Case Study: Prioritizing Health Issues for Jim Cooper (Morning Shift)

This case study focuses on the prioritization of health issues for a 68-year-old patient, Jim Cooper, admitted to a respiratory medical unit with a history of COPD and symptoms of pneumonia. The assignment identifies five key health issues: impaired gas exchange, wheezing cough and obstructed a...Read More

PRIORITIZATION OF HEALTH ISSUES: CASE STUDY ON JIM COOPER (MORNING SHIFT)
PRIORITIZATION OF HEALTH ISSUES: CASE STUDY ON JIM COOPER (MORNING SHIFT)
Name of the Student
Name of the University
Author’s Note

1PRIORITIZATION OF HEALTH ISSUES: CASE STUDY ON JIM COOPER (MORNING SHIFT)
Table of Contents
Part One......................................................................................................................................2
Identification of five patient health issues.............................................................................3
Three health issues given highest priority..............................................................................3
Part Two.....................................................................................................................................4
Ranking the health issues in order of priority........................................................................4
Rank one.................................................................................................................................4
Rank two................................................................................................................................5
Rank three..............................................................................................................................5
Part Three...................................................................................................................................5
References..................................................................................................................................8

2PRIORITIZATION OF HEALTH ISSUES: CASE STUDY ON JIM COOPER (MORNING SHIFT)
Part One
A sixty eight year old patient named Jim Cooper was transferred to respiratory
medical unit from the emergency department during the morning shift. Post receiving the
handover, potential risk factors need to be identified along with careful assessment of his
health complications. Identification of the warning signs along with prioritization of the
health issues is a vital task as the registered nurse on duty in the morning shift so as to check
the deterioration of health along with limiting the potential risks along with providing the best
possible care to achieve optimal health outcomes for patient, Jim Cooper.
The patient vitals were analysed and on evaluation with the normal ranges, the
following critical issues were noted.
Body Vitals Normal range Patient Readings Remark
Heart rate
60 and 100 beats per minute
(bpm)
118 bpm Elevated heart rate
Rate of
respiration
12 to 20 breaths per minute 36 breaths/min High rate of respiration
Oxygen
saturation
95%-100% 88%
(RA– 93%; 2L O2
NP)
Impairment of the gas
exchange, Low oxygen
saturation
Blood
pressure
120/80 mm Hg 146/92 mmHg Increased blood pressure
noted
Temperature 36˚C to 37˚C 38˚C oral Hyperthermia
Auscultation
Loud and high pitch of
bronchial breath sound over
trachea is considered normal
Scattered wheeze in
both the lung fields
Obstruction in the airway
pathway

3PRIORITIZATION OF HEALTH ISSUES: CASE STUDY ON JIM COOPER (MORNING SHIFT)
Diagnostic test results
Spirometr
y
FEV1 at 50% predicted
CXR Lower left lobe consolidation
ECG Sinus tachycardia
ABGs
pH 7.32 and PaCO2 55mm Hg and PaO2 70 mm Hg and HCO3
25mmol/L
FBC Hemoglobin 142mmol/L, WBC 13.8x109/L
U&Es
Urea level 11.3mmol/L,
Creatinine level 75 μmol/L,
Na level 133 mmol/L,
K level 3.7mmol/L,
Cultures
Bacterial culture of sputum and urine. Pneumococcal antigen found
Community acquired pneumonia has being diagnosed
Identification of five patient health issues
The five health issues of the patient that require nursing attention includes the
following.
i. Impairment of the gas exchange
ii. Wheezing cough and obstructed airway
iii. Hyperthermia
iv. Hypercholesterolemia
v. Alcohol withdrawal and probable depression

