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Mr. Edward Hunter, an 89-year old widower, was admitted to your medical ward with
hypoxaemia (oxygen saturatlons 82% in the ambulance) and a recent history of viral
influenza. He has been receiving intensive home support from the’acute care in the home’
nursing team for over 6 months, which includes home oxygen therapy as his chronic
obstructrve airways disease worsens limiting his ability to care for himself at home.
Within 24 hours of admission Mr. Hunter’s condition continues to deteriorate, He is
receiving 10 liters of oxygen via a Hudson mask. Severe dyspnoea renders him immobile and
barely able to eat. He has little appetite and is cachexic. Overnight night he becomes quite
restless, breathless, tachypnoeic and develops a productrve cough. The respiratory team
reviews Mr. Hunter because he was experiencing increased pleuritic pain cn inspiration and
was expectorating rust colored sputum. Subsequently, he was diagnosed with
pneumococcal pneumonia and was prescribed cough suppressant, a sedative and
a ntibiotics.
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Question 1. Mr. Hunter is 89 yeors old. Whot ore the specific considerotions a Registered
Nurse should understond in relotion to the clinicol monifestations of pneumonia in the older
person?
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Question 2. Outline the pathophysiology of altered ventilotion and diffusion in relation to
M r. Hu nter’s pne u monio.
Updated: Marc Broadbent 01/18 3lP;:rge
Yesterday evening, in handover to the night duty nurse, it was explained that Mr. Hunter
was becoming confused and drowsy during the day but was easily roused and orientated
once woken and maintaining oxygen saturations 92 -94%.
Mr. Hunter is clearly distressed and extremely dyspnoeic.
The consultant reviews Mr. Hunters medication and prescribes
Oxygen (hlgh flow) to achieve oxygen saturation > 92%
Benzyl penicillin 1.29 lV 6 hourly for a total of 7 days
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lnterpreting information can be difficult if you process it subjectively based on your own
past experiences, beliefs and opinions. By critically appraising the information about the
various types of pneumonia, it is possrble to make a reasoned judgment about Mr. Hunter’s
future management.
Question i. What ore the differences between hospital acquired pneumonia (HAP,
community acquired pneumonio (CAP)ond aspiration pneumonio?
Part 2. The consultant also requests that Mr. Hunter has 4 hourly observations of his vital
signs and to report a heart rate above 100 and oxygen saturations be ow 90% and a
temperature above 38.5c.
Ta ke ar tion
The registered nurse recognises that Mr. Hunter requires care beyond that requested by the
cons u lta nt.
Question 4. Exploin the nursing core required the patient with pneumonia. Provide a
rotionole for all elements of the core provided thot reflects the porticulor needs of Mr.
Hunter.
Updated: Marc Broadbent 01/18 4lPage
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euestion 5. The consultont hos osked to be informed if Mr. Hunters heort rote rises above
L00, oxygen saturotions fotl below 90% and his temperoture rises above j8.5c. ln the context
of o potient with pneumonio, exploin the rationol/s for monitoring the specific porometers
requested by the consultant.
part 3. The central principles of socialjustice are Self Determination, Equity, Access, Rights
and partlcipation. One morningyou notice that Mr Hunter agitated is more confused and
agitated than normal and his oxygen mask is on the floor. He requests that his oxygen be
stopped as he doesn’t like it as it is causing him discomfort. The RN recognises that he has a
right to control his own treatment, however understands the impact this will have on his
hea lth.
euestion 6. Explain (L) the strotegies you would use to ensure Mr. Hunter understonds the
implicotions of his decisions to refuse the oxygen ond (2) the actions you would take to
monoge the situotion.
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Question 7.
What are the two most important things that you have learned from this scenario and why?
What actions will you take in your future practice because of what you have learned from
this scenario?
ln your reflection identify which of the NMBA Registered Nurse standards for practice relate
to what you have learnt and how your practice will change’
Updated: Marc Broadbent 01/18 5lFage

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