NURBN2022 Nursing Practice 3: Person-Centered Nursing Practice

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Case study scenario:

You are caring for Sarah Smith, a 36-year -old female in the respiratory ward in a large metropolitan hospital.

Sarah presented to the Emergency department yesterday with a 3-day history of increasing shortness of breath, a productive cough, and a fever. On examination, Sarah has decreased air entry and the presence of coarse crackles in the middle-left thorax. A chest X-Ray confirms consolidation in the middle-left lobe. Blood cultures and sputum cultures confirm that Sarah has Community- Acquired Pneumonia (CAP). The Covid-19 PCR test is negative, and Influenza PCR is pending.

Medical History

  • Mild asthma since childhood, which is well managed with Seretide MDI (Fluticasone propionate) and occasional salbutamol inhaler
  • Non-smoker
  • Vaccinated for pertussis & Covid - 19 but not influenza

Social History

  • Lives with partner Michael and two children aged 8 and 6
  • Works part-time as a primary school teacher

Objective data

Temperature 39.2° C

Pulse rate 100 beats/minute Respiratory rate 28 breaths/min Blood pressure 110/60 mm Hg

SpO2 92 with 2 L oxygen via nasal prongs GCS 14

A peripherally inserted intravenous catheter (PIVC) L) hand with Normal Saline 1000mls @ 125mls/hour

Urine output 350mls for the last 12 hours, orange in colour.

Subjective data

  • speaking in 5-word sentences, is too breathless to eat and takes small sips of
  • Sarah experiences a constant productive cough with green/light brown
  • Sarah is resting on two pillows.
  • Sarah is pale in colour, diaphoretic, and appears
  • Sarah reports 2/10 pleuritic thoracic pain and declines
  • Dry mucous membranes and sunken

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