Nursing Case Study: Pneumococcal Pneumonia in Elderly Patient

The case study presents an elderly patient diagnosed with community-acquired immunity, admitted with pneumococcal pneumonia and severe sepsis, complicated by chronic bronchitis and a history of smoking. The patient's airway is severely obstructed, exhibiting symptoms of dyspnea and airflow limitation, exacerbated by sepsis. Breathing is compromised, with an elevated respiratory rate, low blood pressure, and reduced oxygen saturation. Circulation reveals tachycardia and low diastolic blood pressure. The patient has a GCS score of 15, indicating alertness, but reports severe pain. The nursing strategy focuses on high-intensity oxygen therapy, aiming for specific oxygen saturation levels based on the patient's risk factors. Arterial blood gas (ABG) analysis reveals lower pH values indicating acidosis, normal alveolar arterial oxygen gradient, and elevated PaCO2, confirming severe respiratory sepsis. Bicarbonate levels are normal, while lactate analysis is high. The case study underscores the critical importance of comprehensive assessment, tailored nursing interventions, and ABG analysis in managing this complex clinical scenario.

Case study
The case review showcase an elderly patient previously diagnosed with community acquired
immunity. He has been on intravenous hydration, IV anti biotics poperaclin and Tazobactam
TDS and finally hydrocortisone. He is a heavy smoker nursing chronic bronchitis and is
admitted with pneumococcal pneumonia having severe sepsis.
Airway
The airway passage for the patient is severely obstructed with manifestation of bronchitis.
The patient might be suffering from dyspenia, which affect the trachea; the shortness of
breath can be severity in the case. Further dyspenia can be characterised from the patient,
with chronic respiratory sepsis on the patient, there is observation of airflow limitation. The
limited airway is linked to occurrence of sepsis occurs when the body is overwhelmed and
threatened with an infection which damages tissues, lungs and can even cause death.
Symptoms associated with sepsis infection include shortness of breath, high rate, shiver,
disorientation and sweaty skin cover.
Breathing
The associated risks factors of smoking, bronchitis infection, old age and pneumonia has
elevated the symptoms portrayed by the patient. The observed respiratory rate is higher than
normal range of 12-28 bpm for persons aged over 65 years. Further the blood pressure is
lower occasioned by the high fever temperature noted from the measurements undertaken.
The patient is exhibiting a respiratory rate of 35bpm, with increased expiratory phase and
SPO2, 82% on oxygen at 6L using Hudson mask. The higher marker of greater than .25bpm,
depicts severe respiratory sepsis. Deep breath Assesment shows that the chest expansion is
inversely proportional. The inspired oxygen counteraction and the Spo2 reading indicate
hyprcarpia.
Circulation
The sinuses assessment for the patient shows that the rates are 125bpm, while the blood
pressure is 80/60mmHg. Lower diastolic blood pressure indicates reduced output of the
cardiac. The role of nurse is to assess the veins of the patient, measuring and assessments of
capillary refill time. Due to the conditions of the patient there is need to perform heart
auscultation, the heart rate and blood pressure need to be reassessed regularly after every 5
minutes.
Disability
The GSG score has been calculated at 15; E4/V5/M6. The pain assessment of the patient
indicates that she has severe pain of 9/10 rating the measurement of disability Glasgow score

shows that the patient is at 15 ; E4/V5/M6, showing the patient is alert and able to
comprehend and understand conversation coherently
Exposure
The assessments of the patient exposure status indicate that there is positive use of muscles
and ankles with no swollen locations or injuries.
Glucose
The patient glucose status shows 5.4 mmol/L. The patient depicts normal blood sugar levels
ranges for the patient. Thus the patient has no signs of blood sugar level imbalances.
Nursing strategy
Provision of high intensive oxygen therapy for the patient is an effective nursing strategy.
This can be provided by oxygen reservoir flowing at 15Lpm, in order to minimise the
prevention of collapse of reservoir during the inspiration process.
Rationale
In acute respiratory sepsis, the aim is to ensure that there is maintenance of oxygen saturation
of 94%-98%. Patients such as in the case study who are at risk for hypercapnic respiratory
failures need to have oxygen saturation of 88%-92%.
Arterial blood gas analysis
ABG analysis provides oxygenation process, ventilation adequacy and acid –base
measurements. The ph status of the patient shows lower range values. The ph indices of the
patient show lower range values, signifying low level acidosis action. The Pressure of
Oxygen saturation (PaO2) exchange levels signifies normal alveolar arterial oxygen gradient
exchange. Thus measure of diffusion of oxygen in the alveoli level into the blood is
functional. The patient’s (PaCo2) levels indicate high values, which signify a severe
respiratory sepsis, which confirms sepsis diagnosis on the left side of the chest as displayed
by the chest X-ray. Bicarbonate ion (HCO3) illustrate normal range values, thus Bicarbonate
balance are in normal ranges, further the BE are signifying normal ranges however the lactate
analysis is high against the range values of 0.3-0.8 mmol/L.