Pt with Pneumonia clarifying nursing problems

[Coop_696]

hi all

don't worry i am not asking you to do my assignment for me i just need some clarification on one of the qs as the lecturer is leaving me more confused than ever (i did see her)

i have the following case study:

75 year old male admitted to the medical ward with pneumonia. he has been feeling generally unwell and coughing for the past two weeks. when you come in to see him, he is sitting up in bed. has an audible inspiratory wheeze. other data include: temperature: 38.5 0c, respiration rate: 24 breaths/min, oxygen saturation: 95% on oxygen mask 5l/min, skin colour: pink.

question 1 : select 3 signs or symptoms from above. justify/explain the underlying pathophysiology for each selected sign or symptom, using current evidence-based literature.

i focused on fever/elevated temp, audible wheeze and low o2 sats although i'm contemplating using his cough instead as it has some nicer articles to back it up pathophys wise!

any thoughts? i've written up a paragraph for each sign or symptom already so just deciding which 3 to use :-)

question 2 : based on the assessment data stated above, identify two priority problems. briefly explain how each identified problem relates to the patient's assessment data?

now this is the q i have problems with! i know that associated nursing diagnoses would be: ineffective airway clearance, impaired gas exchange, activity intolerance, risk for fluid volume deficit or actual fluid volume deficit, risk for knowledge deficit and risk for nutrition imbalance (less than body needs)

i have decided after discussion with the lecturer to use ineffective airway clearance as one of my priority problems however she left me very confused as she kept saying nursing problems/priority problems arent the same thing (she was ok with me using ineffective airway clearance though) but everything i've read seems to say they are (the tutors seem to think they are the same too). also i'm not entirely sure which second problem i should focus on as the lecturer said ineffective airway clearance and impaired gas exchange are too similar... i would have thought they where the 2 priority problems? and due to the minimal information i'm also not sure if i can state that he has activity intolerance or deficient fluid volume (another major priority)

any help would be greatly appreciated! i've been going around in circles the last few hrs (i still have a week to figure this out at least :-))

also it's only 500 words hence the whole only a paragraph for each sign or symptom!

[Coop_696]

Anyone? help? pretty please?!

[Julianka]

hi looks like we are struggling with the same assignment...QUT??? second year?

[Coop_696]

Argh! Yes!!! haha I even went and had a meeting with Jo but she only said that I seem to have well developed critical thinking skills and that my ineffective airway one is more than fine to use. However she kept saying we can't use nursing diagnoses and had to use priority problems :S and she gave me no help whatsoever in confirming if I was on the right track for the second problem.

I think a lot of people are using nursing diagnoses buuuuut Jo said she is looking for more than that(?) So confusing and my tutor hasn't said anything about the assignment at all!

Are you having similar problems? it's so hard when there is no more information than that! Have you got any thoughts on what she wants?

[pharmgirl]

wow. I'm at a loss. Granted airway clearance and gas exchange are similar but they are 2 different things. I wouldve gone with both of them as well. However, since that isn't what she is wanting....the only thing I can think of would be to go down the ABC list. Airway you have covered, Breathing (wheezing, gas exchange, can't use, too similar per intructor) so I guess we move to Circulation? Impaired tissue perfusion? d/t poor oxygenation? Fever = dehydration = fluid deficit etc.,etc.,??? Maybe I'm reading into it too much, there really isn't very much information in the case study.

As far as the problem/priority? My take on what she is wanting is there are several problems assoc. with this diagnosis. Risks of several things. However they are not the same as "priority" issues. I dont think she wants someone writing down Increased risk of skin integrity when there are other issues that would be initially more important.

I hope this helps maybe a little. Just my take on it, but I dont know your instructor either. Good Luck and let me know what you come up with. I'm curious!!!

[Coop_696]

Hi pharmgirl!

Thanks for your input :-) I'm worried I'm reading too much into it as well as I had similar thought process... I think almost everything is a "risk for" as even with fluid volume deficit we don't know anything further than the above info... it doesn't say if he is drinking/eating normally or has increased fluid intake *tears hair out*

Perhaps I should just say he has it/impaired gas exchange try and relate it as much as possible to the case study and just use some generic pathophys (My para on fever has a bit about the cooling mechanism the body employs to decrease it so hopefully that backs me up a bit!)

perhaps I can just use the terms 'possibly and likely' a lot! lol

hmmm now just to decide which is more important as well as dissimilar enough too ineffective airway clearance! at least for the second assignment (based on the same case study but using interventions based on problems) she will be giving us the problems to work from!

[Coop_696]

Well I ended up going with impaired gas exchange and ineffective airway clearance as they seem like the biggest problems to me! Although I have heard a cpl of people are going with dysfunctional/altered breathing patter (I don't think there is enough evidence to use it though)