Prioritizing Patient Health Issues: Jim Cooper Case Study (UTS)

This report presents a case study analysis of Jim Cooper, a 69-year-old male admitted with community-acquired pneumonia. The assignment identifies and prioritizes five key patient health issues based on the morning shift report: difficulty breathing and impaired oxygenation, fluid volume deficit, anxiety, hyperthermia, and self-care deficit. The top three priorities, determined using the ABCDE assessment, are difficulty breathing, fluid volume deficit, and hyperthermia. The report provides a rationale for the order of prioritization, supported by current literature, and outlines the nurse's role in addressing each priority. Interventions include proper patient positioning, oxygen administration, intravenous fluids, antipyretics, and antibiotic therapy. The report emphasizes the importance of following nursing standards of practice to achieve positive patient outcomes.

Nursing
Student Name:
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Part one: Introduction
I have chosen the case of Jim cooper for this case study and this assessment will be presented
based on the morning shift report. From the case study, Jim cooper falls under the category of
people with a high risk of CAP and also presents with most of the signs and symptoms.
Community-acquired pneumonia is pneumonia acquired outside the hospital setting (Jain et al
2015, pp.835-845). The most common causative pathogens are streptococcus pneumonia,
Haemophilus influenza and atypical bacteria which include: mycoplasma pneumoniae,
chlamydia pneumoniae and legionella species. This infection can occur on its own or following a
flu infection. The most common predisposing factors to community-acquired pneumonia include
old age (>65 years), cigarette smoking, alcohol intake, and immunosuppressive conditions. Other
risk factors include conditions such as COPD, cardiovascular diseases, diabetes mellitus and
chronic liver diseases (Prina et al 2015, pp.153-160). The most common clinical manifestations
of community-acquired pneumonia include productive cough with greenish sputum, high fever,
chills and shivering, sharp chest pains and shallow rapid painful breathing (Prina, Ranzani and
Torres 2015, pp.1097-1108). This condition is however manageable if detected early and
appropriate interventions started as soon as possible.
Part two: Five priorities of care
This assignment will present case study 1, Jim cooper's health priority needs based on the
morning shift report. The five priorities of Jim cooper's health needs include the following: The
patient has difficulty in breathing as the patient reports to be sitting down the whole night and
also use of accessory muscles in breathing and impaired oxygenation due to lung consolidation
as a result of pneumonia (Ahtisham and Jacoline 2015). Secondly, the patient also has signs of
dehydration, therefore fluid volume deficit and decreased cardiac output (Castellan, Sluga, Spina
and Sanson 2016, pp 1273-1286). Besides, the patient is experiencing anxiety due to the
perceived threat to physical and emotional integrity. Jim Cooper has been taking care of himself
independently, and the disease has caused alteration and since he lives alone, anxiety is a result
(Nshimimana et al 2019). Fourthly, hyperthermia related to the body's response to infection as
evidenced by a high temperature of 38 degrees Celsius. Finally, the patient experiences self-care
deficit as he is not able to do all the things, he used to for himself hence requires someone to help
him. Therefore, the patient needs a relative or his child to take care of him.

Part three: Three top priorities of care
The three top highest patient-health issues from the five to be addressed include difficulty in
breathing and impaired oxygenation, fluid volume deficit and hyperthermia. The rationale for
this order of priority is based on the ABCDE assessment in nursing. With this, the priority is the
airway then breathing then circulation, level of consciousness and exposure (Tunlind, Granstorm
and Engstorm 2015, pp.116-123). Jim Cooper has patent airway but breathing difficulties. He
also has problems with the circulatory system and on exposure, the skin is not normal.
The first nursing care priority is difficulty in breathing related to the disease process (pneumonia)
as evidenced by the patient sitting down the whole night, use of accessory muscles during
breathing, respiratory rate of 36 breaths per minute, difficulty in speaking and scattered wheeze
on both lungs on auscultation. The chest x-ray also shows the presence of lung consolidation
(McAuley and Chawda 2017). Pneumonia is an infection that causes accumulation of pus in the
alveoli and therefore this affects the normal breathing pattern and gaseous oxygenation. The
SPO2 is 83% on room air. The production of a lot of mucus also impairs normal breathing as
accumulation affects the free flow of air to the lungs (Phillips-Houlbracq et al 2018, pp.290-
296). The nurse can intervene this by positioning the patient properly in bed by elevating the
head of the bed to sitting fowlers or semi-fowlers position to facilitate proper chest expansion as
abdominal contents are not compressing on the chest. The nurse also will administer oxygen via
nasal prongs. This increases oxygen supply to the lung and the tissues especially the vital organs
(Stephan et al 2015, pp.2331-2339). Once the oxygen saturation is within normal (95%-100%)
the respiratory rate will drop to a normal level. This is because chemoreceptors sense the oxygen
levels in the blood and send a signal to the respiratory muscles and therefore normalization of
respiratory rate to between 16 and 20 breaths per minute. If the secretions are too much
suctioning can be done to clear the airway and hence ease airway entry.
Secondly, fluid volume deficit related to inadequate fluid intake as evidenced by poor skin turgor
on physical, increased heart rate of 118 beats per minute, capillary refill of 3 seconds, pale and
dry mucous membranes and high blood pressure of 142/88 mmHg (Serkova and Mareckova
2019, pp.1041-1051). Dehydration can be fatal if not intervened promptly. Decreased fluid in the
body affects the transport of important nutrients and components such as oxygen, especially to
vital organs. Severe dehydration can complicate to hypovolemic shock which is a fatal condition.

