Case study - Community-acquired pneumonia: Nursing

Nurse Jodie works on a medical-surgical unit and is caring for Ann, a 44-year-old with a history of smoking who was recently admitted for community-acquired pneumonia. In collaboration with the registered nurse, RN Seth, Nurse Jodie goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Ann’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Jodie recognizes important cues including Ann’s vital signs, which are temperature 101.5 F or 38.6 C, heart rate 100 beats per minute, respirations 21 breaths per minute and regular, blood pressure 105/68 mmHg, and oxygen saturation 90 percent on room air. Upon auscultation, Nurse Jodie notes coarse crackles and slight wheezing. Nurse Jodie also observes that Ann can’t speak in full sentences without becoming short of breath.

Next, Nurse Jodie analyzes these cues. Nurse Jodie reviews the electronic health record, or EHR, and notes Ann’s WBC count is elevated at 12,500 cells per mm3. Nurse Jodie knows that an infection is likely causing inflammation in Ann’s lungs. This can result in fluid entering Ann’s alveoli, which can impair gas exchange; as well as narrowing of her airways, which can interfere with her breathing. Nurse Jodie recognizes that Ann needs effective respiratory management.

Next, using the information she has gathered along with Ann’s medical history, Nurse Jodie discusses her findings with RN Seth, and they choose a priority hypothesis of ineffective gas exchange.

Then, they generate solutions to address Ann’s infection that will include pharmacologic and nonpharmacologic interventions. They establish the expected outcome that after intervening, Ann will maintain an oxygenation saturation above 92 percent during the shift.

Nurse Jodie then takes action to implement these solutions.

Nurse Jodie: I'm going to give you some oxygen to help you breathe a little easier. This plastic tubing will go around your ears and the prongs will go into your nose. It's important that you breathe in through your nose so the oxygen will go into your lungs.

Ann: Okay, I hope it helps.

Nurse Jodie: Your health care provider also ordered an antibiotic called ciprofloxacin, some fluids to go through your IV, and these acetaminophen tablets to help with your fever.

Ann: Okay.