4PRIORITIZATION OF HEALTH ISSUES: CASE STUDY ON JIM COOPER (MORNING SHIFT)
Three health issues given highest priority
Based on the fact that Jim Cooper has been admitted with breathing difficulties along
with medical history in chronic obstructive pulmonary disease, three health issues given
highest priority are impairment of the gas exchange in addition to wheezing cough and
breathing issue along with hyperthermia (Elbehairy et al. 2015). Fever of 38˚C might be due
to pneumonia infection in the lungs leading to hyperthermia. The alcohol withdrawal along
with symptoms of depression like loneliness can be taken into consideration after stabilizing
his critical health conditions (Mirijello et al. 2015). A structures patient centered care
management plane must be formulated to provide physical comfort along with emotional
support by involving the members of his family in addition to recommending experts from
alcohol rehabilitation program and psychiatric facilities to aid Jim in reducing his anxiety,
loneliness, social issues and depression (Iasiello et al. 2016).
Part Two
Ranking the health issues in order of priority
Rank one
Management of the impairment of gas exchanges has been given maximum priority as
impaired gas exchange involves low oxygenation and inadequate elimination of carbon
dioxide from the lungs at the alveolar-capillary membrane and thereby has taken Jim’s COPD
at a progressive stage (Hoiland and Ainslie 2016). The diagnostic test has revealed
community-acquired pneumonia and Jim already has a medical history of COPD which is
incurable but can be managed with proper medical intervention (Alwadhi et al. 2017).
Although he is being administered 2L oxygen, the oxygen saturation has not gone up beyond
93% which is a matter of concern (Iasiello et al. 2016). The arterial blood gas (ABGs) tests

5PRIORITIZATION OF HEALTH ISSUES: CASE STUDY ON JIM COOPER (MORNING SHIFT)
show the partial pressure of the carbon dioxide (PaCO2) in the arterial blood to be 55mm Hg,
which indicates hypercapnia that is fatal as it might induce coma if not managed immediately
with medical intervention as required (Feller-Kopman and Schwartzstein 2018).
The chest radiography report along with culture results has revealed critical
pulmonary pneumonia infection of the patient which has filled Jim’s lungs with fluid and pus
thereby obstructing the gaseous exchange leading to the decrease in the level of oxygen
saturation (Wenker et al. 2017). Therefore, oxygen therapy is a fundamental requisite for the
patient along with administration of IV antibiotics to manage the pneumonia infection and aid
recovery of the impaired gas exchange.
Rank two
Wheezing cough along with obstructed airway has been given second priority.
Auscultation had reported presence of wheezes which are scattered in both the lung fields
which reflects obstruction in the airway path which has led to the lowering of adequate
gaseous exchange in the lungs (Shigemura et al. 2017). Jim also has a productive cough
which indicates presence of thick sticky mucus further blocking the airway passage and
causing breathing difficulties and lowering the oxygen saturation level for Jim. Protocols for
airway clearance techniques (ACTs) must be encouraged by the nurses so as to loosen the
mucus from the walls of the airway passage and help the patient improve the oxygen uptake
(Dang and Dearholt 2017).
Rank three
The third issue that requires attention with priority is the fever of 38 °C which is most
probably due to the pneumonia infection in the lungs. The hyperthermia is making the patient
uncomfortable and anxious which is not desirable given his hypertensive body vital reading
of 146/92 mm Hg (Alexander et al. 2015). The nurse can suggest administration of antipyretics to

6PRIORITIZATION OF HEALTH ISSUES: CASE STUDY ON JIM COOPER (MORNING SHIFT)
the physician as a clinical management of the fever and replace blanket with thinner sheets for
covering the patient. Lowering the temperature is vital as the increased temperature might make the
patient irritable and increase the level of anxiety which is not desirable as he already has an elevated
rate of respiration and high blood pressure (Atalla, Aboalizm and Shaban 2016).
Part Three
In order to concentrate on health issues of Jim Cooper with efficacy is one of the
eminent roles of nurses along with reducing the potential risk factors with the scope of
nursing practice. Chief role of registered nurse in Jim’s care is to monitor the oxygen therapy
of the patient and regulate it as per requirement as it will be a long term therapeutic need to
aid the patience attain proper gaseous balance (Nurse Organisation, 2017). The nurse must
also check the dosage of the medication during administration and maintain the precise
timings of administration of the medications. The nasal cannulas, non-rebreathing facemask
along with the Hudson mask along with extensions of the cannular channel must be kept
handy by the nurse along with extra supplies as these equipments are vital in delivering
oxygen delivery (Kurhekar et al. 2017).
The nurse must maintain a checklist of the vital reading that needs to be monitored
and filled out regularly. Monitoring of the Glasgow Coma Scale for Jim must be done on a
regular basis to asses health condition and predict deterioration of Jim’s hypoxia and
hypercapnia which are potential risk factors of coma (Nurse organization,2017).
The clearance of airway along with proper expansion of the lung is the decisive
components of good respiratory health. However, both these factors are compromised in case
of Jim. The medical history of chronic obstructive pulmonary disorder along with the thick
sticky mucus because of Jim’s pneumonia is the main causes obstructing the airway and
leading to a ineffective airway clearance. The various procedures of airway clearance

