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-tinged 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. What are the three risk factors for pneumonia for this client and why
2. 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. for normal ranges and indication of normal/abnormal VS, 1 mark for explanation. 

T 37.4 C	HR 110/bpm
BP 105/80	O2 sat 85%
RR 30/min

 

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

 

4. Explain the significance of each of the findings. 

Lab test	Findings	Normal Findings
Arterial Blood Gases (ABGs)	pH 7.32 PaCO2 54 PaO2 62   HCO3– 24	pH 7.35-7.45  PaCO2 35-45 mmHg  PaO2 80-100 mmHg   HCO3– 21-28  mmol/L
Leukocytes (WBC)	14.8	3.5-12 x 109/L
Hemoglobin (Hb)	100	120-160 g/L (F)
Hematocrit (Hct)	0.48	0.37-0.47
Sodium (Na+ )	147	135-145 mmol/L