Case study: You are caring for Sarah Smith, a 36-year -old female in the respiratory ward in a large metropolitan hospital. Sarah presented to the Emergency department yesterday with a 3-day history of increasing shortness of breath, a productive cough, and a fever.

Case study scenario:

You are caring for Sarah Smith, a 36-year -old female in the respiratory ward in a large metropolitan hospital.

Sarah presented to the Emergency department yesterday with a 3-day history of increasing shortness of breath, a productive cough, and a fever. On examination, Sarah has decreased air entry and the presence of coarse crackles in the middle-left thorax. A chest X-Ray confirms consolidation in the middle-left lobe. Blood cultures and sputum cultures confirm that Sarah has Community- Acquired Pneumonia (CAP). The Covid-19 PCR test is negative, and Influenza PCR is pending.

Medical History

• Mild asthma since childhood, which is well managed with Seretide MDI (Fluticasone propionate) and occasional salbutamol inhaler
• Non-smoker
• Vaccinated for pertussis & Covid - 19 but not influenza

Social History

• Lives with partner Michael and two children aged 8 and 6
• Works part-time as a primary school teacher

Objective data

Temperature 39.2° C

Pulse rate 100 beats/minute Respiratory rate 28 breaths/min Blood pressure 110/60 mm Hg

SpO2 92 with 2 L oxygen via nasal prongs GCS 14

A peripherally inserted intravenous catheter (PIVC) L) hand with Normal Saline 1000mls @ 125mls/hour

Urine output 350mls for the last 12 hours, orange in colour.

Subjective data

• speaking in 5-word sentences, is too breathless to eat and takes small sips of
• Sarah experiences a constant productive cough with green/light brown
• Sarah is resting on two pillows.
• Sarah is pale in colour, diaphoretic, and appears
• Sarah reports 2/10 pleuritic thoracic pain and declines
• Dry mucous membranes and sunken