues that the patient was suffering from were related to past diseases. He clinical
sufferings were because of the surgeries that once he had undergone (Dalton, Gee & Levett-
Jones, 2015). This assignment is dealing with the pathophysiological process that the patient was
suffering from. It is also dealing with the priorities of nursing care and also with the psychosocial
issues that the patient had been suffering from.
Discussion
Changes in the clinical presentation and pathophysiology
The patient of the provided case study is a female of 56 years of age, and his name is Mrs
Carole Kennedy. She was admitted to the hospital with the clinical issue of pneumonia. The past
medical history of the patient is showing that he had suffered from ischemic heart diseases,
hypertension and peripheral vascular disease (Bartoletti et al.,2017). She had undergone
coronary artery bypass graft and saphenous venous graft, to the left anterior descending coronary
artery and the diagonal branch. Two years ago, the patient had undergone percutaneous trans
luminal coronary angioplasty. She had smoked for the past 30 years, and when she left smoking,
she was diagnosed with coronary diseases. Her clinical observation at 8.A.M was reasonable, but
suddenly after 30 minutes, she was found to be sweating, and at that time, all of her vital signs
has increased a lot. The pain score was 4/10, which started at the time while she was lying on the
bed only. The physical symptoms reported, were the sudden sweating and slight breathlessness
and the peripheries were a little cold to touch. Her subjective symptoms were that the values of
all of her vital signs have increased. The heart rate had increased to 116 bpm, the body

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temperature was slightly increased to 37.2, and the respiratory rate was increased to 26 beats per
minute. The blood pressure got reduced to 105/70 mmHg, and the level of saturated oxygen was
also got reduced to 92% within the room.
The pathophysiology behind this is that patients suffering from pneumonia show a sudden
increase in body temperature and because of this, the body temperature of the patient has got
increased (Mahfuz et al., 2017). The patient was suffering from chest pain as the windpipe, and
the muscles become tenderer. Due to pneumonia, the patient was suffering from mucous
clogging as she was not able to breathe correctly. The concentration of oxygen saturation was
reduced to 92%, the average value of which should be 95%. As the level of oxygen decreased the
respirator rare had increased. The past medical history of the patient shows that she had had
coronary artery disease and had undergone several surgeries (Torres et al., 2015). Patients who
had suffered from pneumonia have chances of developing heart diseases. So in the given case, it
can be said that the patient may again suffer from heart diseases as he had acquired pneumonia.
The blood pressure of the patient suddenly increased as she suddenly became tensed because of
the chest pain. In the past, also she had suffered from hypertension, and she uses to do
hypertension frequently.
The priorities of care
While providing care to the patient, the nurse must consider the preferences of the
patient. The patient of the presented case study was suffering from pneumonia, so she must be
suffering from problems associated with airway, breathing and circulation (Chan et al., 2016).
The patient must be cautious about the fact that the airway must be cleared so that she can
breathe properly. When the patient is unconscious, the airway management must be done to
prevent the patient from hypoxia. The common problems of the unconscious patients are
blocking off the pharynx by the tongue, when a foreign body is inhaled and vomiting. The head
and chin of the patient should be slightly tilted to allow the air to pass (Nakamura et al., 2015).
The patient of the given case study was conscious so she must be taught to include the
paradoxical movements of the chest, using the accessory muscles to breadth. The patient should
know tracheal deviation, inhale and exhale of air by making noises ad cyanosis.
The next area of assessment is breathing for both conscious and unconscious patients. At
first, the nurse has to assess the breathing rate of the patient is healthy or not. If the respiratory

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rate goes down, then CPR should be considered; however, the healthcare professionals have their
protocols to maintain the respiratory rate. The position of the patients must be changed in acute
cases. The patient of the given case study was conscious the care giver should immediately
assess for life-threatening conditions and depending on the status of the patient, the diagnoses
should be made (Donovan et al., 2015). The patient of the case study had been suffering from
pneumonia so the nurses should check the accessory muscles of breathing, abdominal breathing,
the proper position of the patient and sweating. The rate, depth and rhythm of the respiration
must be checked and analysed. Apart from all of these, the deformity of the chest and the chest
movement must also be corrected. The nurse should listen to the noise of breath over a short
distance to reveal any dysfunction is present or not (Considine & Currey, 2015). The patient of
the given case study should be analysed with all of these diagnoses.
After the breathing comes, the circulation of the air to the rest of the body. Once oxygen
has been delivered to the lungs through the clear airways and efficient respiration, oxygen has to
be circulated to the rest of the body. At first, the pulse has to be checked to make sure that
whether the person is breathing or not and then only the further steps should be provided.
According to the modern protocols for the non-breathing persons, the person has to lay down to
check the pulse. However, this step needs to be omitted if the rescuers are not sure in
determining whether the patient has a pulse or not. In this case, there is less risk of harm if the
chest compressions are performed (Ferrada et al., 2018). The healthcare professionals must keep
in mind the facts that they should include the pulse check under the ABC check. For the persons
who are breathing their chances that the diagnoses can be considered further. The color and the
temperature of the hands should be assessed, whether it is cold, blue, pink or pale. Capillary refill
is an assessment to find whether the capillaries are working or not. The pulse should be checked
by considering both centrally and peripherally. The blood pressure should be checked for
assessing whether there is any sign of shock or not (Chadwick & Withnell, 2016). The healthcare
professionals must also consider the facts of auscultation of the heart. Electrocardiograph can be
done to assess the underlying conditions of the heart. The patient of the given case study should
be evaluated withal of these methods. The airways, breathing and circulation are the priorities of
the patent as she was suffering from pneumonia.

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Psychosocial issues
A patient, whether suffering from a mental or physical illness, has to suffer from
psychosocial specific problems relating to the diseases. A person suffering from pneumonia face
difficulties in talking with the people as they continuously cough and suffer from breathlessness.
Some people are there who have a habit of insulting people suffering from problems in
breathing. Pneumonia is an infectious disease and easily gets spread from one person to another.
So the patients may feel secluded from the other people (Singla et al., 2015). The family members
play an essential role in improving the mental conditions of the patients. Apart from the doctors
and the nurses, the family members should communicate with the patient effectively so that the
patient does not suffer from depression. Not only pneumonia a patient suffering from any other
diseases suffer from depression. They rarely talk with other people and also are not able to share
their health issues with other people (Ducat et al., 2015). The family members and friends should
support the patient, respect her so that she do not feel neglected. In the given case, the patient
used to live alone, so in this case, the family members will not be able to take care of her. The
nurses only have to do everything for her (Hudson et al., 2017).
Conclusion
The assignment has come to an end. From this assignment, much about clinical reasoning
can be learnt. The diseases that a patient suffer are very much related to past health issues. So a
patient, when acquiring a particular infection, must be aware of all the expected future effects of
the disease. A patient must start taking prevention at the onset of any illness to avoid an
exacerbation of the disease during the later stages of their life. The patient of the given case
study

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