Jaspreet Patel is an 80-year-old widowed female who has been in hospital for three weeks following an ischemic stroke

Jaspreet Patel is an 80-year-old widowed female who has been in hospital for three weeks following an ischemic stroke. She has significant left sided weakness and cannot mobilize or reposition herself in bed. She has been on nasogastric feeds for the past two weeks, but they have been slow to advance and have been stopped and started intermittently due to diarrhea.

The client has no family. Past medical history is unclear except for hypertension. Speech is garbled with word finding difficulties since the stroke.

The client’s usual VS are T 36.5C P 80 bpm R 22, BP 138/84 O2 sat 91% on room air

Assessment Findings this morning.

• Increased fatigue over the past 3 days
• Alert and oriented X 2-disoriented to place this morning
• Anxious and distressed
• Dyspnea and SOB
• Accessory muscle use
• Breath sounds diminished to bases bilaterally
• Productive cough with green blood-tinges sputum—difficulty expectorating
• Expiratory wheeze bilaterally
• Barrel chest
• Skin is pale, hot and dry
• Strong peripheral pulses
• Urine is clear and concentrated with U/O 100 cc overnight
• Intermittent chills
• Fingernails are yellow with clubbing present

1. You assess your patient and get the following Vital Signs. Explain the rationale for each of the VS findings below. Indicate whether they are normal or abnormal, indicate normal ranges, and explain your rationale for the change in VS. 1 mark for normal ranges and indication of normal/abnormal VS, 1 mark for explanation.

2. What are the three risk factors for pneumonia for this client and why

3. What type of pneumonia might you speculate that this client has? Why?  

4. What are two assessment findings that suggest an underlying respiratory disease that is not pneumonia? And why?  

5. What assessment finding (list 1) suggests the possibility of delirium? Why is this important to know for nursing?