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    Scenario Title: Community Acquired Pneumonia Learning Outcomes: 1. Assessment and Recognition of The Signs and Symptoms of Pneumonia

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    Dud Acc
    1. The patient is a 62-year-old female brought to the ED for shortness of breath and hypoxia, and is being treated for presumed community-acquired pneumonia. 2. Her condition is worsening, with declining oxygen saturation despite supplemental oxygen. 3. She has significant comorbidities including obesity, pulmonary hypertension, and a history of respiratory failure requiring intubation.

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    Scenario Title: Community Acquired Pneumonia Learning Outcomes: 1. Assessment and Recognition of The Signs and Symptoms of Pneumonia

    Uploaded by

    Dud Acc
    38 views6 pages
    1. The patient is a 62-year-old female brought to the ED for shortness of breath and hypoxia, and is being treated for presumed community-acquired pneumonia. 2. Her condition is worsening, with declining oxygen saturation despite supplemental oxygen. 3. She has significant comorbidities including obesity, pulmonary hypertension, and a history of respiratory failure requiring intubation.

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    Pneumonia

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    1. The patient is a 62-year-old female brought to the ED for shortness of breath and hypoxia, and is being treated for presumed community-acquired pneumonia. 2. Her condition is worsening, with declining oxygen saturation despite supplemental oxygen. 3. She has significant comorbidities including obesity, pulmonary hypertension, and a history of respiratory failure requiring intubation.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    38 views6 pages

    Scenario Title: Community Acquired Pneumonia Learning Outcomes: 1. Assessment and Recognition of The Signs and Symptoms of Pneumonia

    Uploaded by

    Dud Acc
    1. The patient is a 62-year-old female brought to the ED for shortness of breath and hypoxia, and is being treated for presumed community-acquired pneumonia. 2. Her condition is worsening, with declining oxygen saturation despite supplemental oxygen. 3. She has significant comorbidities including obesity, pulmonary hypertension, and a history of respiratory failure requiring intubation.

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    Scenario Title: Community Acquired Pneumonia

    Learning Outcomes: 1. Assessment and recognition of the signs and symptoms of pneumonia.
    2. Initiate interdisciplinary collaboration in a hospital setting.
    3. Select appropriate interventions
    • Check vital signs.
    • Oxygen – Apply 2-4 L/nasal cannula as ordered
    • Insert a Foley catheter
    • Complete an assessment specific to evaluate pulmonary edema.
    • Administer an IV medication
    4. Monitor therapeutic response to interventions (Outcomes).
    • Monitor that patient will not have difficulty breathing and will
    maintain oxygen saturations at > 90%.
    • Monitor urinary output
    Scenario Goals: Initial management of a dyspneic, hypoxic patient with presumed pneumonia
    Patient Case Summary:

    You are on call for ED Nurse, and you are asked to take care a 62-year-old lady who was brought in by EHS with
    shortness of breath and is being treated by the emergency physician as a pneumonia based on her initial vitals which
    included a fever of 38.7, oxygen saturation of 84% on room air, and her radiographic findings. They ordered some initial
    investigations and gave her a dose of levofloxacin. They also gave her Ventolin and Atrovent nebs. They are concerned
    because she in the past has had an episode of hypoxic respiratory failure requiring intubation. You have her on your list
    and are busy seeing other patients when her nurse pages you that her oxygen saturation is worsening.

    ADDITIONAL PATIENT INFORMATION


    Detailed Case Data: Name: Mrs. Jones MC#:
    Gender: F Age: 62 Weight: 98kg Height: 165cm BMI: 36
    Other information:

    Vital Signs:
    Time or Triage (t- First gas 0:00 0:05 0:15 (fast 0:20
    5h) (t-4.75h) (called to forward)
    assess)
    State Dyspneic Speaking Speaking Now Increased Intubated, on a
    short short more WOB, volume assist mode
    sentences sentences, upright, decreased with tidal volumes set
    restless, with SpO2 to 6 mL/kg, initial
    pulling at HFNP FiO2 100 with PEEP
    mask 18.
    Temperature 38.7 38.4 37.2 37.2 37.2 36.8
    Heart Rate 115 105 110 110 120 95
    Blood Pressure 130/80 130/80 145/85 140/80 150/80 125/75
    Respiratory Rate 36 32 32 32 28 16
    Pulmonary Pressures

    pg. 1
    Oxygen Saturation 84% on RA 98% on 85% on 90% on 85% on 90% on the ventilator
    100% 88% with 100% 100% FiO2
    FiO2 NRB FiO2
    (high flow
    nasal
    prongs)
    Cardiac Rhythm Sinus tach Sinus tach Postintubation
    hypotension and PEA
    arrest if not volume
    resuscitated in tandem

    If not intubated,
    hypoxic respiratory
    arrest
    Other: CXR#1 ABG #1 ABG#2
    correlates and correlates
    with now CXR#2 with now
    correlate
    with now

