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
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