CRITICAL THINKING SUMMARY

Student: ____Andrea Crapsey______________

Patient Dx: __Pneumonia_____________________________________ Age: _73__
Allergies: __PCN, sulfa, valdecoxib, sulfamethoxazole with trimethoprim_____________
The MEDICAL DIAGNOSIS that brought the patient to the hospital is:
Pneumonia, COPD Exacerbation, Unstable Angina

PATHOPHYSIOLOGY of diagnosed disease: (From text)

Pneumonia is an inflammation of the lungs occurring commonly in the bronchioles, interstitial
lung tissue, or the alveoli. The injurious agent is often a microorganism including bacteria,
viruses, and fungi, and can result from a noninfectious inhaled irritant. Pneumonia is usually
spread through respiratory droplets. Defense mechanisms usually get rid of pathogens but
sometimes the pathogens or irritant can get through.
Braun, C. A., & Anderson, C. M. (2011). Pathophysiology: A clinical approach (2nd ed., pp. 340341). Philadelphia, PA: Lippincott Williams & Wilkins.
SYMPTOMS typically seen with this diagnosis include (as identified in your text):
Fever, chills cough, sputum production, fatigue, loss of appetite, dyspnea, tachypnea,
tachycardia, pleuritic pain, adventitious breath sounds, fluid in lungs, inflammation.
PATIENTS SYMPTOMS of the diagnosed disease include:
Dyspnea, tachypnea, tachycardia, sputum production, crackles in bases of lungs.
NUTRITIONAL ASSESSMENT:
Height (actual or estimated): __59 inches____ Weight (actual or estimated): __97.2 kg___
Estimate Ideal Body Weight (Male: 105lb + 6lb/inch > 5. Female: 100lb + 5lb/inch > 5): ___45.5 kg___
Does this patient have characteristics of a well-nourished person? Yes _____ No __X___
Explain your answer.
Albumin level was not available, but other signs/symptoms of this pt. that indicate they are not
well nourished are that they are overweight, have Type II DM, and does not display healthy or
nutritious food choices.
PSYCHOSOCIAL STAGE OF DEVELOPMENT
What is the patients developmental stage?
Ego integrity vs. Despair
Has he/she met the necessary accomplishments? Yes __X__ No _____
Explain.
KM has accepted her successes and failures in life, she is going forward in life with a positive
attitude about what she can accomplish in the future.
How is this illness affecting the patients ability to meet these necessary accomplishments?
KM has the possibility to develop depression if she cannot make future accomplishments.

NURSING DIAGNOSIS/OBJECTIVES/INTERVENTIONS
Indicate below the 2 priority nursing diagnoses that are most relevant for your patient.
#1 NURSING DIAGNOSIS (problem r/t)
Activity intolerance r/t imbalance between oxygen supply and demand (hx of COPD), AEB SOB
on exertion and exhaustion with ambulating to bathroom.

DEFINING CHARACTERISTICS (S/S) that support this diagnosis:

SOB, coughing, audible wheezing, exhaustion upon reaching destination with ambulation,
respirations >20 with ambulation.
OBJECTIVE/PATIENT OUTCOME for this diagnosis:
Pt will demonstrate increased tolerance to activity within 6 weeks, AEB decreased SOB on
exertion and increased tolerance with ambulation.
NURSING INTERVENTIONS that will assist the patient to resolve the above identified diagnosis:
1. Instruct and assist pt in using conscious, controlled breathing techniques during exercise,
including pursed lip breathing, and inspiratory muscle use.
2. Slow the pace of care. Allow the pt extra time to carry out physical activities.
3. Instruct the pt on techniques to utilize for avoiding activity intolerance, such as controlled
breathing techniques and simplifying ADLs.
#2 NURSING DIAGNOSIS (problem r/t)
Ineffective breathing pattern r/t inspiration and expiration that does not provide adequate
ventilation, AEB SOB, audible wheezing, and cyanosis.

DEFINING CHARACTERISTICS (S/S) that support this diagnosis:

SOB, dyspnea, tachypnea, cyanosis, breathing through pursed lips with exertion.
OBJECTIVE/PATIENT OUTCOME for this diagnosis:
Pt will tolerate activity without the symptoms listed above within 6 weeks.
NURSING INTERVENTIONS that will assist the patient to resolve the above identified diagnosis:
1. Monitor respiratory rate, depth, and ease of respiration for normal respiratory rate.
2. Ensure that pt in dyspnic state has received any ordered meds, oxygen, and other treatments
needed.
3. Auscultate breath sounds, noting decreased or absent sounds, crackles or wheezes.
COMPLICATIONS:
If this patients condition were to worsen, what would be the most likely reason and why?
Clients condition could worsen due to environmental changes, physical activity changes, or
diet changes. Any of these changes could affect pts COPD or heart health.
How would you know this is happening?
Pt would have increased SOB, increased infections, more anginal pain, and increased
tiredness.
What will you do if this happens?
If these conditions were to happen, I would educate the pt about how to increase physical
activity to decrease COPD exacerbations overall, and possibly medicate the pt or apply oxygen
before ambulating the pt to the bathroom or through the halls.

