Case Study: Pathogenesis, Nursing Strategies, and ABG Analysis

This case study analyzes Mr. Farouq, a 75-year-old male diagnosed with community acquired pneumonia and severe sepsis. The analysis explores the pathogenesis of his condition, focusing on pneumococcal pneumonia and its progression. The assignment evaluates a high-priority nursing strategy aimed at improving the patient's airway patency, including rationale. Furthermore, it critically analyzes the arterial blood gas (ABG) results, revealing arterial hypoxemia, hypercapnia, and elevated lactate levels, which are correlated with the underlying sepsis. The study highlights the importance of nursing interventions such as secretion elimination, chest physiotherapy, and positioning to enhance respiratory function and conserve energy. The case underscores the critical role of nurses in managing pneumonia, emphasizing the need for comprehensive care, including patient education and discharge planning.

SHORT ANSWER ABOUT
CASE STUDY

TABLE OF CONTENTS
Critically analyse and explain the pathogenesis of the patient’s condition or deterioration?......1
Select a high priority nursing strategy, and include a rationale...................................................1
Critically analyse the arterial blood gas (ABG) results, and relate them to the underlying
pathogenesis?...............................................................................................................................2

Critically analyse and explain the pathogenesis of the patient’s condition or deterioration?
This is to evaluate a given case of 75 years old male patient named Mr Farouq due to a
diagnosed illness of community acquired pneumonia. He was admitted in the high acuity unit
with some initial treatments involved intravenous hydration with 3 distinct medications. After
which, the client reported issues in inhalation due to short breath.
Also, there existed several other diagnoses with a chest x- ray that discovered pneumonia
on the left side of his lower lobe. Beside this, on considering his past medical history, he has
been detected with pneumococcal pneumonia with severe sepsis.
It is therefore on analysing the pathophysiology of Mr Farouq and his deteriorated
condition, it has been found that Pneumococcal pneumonia is a type of pneumonia that severely
affects the upper respiratory area of an individual. Pneumonia is basically referred to be a lung
disease where pneumococcal pneumonia also spreads to the middle ear, blood and nervous
system of the patient.
The elderly people who are more than 65 years of age are at a greater risk of getting
affected from pneumococcal pneumonia as compared to the young individuals. It is however one
of the serious forms of pneumococcal ailment with some common signs of cough, trouble in
breathing with fever and chills, etc.
This is on considering the present case of Mr Farouq, he has been found to suffer from
Pneumococcal pneumonia with severe sepsis. Sepsis is referred to be yet another complicated
issue that gives a life threatening response to any such infectious trauma. This is mainly on
considering the fact where sepsis directly results in the failure of any body organ by together
leading to deteriorate the tissues.
This together involves some common symptoms of shortness of inhalation and high body
temperature, etc., where the patient in the current case has also found to deal with a high sinus
rhythm of 125 bpm along with a high body temperature of 39 degrees Celsius.
Apart from this, Mr Farouq has a past history of smoking for a very long time that has
raised the chances of getting infected from pneumococcal pneumonia with severe sepsis caused
due to a bacteria called Streptococcus pneumonia.
His chest x-ray has also provided some evident results of lower lobe pneumonia at the left
side of his chest. His overall condition is intensely terrible with a very low rate of blood pressure
that mostly leads to fatal cases of pneumonia with high chances of patient’s death.
1

Select a high priority nursing strategy, and include a rationale
It is on referring to the current case of Mr Farouq where he has been found to suffer from
community acquired pneumonia (CAP) which is one of the deadliest causes of death at a global
level. Nurses are known to play a pivotal role in the healthcare settings with a foremost
responsibility of performing both dependent and interdependent functions to aid into the
recovery of patient and his wellbeing.
On considering the present case of Mr Farouq, after the carried assessments and diagnosis
of the patient’s present condition, there exists a need of nursing care plan with some goals that
will involve improving the airway patency of the patient. This is on considering the existent
situation of Mr Farouq who has been diagnosed with some fine crackles at the base of his left
lung.
Resting is yet another main objective to converse energy with a proper maintenance of
suitable fluid volume and sufficient nutrition. For this purpose, it is also important for the nurse
to understand the overall treatment protocol along with the preventive measures by ensuring the
absence of any obstacles.
Although, all the above specified goals must be assisted by apt nursing priorities that firstly
involves the enhancement of patient’s respiratory functions by preventing any complication and
undertake a supporting restorative procedure.
Lastly, providing data about the procedure of the identified disease, its prognosis and
treatment is also a prime responsibility of the nurse. Several nursing interventions are known to
play a significant role in the management of pneumonia.
It is where elimination of secretion along with chest physiotherapy and coughing exercise
must be given to Mr Farouq to improve his airway patency. Likewise, to encourage rest and
conserve energy, the nurse should take assist the patient to situate himself in a semi fowler’s
position.
All of these nursing strategies should be followed by a proper evaluation of the patient’s
condition to check the attainment of the formulated goals. In addition to this, the patient should
be guided with clear guidelines of discharge and home care with appropriate and precise
documentation of the same.
2

Critically analyse the arterial blood gas (ABG) results, and relate them to the underlying
pathogenesis?
This is to assess the ABG results of Mr Farouq which has been done to measure the level
of oxygen and carbon dioxide in his blood. This also involves the evaluation of one’s acid level
in the body, also known as pH level whose consistency shows the sign of a healthy body.
 Here, on considering the case of Mr Farouq, a slightly low pH level has been observed
with 7.24 that is 0.11 less than the normal range of 7.35-7.45. This indicates a normal
result where the patient’s body has shown alkaline range of pH.
 It has been followed by the PaO2 level that normally ranges from 80-100mmHg where
Mr Farouq has a very low level of PaO2 that ranged merely 55mmHg. This in turn
reflected the signs of arterial hypoxemia that means an irregularly low oxygen level in the
blood. It can be together related to his low SPO2 which is merely 82% and must be 90%
or above as per its standard rate.
 PaCO2 has together been measured which normally ranges from 35-45mmHg and where
the patient in the present case has been found to have high level of PaCO2 ranging
56mmHg. This directly impacts upon the acid levels of blood where on considering the
existing test of Mr Farouq, this indicates the presence of hypercapnia. It also depicts the
condition of hypoventilation in him which is also not compatible with his alkalosis
respiration.
 Although, his bicarbonate level has been diagnosed to be normal with 24mmol/L HCO3.
It has been followed by a testing done for BE or base excess that has been found to be -
2mmol/L.
 Lastly, his lactate level has been found to be 5.2mmol/L which is very high and should
normally range from 0.3-0.8mmol/L. This clearly depicts some severe condition in
patients where on referring to the current case of Mr Farouq, this diagnostic result has
directly indicated the presence of sepsis in him. It is with uneven flow of oxygen and
blood all over his body with a severe lower shock.
3