    Chief Complaint: Shortness of breath


    Past Medical History: OSA with resultant pulmonary HTN and right heart failure, HTN,
    dyslipidemia, Type II DM, previous TIA, hypothyroidism
    Medications: Synthroid, Metoprolol 100 bid, Plavix, Furosemide 40 bid, Novolin NPH and
    Novolin Toronto, Metformin, enalapril, warfarin, amlodipine
    Allergies: NKDA
    Data Summary: (if normal, please indicate)
    Relevant Lab Data: ERP had already drawn: VBG, CBC, lytes, BUN, Cr, Coags, Troponin, and
    Blood cultures x 2.
    Repeat troponin, ABG, sputum culture can/should be requested by the
    medicine resident, and the repeat ABGs/Trops can be provided to them. See
    attached.
    Troponin stable X2 at 54.
    Leader may opt to not repeat ABG after they get the first one and then the
    patient gets worse.
    Relevant Imaging Data: CXR x 2 in ED, and previous CXR for comparison. See attachments.
    ECG: see attachment

    pg. 2
    Relevant Physical Exam On initial examination:
    Findings: • General: appears awake and alert, tachypneic but not significantly
    distressed, head of bed at 45 degrees, patient is slouched down in the
    bed.
    • CNS: alert and oriented, mentating well, normal neurologic exam.
    • CVS: blood pressure and heart rate as per vitals. JVP ~5cm ASA, no
    pedal edema
    • Resp: tachypneic, able to speak ~5-word sentences, denies significant
    distress, no intercostal indrawing or paradoxical abdominal motion. On
    auscultation, decreased breath sounds to both bases, worse on the right,
    with some bronchial breath sounds. No other adventitia.
    • GI: belly soft, no masses/organomegaly. Tympanic with bowel sounds
    throughout.
    • MSK/Derm/Heme: no leg swelling/erythema/calf tenderness
    Oxygen saturation improves with improved position and increase in FiO2.
    Then oxygenation worsens:
    • Still alert and oriented
    • CVS exam unchanged
    • Only speaking 1-2 words at a time. RR not as high but has intercostal
    indrawing and paradoxical abdominal movement.
    • Remainder of exam unchanged.

    Xavier Ateneo University Hospital Jones, Jane


    Central Laboratory Reporting 21/09/1953
    Faber Hall Building
    5788 University Ave

    ARTERIAL BLOOD GASES


    Collection Date: Today
    Collection Time: 10 min ago

    Procedure Units Ref. Range


    TEMPERATURE C 37.2
    FIO2 .88 on NRB
    ACID/BASE@37C
    pH [7.35-7.45] 7.40
    PCO2 mmHg [35-45] 46
    PO2 mmHg [80-103] 48
    HCO3 mmol/L [21-29] 28
    BE [-3 – 3] 3
    OXYGEN STATUS@37C
    O2 CONTENT mL/dL [15.6-21.0] 13.1
    SO2 % [94-98] 85
    OXYHEMOGLOBIN % [94-98] 83
    HEMOGLOBIN g/L [115-155] 112
    CARBOXYHGLOBIN % 1.7

    pg. 3
    METHEMOGLOBIN % [< 1.0] 0.4
    ELECTROLYTES
    SODIUM mmol/L [138-145] 138
    POTASSIUM mmol/L [3.6-4.7] 4.1
    IONIZED CALCIUM mmol/L [1.07-1.41] 1.28
    METABOLITE
    LACTATE mmol/L [0.5-2.0] 3.1

    Xavier Ateneo University Hospital Jones, Jane


    Central Laboratory Reporting 21/09/1953
    Faber Hall Building
    5788 University Ave

    ARTERIAL BLOOD GASES


    Collection Date: Today
    Collection Time: 10 min ago

    Procedure Units Ref. Range


    TEMPERATURE C 37.2
    FIO2 100 on HFNP
    ACID/BASE@37C
    pH [7.35-7.45] 7.40
    PCO2 mmHg [35-45] 49
    PO2 mmHg [80-103] 48
    HCO3 mmol/L [21-29] 30
    BE [-3 – 3] 4
    OXYGEN STATUS@37C
    O2 CONTENT mL/dL [15.6-21.0] 13.1
    SO2 % [94-98] 85
    OXYHEMOGLOBIN % [94-98] 83
    HEMOGLOBIN g/L [115-155] 112
    CARBOXYHGLOBIN % 1.7
    METHEMOGLOBIN % [< 1.0] 0.4
    ELECTROLYTES
    SODIUM mmol/L [138-145] 138
    POTASSIUM mmol/L [3.6-4.7] 4.1
    IONIZED CALCIUM mmol/L [1.07-1.41] 1.28
    METABOLITE
    LACTATE mmol/L [0.5-2.0] 3.4

    pg. 4
    pg. 5
    pg. 6

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