Acute Life Threatening Conditions: Pneumonia Case Study & Analysis

This pneumonia case study delves into the pathogenesis of septic shock, explaining how it arises from the interaction between the host's immune system and pathogens, leading to hypoxia due to intrapulmonary shunting and cerebral perfusion issues. It highlights the reduced kidney perfusion causing dark urine and the impact of septic shock on blood volume and tissue perfusion. The study further examines the patient's verbal dysfunction due to potential brain dysfunction from sepsis, high respiratory rate as a compensatory mechanism, and fine crackles indicating exudate accumulation. The nursing strategy prioritizes effective airway clearance through assessment of chest movements, auscultation of lung fields, and monitoring of nebulizer and physiotherapy treatments. The analysis of ABG results reveals acidosis and high PaCO2 levels, indicative of a respiratory problem, along with elevated lactate levels due to anaerobic metabolism. Desklib offers a wealth of similar solved assignments and past papers for students.

Running head: PNEUMONIA CASE STUDY
PNEUMONIA CASE STUDY
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1PNEUMONIA CASE STUDY
Pathogenesis
Septic shock can be due to the pneumonia and is generated as a systemic inflammatory
responses caused due to the interaction between the immune system of the host and the
pathogens. The hypoxia in the patient having pneumonia is principally due to the persistence of
the blood from the pulmonary artery to the consolidated lung generating an intrapulmonary
shunt. The persistent pulmonary flow of the blood to the lung is caused by a failure of the
hypoxic pulmonary vasoconstriction. Hence there is a decreased level of oxygen availability in
the alveoli of the lungs. Cerebral perfusion also occurs in sepsis due to systematic inflammation,
this may cause cerebral hypoxia.
The kidney perfusion might have been reduced in the patient suffering from sepsis due to
pneumonia, which is the cause of dark colored urine, in a simpler way as the kidney detects the
low blood pressure and tends to hold back the fluid in the body with low fluid content in the
urine making it darker.
It can be found that the SpO2 volume is low that relates to the decreased tissue perfusion
due to the less circulating volume. In septic shock the circulatory blood volume is inadequate
that causes decreased peripheral vascular perfusion and the cellular metabolic derangements, at
first in the non vital organs and then in the vital tissues. This inadequate microcirculatory
perfusion is the attributing factor of all common types of shocks. This causes the generation of
histamine, serotonin, lysosomal enzymes that induces increased capillary permeability. It results
in decreased cardiac output and augmented peripheral resistance.

2PNEUMONIA CASE STUDY
Sepsis is sometimes characterized by brain dysfunction as it can cause microglial
activation and blood brain barrier dysfunction. All this might have causes the verbal dysfunction.
High respiratory rate is found in Farouq as lung is the most common site of infection and
tachypnea (higher breathing rate) is normally used as a compensatory mechanism for metabolic
acidosis, although there had been an equal rise and fall of the chest muscles, which signifies that
he is breathing easily. Fine crackles at the base of the lung sounds signify accumulation of
exudates in the airways that can be caused due to pneumonia. Farouq has hyperthermia with 39
℃, which might have been caused due to the inflammation of the lungs. The proinflammatory
cytokines are released in sepsis that causes inflammation in the lungs leading to high
temperature. D- E4V4M6 signifies that the Glasgow coma scale of the patient is 14, which
signifies that the patient is not in coma stage. Patients having the score within the range 3-8 are
always used to be in coma. Farouq had been suffering from low blood pressure as cytokines
released during septic shocks dilate the blood vessels causing low pressure.
High priority nursing strategy and rationale
One of the high priorities of nursing care includes the effective clearance of the airways.
Ineffective airway clearance can be done by assessing the rate of the chest movements and the
respirations. The case study reveals the fact that the patient had been suffering from shortness of
breath hence the airway should be managed properly. The lung fields have to be ausculated and
the areas of the increased or decreased airflow should be noted. Check for the crackles wheezes.
It is necessary to monitor and assess the effects of the nebulizer treatment and various respiratory

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physiotherapy treatments. Patient should be assisted in taking the bronchodilators, mucolytics,
and analgesics.
Rationale: Rate and depth of respirations would help to detect any tachypnea is present. Lung
fields have to be ausculated as decreased airflow may take place in parts with the consolidated
fluids. Crackles and wheezes would help to determine any fluid accumulation, obstruction or
airway spasm. Nebulizers help in the expectoration and liquefaction process, clearing the
airways.
Critical analysis of the ABG results
Low pH of the blood gases indicates that acidosis. The diagnostics reveals that the
PaCO2 level of the patient is quite high from the standard value. High PaCO2 level along with
acidosis signifies a respiratory problem. The bicarbonate level of the patient is in the normal
range. Patients suffering from pneumonia show CO2 in the alveolar air. The respiratory
mechanism shows weak response to the oxygen depletion as compared to that of the excess
carbon dioxide. The value of lactate is quite higher than the normal range. Severe pneumonia
and sepsis can cause the reduction in the blood volume that further increases the hypoxia in the
tissues and increases the anaerobic metabolism. Anaerobic metabolism increases the production
of the lactate by the NA- K ATPase channel and decreases the utilization of the lactate in the
muscles. Hence the lactate value is much higher in the given patient.