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Geriatric Nursing (NUR 4090) Case Studies - Case study

John Marsh
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New York City College of Technology

Geriatric Nursing (NUR 4090)

Case studies – Case study

1. Harry Smith, 70 years of age, is a male patient who is admitted to the medical-surgical unit
with acute community-acquired pneumonia. He was diagnosed with paraseptal emphysema 3
years ago. The patient smoked cigarettes one pack per day for 55 years and quit 3 years ago.
The patient has a history of hypertension, and diabetes controlled with oral diabetic agents.
The patient presents with confusion as to time and place. The family stated that this is a new
change for the patient. The admission vital signs are as follows: blood pressure 90/50 mm
Hg, heart rate 101 bpm, respiratory rate 28 breaths/min, and temperature 101.5°F. The pulse
oximeter on room air is 85%. The CBC is as follows: WBC 12,500, platelets 350,000, HCT
30%, and Hgb 10 g/dL. ABGs on room air are pH 7.30, PaO2 55, PaCO2 50, HCO3 25.
Chest x-ray results reveal right lower lobe consolidation, presence of apical bullae, flattened
diaphragm, and a small pleural effusion in the right lower lobe. Lung auscultation reveals
severely diminished breath sounds in the right lower lobe and absence of breath sounds at the
base. The breath sounds in the rest of the lungs are slightly decreased. The patient complains
of fatigue and shortness of breath and cannot finish a short sentence before the respiratory
rate increases above the baseline and his nail beds and lips turn a bluish tinge and the pulse
oximetry decreases to 82%. The patient is diaphoretic and is using accessory muscles. The
patient coughs weakly, but he does not raise any sputum. (Learning Objective 3)



Geriatric Nursing (NUR 4090) Case Studies - Case study

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