NU142 Unit 5 Case Study Analysis Example

Three Assessments, One Turning Point: A Case Study Analysis of a Composite 29-Year-Old Woman With Epilepsy Admitted After a Seizure With Aspiration Pneumonia, Read at Morning, Midday and Evening as Her Breathing Changes

[Student Name]

Purdue University Global

NU142: Medical-Surgical Nursing I

Unit 5 Case Study Analysis

[Instructor Name]

[Date]

The patient is composite; values are bracketed where illustrative, and treatment decisions belong to the provider.

The Case

[Ms. B.], a composite 29-year-old library assistant with epilepsy, had a generalized seizure at home overnight. Her roommate found her drowsy, with vomit on the pillow. In the emergency department, a chest X-ray showed patchy opacity in the right lower lobe, and she was admitted with suspected aspiration pneumonia. During a seizure, the protective reflexes that keep stomach contents out of the airway are lost, so vomit can be inhaled; the right lower lobe is commonly affected because of the angle of the right main bronchus (Mandell & Niederman, 2019). She was started on IV antibiotics, her antiseizure medicine was continued and she received oxygen as needed.

Assessment One: Morning, 0800

Temperature [37.9] C, heart rate [98], respirations [20], blood pressure [118/74], oxygen saturation [94] percent on room air. Alert and oriented, tired. Productive cough, crackles at the right base. Interpretation: an infection in one area of lung, with mild changes in vital signs and normal mental status. She is stable but needs regular reassessment, with deep breathing, coughing and early mobility encouraged.

Assessment Two: Midday, 1300

Temperature [38.4] C, heart rate [108], respirations [24], blood pressure [112/70], saturation [92] percent on [2] L of oxygen by nasal cannula. Alert, oriented, more short of breath walking to the bathroom. Crackles now at the right base and mid-lung. Interpretation: worsening, but within what can happen early in pneumonia as antibiotics take effect. Each value has moved in the wrong direction. The nurse increases monitoring to every two hours and reports the trend to the provider, who keeps the plan but asks to be called for further change.

Assessment Three: Evening, 1800

Temperature [38.9] C, heart rate [122], respirations [30], blood pressure [98/60], saturation [89] percent on [4] L. She is restless, answers slowly and asks twice where she is. Using accessory muscles. Interpretation: this is the turning point. Her breathing rate has risen by half since the morning, oxygen need has doubled, blood pressure is falling and she is newly confused. Together these meet commonly used warning criteria for sepsis and suggest her lungs are failing to keep up.

No single number at 1800 was the alarm; the alarm was that every number had moved the same way and her mind had changed with them.

What the Nurse Does at the Turning Point

The nurse stays with her, raises the head of the bed, increases oxygen as allowed by protocol, and calls the rapid response team rather than only paging the provider, because the combination of confusion, fast breathing and falling pressure needs immediate assessment. The nurse reports using SBAR, a structure that gives both clinicians the same frame (Haig et al., 2006): the change from morning, the current values, the concern for sepsis and respiratory failure, and a request for evaluation at the bedside. Blood cultures, lactate and a repeat chest X-ray may follow. Seizure precautions continue, since fever and illness can lower her seizure threshold (Harding et al., 2023).

Why the Midday Reading Matters Too

The evening deterioration did not come from nowhere. At midday every vital sign had worsened slightly. A nurse who compares each reading with the last, rather than with normal ranges alone, sees the direction early and increases monitoring, as happened here. Early warning scores combine these values to make the trend visible.

What Could Have Been Done Earlier

Looking back, two steps might have shortened the time to escalation. At midday, the nurse could have calculated an early warning score; her combination of fever, a heart rate over 100, a breathing rate of 24 and a new oxygen requirement would already have scored in the range many hospitals use to trigger a provider review at the bedside rather than by phone. The nurse could also have asked the provider to set specific call parameters at that time, such as a breathing rate over 28 or a saturation under 90 percent, so that the evening deterioration triggered a call the moment it began. Neither step was wrong to miss, but both are habits that make a turning point easier to catch.

Priorities

Breathing and oxygenation come first, followed by circulation and signs of sepsis, then infection control and seizure safety, then comfort and teaching. Her antiseizure medicine must not be missed, because a seizure while she is hypoxic would be especially dangerous.

Evaluation

After rapid response assessment she received IV fluids and was moved to a higher level of care. By the next morning her breathing rate was [22] and saturation [94] percent on [2] L, and she was oriented. Her antibiotics were broadened, and she had no further seizures during the admission.

References

Haig, K. M., Sutton, S., & Whittington, J. (2006). SBAR: A shared mental model for improving communication between clinicians. The Joint Commission Journal on Quality and Patient Safety, 32(3), 167-175. https://doi.org/10.1016/S1553-7250(06)32022-3

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.

Mandell, L. A., & Niederman, M. S. (2019). Aspiration pneumonia. The New England Journal of Medicine, 380(7), 651-663. https://doi.org/10.1056/NEJMra1714562