Case Study on Pneumonia
Case Study: Pneumonia and Pressure Ulcer Prevention in an Elderly MICU Patient
June 6, 2012 Case Study: Pneumonia and Sepsis in an Elderly MICU Patient L.M. is a 75-year-old female who suffers from severe dementia and lives in a SNF. She was diagnosed with lung cancer in 2005 and as a result had a right upper and middle lobectomy. She also has a history of severe emphysema. L.M. has had several pneumonic infections and has an allergy to Pneumovax. She has a recurrent aspiration risk and received a tracheostomy and a PEG tube in January 2012. On Aril 25, 2012, L.M. was found to be increasingly fatigued, somnolent, and had shortness of breath accompanied with tachycardia as witnessed by the staff at the SNF. When she arrived at the emergency department, she was tachycardic with a heart rate in the 130-140’s and tachypnic with a respiration rate in the 30-40’s. L.M., who normally depends on 2 liters of oxygen at home, desaturated to 88% requiring oxygen support increased to 4 liters. Her baseline systolic blood pressure is 100-110 and it was measured in the low 90’s in the ED. She also had an increased temperature of 38.2 degrees Celsius. As a result of L.M.’s increase in temperature, heart rate, and respiratory rate accompanied with pneumonia, the emergency department treated her for sepsis. Labs drawn showed an increase in white blood cells and lactic acid, as well as an increase in PC02 and a decrease in PO2. She was aggressively resuscitated with IV boluses as necessary followed by maintenance normal saline. She was also administered Vancomycin, Cefepime, Azithromycin, and Metronidazole. In addition, her chest x-ray illustrated a near complete opacification of the right lung field. She was diagnosed with sepsis secondary to pneumonia complicated by a right lower lung collapse due to mucus plugging. I assumed care of L.M. in the MICU ten days after her admission in the ED. She had been intubated and put on a mechanical
June 6, 2012 Case Study: Pneumonia and Sepsis in an Elderly MICU Patient L.M. is a 75-year-old female who suffers from severe dementia and lives in a SNF. She was diagnosed with lung cancer in 2005 and as a result had a right upper and middle lobectomy. She also has a history of severe emphysema. L.M. has had several pneumonic infections and has an allergy to Pneumovax. She has a recurrent aspiration risk and received a tracheostomy and a PEG tube in January 2012. On Aril 25, 2012, L.M. was found to be increasingly fatigued, somnolent, and had shortness of breath accompanied with tachycardia as witnessed by the staff at the SNF. When she arrived at the emergency department, she was tachycardic with a heart rate in the 130-140’s and tachypnic with a respiration rate in the 30-40’s. L.M., who normally depends on 2 liters of oxygen at home, desaturated to 88% requiring oxygen support increased to 4 liters. Her baseline systolic blood pressure is 100-110 and it was measured in the low 90’s in the ED. She also had an increased temperature of 38.2 degrees Celsius. As a result of L.M.’s increase in temperature, heart rate, and respiratory rate accompanied with pneumonia, the emergency department treated her for sepsis. Labs drawn showed an increase in white blood cells and lactic acid, as well as an increase in PC02 and a decrease in PO2. She was aggressively resuscitated with IV boluses as necessary followed by maintenance normal saline. She was also administered Vancomycin, Cefepime, Azithromycin, and Metronidazole. In addition, her chest x-ray illustrated a near complete opacification of the right lung field. She was diagnosed with sepsis secondary to pneumonia complicated by a right lower lung collapse due to mucus plugging. I assumed care of L.M. in the MICU ten days after her admission in the ED. She had been intubated and put on a mechanical
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