PHYSICIAN PRESCRIBED MEDICATIONS AND INTERVENTIONS

MEDS/IVs/TX/DIET
(Include dose, route,
frequency)

REASON PRESCRIBED
(Drug Classification,
What is it treating?)

NURSING IMPLICATIONS
FROM TEXT
(Checking for adverse
reactions, preparation &
admin concerns)

PATIENT DATA FROM

YOUR ASSESSMENT
(What data is important to
know before & after
giving)

Important to note
presence of angina,
reassess pain after
admin
Assess BG frequently.
Thromboembolism
possible

Consistent CHO diet

Type II DM, client is

malnourished

Imdur
60mg PO

Antianginal
Treating angina

Assess anginal pain,

check BP/pulse during
admin, take as directed

Solu-Medrol
80mg q8 IV

Steroidal antiinflammatory
Treating pain

Cardizem
180mg PO

Antihypertensive
Treating HTN

Do not stop med

abruptly.
Immunosuppression
may happen & mask
infection
May cause prolonged
PR interval

Cipro
250mg PO

Anti-infective
Treating pneumonia

Celexa
40 mg PO

Antidepressant
Treating depression

Synthroid
50mg PO

Apresoline
100mg

Hormones (synthetic
T4)
Treating
hypothyroidism
Antipyretic/NSAID
Prophylaxis of TIA and
MI
Antihypertensive
Treating HTN

Levamir Flexpen
50 units SC

Antidiabetic
Treating Type II DM

Toprol
100mg PO

Multivitamin
PO BID

Antianginals/
Antihypertensives
Treating angina
Lipid lowering agents
Treating
hypercholesterolemia
Bronchodilator
Treating SOB, chest
tightness
Vitamins
Treating malnutrition

Tylenol

Nonopioid analgesic

Aspirin
325mg PO

Lipitor
80mg PO
Albuterol
1 tx PRN

Observe for anaphylaxis,

monitor bowel function
(diarrhea, bloody stools)
Monitor for suicidal
thoughts, NM alterations,
serotonin syndrome
Assess apical pulse and
BP, assess for chest
pain and
tachyarrhythmias
Monitor pts for
anaphylactic reaction

Monitor BP, pulse, I/O,

ECG continuously.
Watch for bradycardia,
hypoTN
Renal labs this drug is
nephrotoxic
Monitor electrolytes
Monitor thyroid function
studies. Monitor BG in
diabetic pts
Assess hepatic labs

Monitor BP and pulse

regularly

Monitor CBC and

electrolytes

Assess for S/S of

hypoglycemia, monitor
weight, clarify orders
Must watch for HF,
pulmonary edema,
bradycardia
Obtain diet hx and
assess fat consumption

Assess BG for
hypoglycemia

Assess lung sounds,

take pulse and BP
before admin
Look for signs of
nutritional deficiency
Assess pain before

May increase BG, may

decrease cardiac output
May increase muscle
tenderness during
therapy
May cause paradoxical
bronchospasm
May cause increase in
vitamin levels
May cause

650mg PRN

Treating pain

Lovenox
95mg SC

Anticoagulants
Treating PE,
coagulation problems

admin. Assess alcohol

consumption
Assess pr for increased
thrombosis, anginal pain,
monitor hypersensitivity

hepatotoxicity
May cause bleeding,
anemia, hemorrhage

ANALYSIS OF DIAGNOSTIC TESTS

DIRECTIONS:
1.

List all diagnostic and laboratory tests pertinent to the patient's medical diagnosis or medical
treatments (i.e. medications) and provide the patient values for each test. Explain why they are
pertinent for this patient.

2.

List any screening diagnostic and laboratory tests that are not within normal limits. Explain why
these tests are increased or decreased in relation to your patient's medical condition.

Diagnostic/Lab Test
Sodium

Patient Values
137
(was 132)

Analysis of Values
Trending up (toward normal range)

Potassium

5.1
(was 5.6)

Trending down (toward normal

range)

Calcium

___

___

Chloride

103

Normal value

BUN

109
(was 91)

Trending up (due to renal

insufficiency)

Creatinine

2.9
(was 2.8)

Trending up (due to renal

insufficiency)

Blood Glucose

325
(was in 300s)

Trending up (possibly due to illness

and stress of being in the hospital)

VQ scan to rule out PE

Was not able to read results of this scan

Personal reflections:
This critical thinking activity showed my growth becauseI was able to really critically think about my
entire patient and paint the entire picture of what was going on with this patient. I feel that I was able to
explain more things than I expected and I was able to understand what all of the medications and labs
meant and how they corresponded to the diagnoses this patient had received. I believe this shows
growth because of the maturity of my thoughts. They would not have been this complex last semester or

at the beginning of this semester. I have learned to really explore a situation and piece the whole picture
together. I think this also shows curiosity, which in turn shows growth and a passion for the information.
As a result of this critical thinking activity, I have learned how toI have learned how to look at the entire
patient and think about their diagnosis, their medications, and their lab values and piece all of the
information together and think about the result.