The main intervention for this health need is the administration of intravenous fluids especially
when the patient cannot take orally.
Fluids that can be used include normal saline, ringers lactate, and 10% dextrose (Marik et al
2017, pp.625-632). Dextrose will help to correct blood sugars levels and avoid hypoglycemia. It
is important to assess the level of dehydration to know how fast the fluids will be given. The
amount of fluid to be given also depends on the dehydration state of the patient and caution to
avoid fluid overload. The pulse rate and blood pressure should normalize after fluid
administration. This is because the body responded to decreased fluid volume by increasing the
heart rate to increase cardiac output to the body tissues. Also due to body cells lacking water, the
brain sends a signal to the pituitary gland to release vasopressin hormone which causes
vasoconstriction hence raising the blood pressure. Therefore fluid correction normalizes the
blood pressure. The mucous membrane should be moist after rehydration as this leads to
increased blood flow to these sites.
Finally, another health need that needs to be addressed is hyperthermia related to disease
condition (pneumonia) as evidenced by a temperature of 38 degrees Celsius. Fever usually
results due to infection especially bacterial infection. When an infection occurs for example
pneumonia, the hypothalamus senses and the hypothalamic regulatory center induces an upward
displacement of temperature set point hence fever. A temperature elevation is believed to
enhance the body's immunity function to fight the pathogen growth. However, very high
temperatures can cause complications such as brain damage, coma and even death (Meier and
Lee 2017, pp.124-129). Therefore it is important to control the temperature within the normal
levels (36.5-37.5 degrees Celsius).
The nurse can achieve this by first exposing the patient and limit clothing and covering to allow
increase temperature loss. Antipyretics such as paracetamol can be administered as prescribed
especially when there is minimal change in temperature with exposure. The main treatment or
elimination of fever is treating the infection causing the fevers. According to Inzana et al (2015,
p.232), administration of intravenous antibiotics such as azithromycin, ciprofloxacin,
erythromycin, and other antibiotics helps to clear the infection. The drugs should be administered
at the right time and the right dosage for it to be effective and a full course of antibiotic should be

completed to avoid drug resistance. The infection may take days to weeks to clear but symptom
management should always be considered to make the patient as comfortable as possible.
Nurses should perform their work according to set standards and policies. Standards of nursing
practice developed by the American Nursing Association prove rules and definition of competent
care. From the component of professional standards of care define diagnostic, intervention and
evaluation competencies, the nurse has to diagnose the patient and draw a nursing diagnosis
based on the cluster of cues, plan for the intervention required and implement what was planned.
Evaluation should be done to determine whether to continue with the intervention or change it.
Every intervention should have a rationale and it should be to the benefit of the patient's health.
The nurse should always ensure to follow these guidelines and the patient outcome will be
promising (Marion et al 2016).
In conclusion, community-acquired pneumonia is a contagious condition but it has many risk
factors for one to get infected. The condition can be treated if diagnosed early and treatment
initiated as soon as possible depending on the priority. Majority of the patients recover fully with
no complication as long as they adhere to treatment regimen as prescribed. Rarely do
complications occur, but if they occur, they can be life-threatening.

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