7PRIORITIZATION OF HEALTH ISSUES: CASE STUDY ON JIM COOPER (MORNING SHIFT)
techniques must be taught by the nurses along with educating Jim the right way of doing the
airway clearance procedures and the benefits of it (Radermacher, Maggiore and Mercat
2017). The nurse can also recommend physiotherapist’s addition input in the techniques of
airway clearance.
Breathing exercises can be recommended by the nurse with the support from the
physiotherapist. Educating Jim about these breathing exercises will help him control his
COPD post discharge from the hospital. In addition, COPD management could be achieved
by the incorporation of right physical activities and lifestyle habits and the nurse can educate
him and encourage him to follow these advices post discharge as they will help him lead a
healthier life with lesser health complications (Moleyar et al. 2017).
Regular administration of IV antibiotics must be maintained by the nurse in charge
which has been prescribed to aid Jim in reducing the symptoms of pneumonia by the medical
team (Jain et al. 2016). Levofloxacin is the antibiotic of choice for treatment of pneumonia
and precise accurate dosage of Levofloxacin must be prepared before administering it
intravenously (Gamache and Harrington 2017). Careful regular monitoring of the patient is
one of the chief roles of the nurse (Atalla, Aboalizm and Shaban 2016). Any sign of
deterioration or decline of status of the reading of the body vitals must be reported to the
medical team by the nurse immediately and brought to notice along with documenting the
same with accurate time mentioned of the event (Nurse Organisation, 2017).

8PRIORITIZATION OF HEALTH ISSUES: CASE STUDY ON JIM COOPER (MORNING SHIFT)
References
Alexander, M., Durham, C.F., Hooper, J.I., Jeffries, P.R., Goldman, N., Kesten, K.S.,
Spector, N., Tagliareni, E., Radtke, B. and Tillman, C., 2015. NCSBN simulation guidelines
for prelicensure nursing programs. Journal of Nursing Regulation, 6(3), pp.39-42.
Alwadhi, V., Dewan, P., Malhotra, R. K., Shah, D., & Gupta, P. (2017). Tachypnea and other
danger signs vs pulse oximetry for prediction of hypoxia in severe pneumonia/very severe
disease. Indian pediatrics, 54(9), 729-734.
Atalla, H.R., Aboalizm, S.E. and Shaban, H.A., 2016. Effect of nursing guidelines
compliance to infection control among nursing student. J Nurs Health Sci, 5(1), pp.23-34.
Dang, D. and Dearholt, S.L., 2017. Johns Hopkins nursing evidence-based practice: Model
and guidelines. Sigma Theta Tau.
Elbehairy, A.F., Ciavaglia, C.E., Webb, K.A., Guenette, J.A., Jensen, D., Mourad, S.M.,
Neder, J.A. and O’Donnell, D.E., 2015. Pulmonary gas exchange abnormalities in mild
chronic obstructive pulmonary disease. Implications for dyspnea and exercise
intolerance. American journal of respiratory and critical care medicine, 191(12), pp.1384-
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Feller-Kopman, D.J. and Schwartzstein, R.M., 2018. Mechanisms, causes, and effect s of
hypercapnia. Up To Date. Waltham, MA: Up To Date Inc.
Gamache, J. and Harrington, A., 2017, Bacterial Pneumonia Medication, Medscape, viewed
2nd September 2018, https://emedicine.medscape.com/article/300157-medication

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Hoiland, R.L. and Ainslie, P.N., 2016. CrossTalk proposal: the middle cerebral artery
diameter does change during alterations in arterial blood gases and blood pressure. The
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