The Case of Mr. Mohammad With Pneumonia Pleural Effusion

1
Nursing Care of Adults & Older Adults 1

NURS 300
BSN III – FALL Semester
Case No: 4
CASE STUDY ON PNEUMONIA
Prerequisite Knowledge & Skills
 Anatomy and physiology of the respiratory system

 NURS 202: respiratory physical assessment
 NURS 201: O2 administration
LEARNING OBJECTIVES:
Upon finishing this case study, the students should be able to:
Knowledge:
1. Classify pneumonia using the different classification systems.

2. Identify the predisposing factors that can attribute to the development of pneumonia.
3. Describe measures to prevent development of pneumonia.
4. Discuss the pathophysiology of pneumonia and the related clinical manifestations.
5. State the diagnostic tests that are used to diagnose pneumonia and pleural effusion.
6. Demonstrate efficiency in assessing clients who have pneumonia.
7. Describe the treatment modalities used to treat a client with pneumonia including
management of the acute stage of the disease.
8. Plan a proper nursing care for a client with pneumonia.
9. Discuss the combination of therapy utilized in the medical management of the client
with pneumonia (cough syrups; antibiotics; antipyretics).
10. Describe pleural effusion occurrence in pneumonia and the need of patients for
thoracentesis.
Skills:
1. Demonstrate effectively the chest physiotherapy skills {percussion and vibration}.

2. Practice competently the assessment of a client with respiratory problems.
3. Demonstrate sputum specimen collection.
Attitude:
2
- Recognize the importance of collaboration with other health care providers to identify
the clients at risk of developing pneumonia.
CONTENT:
Knowledge
 Definition of pneumonia and pleural effusion.

 Classification of pneumonia.
 Predisposing factors and preventive measures.
 Pathophysiology of pneumonia.
 Clinical manifestations of pneumonia.
 Diagnostic evaluation of pneumonia and pleural effusion.
 Medical management of client with pneumonia.
 Nursing process applied to client with pneumonia.
 Client education and home care considerations.
 Complications of thoracentesis: hemothorax and pneumothorax.
Skills
 Demonstration of chest physiotherapy skills {mainly percussion and vibration}.

 Assessment of client with respiratory problem.
 Demonstration of sputum collection
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Background
Mr. Mohammad, a 62-year old farmer, is married and has three sons and one daughter.
They are all married & living nearby. Mohammad dropped out his study at the age of 12 to help
his father in the farm. He got married at the age of18 to Aisha, who was 15 years old at that time.
Mr. Mohammed used to be active. He worked hard until his children completed their education;
today, everybody is busy with his own life & family commitments. At the age of 50, Mohammed
was admitted to the hospital as a case of stroke; his BP was high but he never noticed any sign.
He used to be a heavy smoker; smoked about 30-40 cigarettes /per day. After 2 months of
hospitalization, he was discharged with right-sided hemiplegia. Aisha found it difficult to
manage, & had to employ a housemaid to help take care of her husband and family chores. Since
that time, Mohammad has always been looking sad & unhappy. He tends to become easily
irritated and that makes everybody avoid him. Mohammad spends most of his time in bed &
rarely moves around on his wheel chair.
Trigger I
For the past 2 weeks, Mohammad suffered from depression. He eats very little & refuses to
get out of bed. For one week, he had severe influenza which worsened his condition.
Immediately after the influenza he became fatigued with bouts of coughing. Mohammad refused
to seek medical attention but was forced to go to the hospital.
In A/E room, nurse Maha attended to Mr. Mohammad who looked tired, dehydrated, with
frequent productive cough, purulent yellow in nature. He developed severe dyspneic attacks that
were relieved by assuming an upright sitting position and oxygen administration. On lung
auscultation, bilateral basal crackles were heard. An oximeter was applied. His V/Ss were: RR =
32/min, P= 115 B/min, BP. = 130/90 & Temp 39C axillary.
The resident on duty examined Mohammad. He ordered chest x-ray that was done
immediately; it revealed bilateral infiltrates and pleural effusion. An initial diagnosis of bacterial
lobar pneumonia was made & Mohammad was admitted to 10 South for further investigation and
management.
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Tasks
1. Mr. Mohammed is diagnosed with pneumonia. What is pneumonia?

