This is an original excerpt written by our team to show structure, depth and referencing. It is modelled on the course named above but is not a university document. Use samples as a study guide and follow your school's academic integrity policy.
Patient at the center
The patient is illustrative. Mr. S., 76, lives alone and was brought in by his neighbor after two days of cough, fever and new confusion. He has type 2 diabetes and COPD. Temperature 38.6 °C, heart rate 108, respiratory rate 26, blood pressure 118/70, SpO₂ 89% on room air. Crackles and bronchial breath sounds in the right lower lobe; chest X-ray shows right lower lobe consolidation. He is admitted to a medical unit with community-acquired pneumonia (CAP).
The concept map
Problem 1: Impaired gas exchange
- Cues: SpO₂ 89%, tachypnea, crackles, new confusion (in older adults, confusion may be the main sign of hypoxia or infection)
- Actions: oxygen to the ordered target; head of bed raised; SpO₂ and respiratory rate every 2 to 4 hours; report rising oxygen needs
- Outcome: SpO₂ at target on room air or baseline oxygen before discharge
Problem 2: Ineffective airway clearance
- Cues: productive cough, weak effort, consolidation
- Actions: coughing and deep breathing, incentive spirometer every hour while awake, fluids unless restricted, early walking
- Outcome: clearer breath sounds and an effective cough
Problem 3: Infection, with risk for sepsis
- Cues: fever, tachycardia, raised white cell count
- Actions: give the first antibiotic dose promptly once ordered; watch for signs of sepsis (falling blood pressure, low urine output, worsening confusion) and escalate early
- Outcome: temperature and heart rate returning to normal within 48 to 72 hours
Problem 4: Risk for falls and acute confusion
- Cues: new confusion, age, unfamiliar setting
- Actions: reorient often, keep glasses and hearing aids in, bed alarm and low bed, toileting schedule
- Outcome: no falls; confusion resolving as infection and oxygenation improve
Links to the treatment plan
The ATS/IDSA guideline for adults with CAP (Metlay et al., 2019) shapes the medical plan the nurse carries out and explains:
| Guideline point | What the nurse watches for or teaches |
|---|---|
| Inpatients without severe CAP are usually treated with a β-lactam plus a macrolide, or a respiratory fluoroquinolone alone | Allergies, QT prolongation risk with macrolides and fluoroquinolones, and correct timing of doses |
| Blood and sputum cultures are recommended for severe CAP and for patients with risk factors for MRSA or Pseudomonas | Collecting cultures before antibiotics when ordered |
| Antibiotics continue until the patient is clinically stable, for at least 5 days in total | Recording vital signs and mental status that show stability; teaching him to finish the course |
| Corticosteroids are not routinely recommended for non-severe CAP | Questioning an order that seems to conflict, and monitoring glucose closely in a patient with diabetes |
Discharge connections
- Teach Mr. S. how to take his antibiotics and when to call for help (worsening breathlessness, fever returning).
- Check his blood glucose control, since infection raises glucose.
- Review his vaccination record and refer as appropriate.
- Arrange follow-up and check that he has support at home, since he lives alone.
Reference
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia: An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, 200(7), e45–e67. https://doi.org/10.1164/rccm.201908-1581ST