2. Based on the above data, what factors could have put Mr. Mohammed at risk of
developing pneumonia? Could pneumonia have been prevented?
3. Discuss the other predisposing factors of pneumonia.
4. What type of pneumonia has Mr. Mohammed developed? How does it differ from the
other types of pneumonia?
(Classify according to the acquisition setting, and/or the causative agent).
5. What other data should be collected (including health history and physical examination)
by the nurse to support the diagnosis of pneumonia? Relate all the findings to the
physiologic changes that take place in pneumonia.
6. What possible complications is Mr. Mohammad at risk of developing due to his
pneumonia?
7. Based on the assessment data obtained from Mr. Mohammad, develop and prioritize at
least 3 nursing diagnoses. Formulate a plan of action that will help Mohammed in the
acute stage of his illness.
You may need to work in your group to formulate an individualized care

plan for Mr. Mohammad. You will need to present it in class.
Trigger II
Nurse Rayan received Mr. Mohammad on the unit. She completed the admission
procedures & followed him to his room. The admission orders included:
 Bed rest
 O2 5L/min via face mask PRN.
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 Laboratory studies: Sputum culture & sensitivity (C/S); CBC, and blood
culture
 Chest physiotherapy 2 times/ day.
 Steam inhalation twice daily.
 IV infusion 500 mL D5W via IV pump at a rate of 62ml/hr.
 Robitussin expectorant 10ml QID.
 Parfalgan 1 gm IV every 6 hours if Temp is above 38.5˚C
 Zithromax 250mg oral for 3 days.
 Claforan 1g IV every 8 hrs for 1 week.
*Antibiotics to be started after sputum collection.
That night, Mr. Mohammad couldn’t sleep due to cough and chest pain. He had severe dyspneic
attacks. The nurse noticed that Mr. Mohammed became confused, irritated, and started to behave
irrationally. He tried to throw the mask away several times. His SpO2 by Pulse oximetry was
86%. The medical team was informed. Investigations on the pleural effusion reflected the need
of Mr. Mohamad for a thoracentesis.
Tasks
1. What are the indications for the requested diagnostic and laboratory tests?
2. What instructions does the patient need for sputum culture?
3. Why in your opinion the antibiotics must be started after collecting the sputum
specimen?
4. How does Robitussin expectorant differ from other cough remedies? {Mucolytics
and cough suppressants}
5. What is pleural effusion, and why did the patient need thoracentesis?
6. What are the complications of thoracentesis?
7. What role does the nurse have given the complication that Mr. Mohammad
developed?
References
Hinkle, J.L., & Cheever, K.H. (2017). Brunner & Suddarth’s Text Book of Medical Surgical
Nursing (14th ed.). Philadelphia: Lippincott, Williams & Wilkins.
Related References
Carpenito, L. J. (2012). Nursing Diagnosis: Application to Clinical Practice (14th ed.)

Philadelphia: J.B. Lippincott Co.
Vallerand, A.H. & Sanoski, C.A. (2019). Davis’s Drug Guide for Nurses (16th ed.).
Philadelphia, PA: F.A. Davis Company.
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Taylor, C., Lillis, C., & Lynn, P. (2015). Fundamentals of nursing: The art and science of
person-centered nursing care (8th ed.). Philadelphia: Wolters Kluwer/LWW.
http://umm.edu/health/medical/reports/articles/pneumonia

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1

Nursing Care of Adults & Older Adults 1

CASE STUDY ON PNEUMONIA

Prerequisite Knowledge & Skills

 Anatomy and physiology of the respiratory system

1. Classify pneumonia using the different classification systems.

1. Demonstrate effectively the chest physiotherapy skills {percussion and vibration}.

 Definition of pneumonia and pleural effusion.

 Demonstration of chest physiotherapy skills {mainly percussion and vibration}.

1. Mr. Mohammed is diagnosed with pneumonia. What is pneumonia?

You may need to work in your group to formulate an individualized care

*Antibiotics to be started after sputum collection.

Carpenito, L. J. (2012). Nursing Diagnosis: Application to Clinical Practice (14th ed.)

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