30.0: Chapter 3

Unfolding Case Study

1. One of the first major findings that is relevant in this case is the fact that this patient does not speak English. Proper communication is key to establishing rapport with patients and to providing a thorough nursing assessment. Patients who do not speak English should be provided with a trained medical interpreter or interpreting service to ensure that communication is clear. It is not appropriate for a young child to interpret for his mother, due to the mature and complicated medical content, medical terminology, and risk for inaccurate interpretation. Although nonverbal communication, hand gestures, and body language can be used during the assessment, an experienced healthcare interpreter will ensure that a thorough nursing assessment can be conducted. Other relevant findings include the abnormal elevated white blood cell (WBC) count, cough with expectoration, and fever, all of which are indicative of infection. The ear pain reported as an 8/10 is also concerning and warrants follow-up.

2. More information should be obtained about the patient’s reported ear pain. The nurse should perform a focused pain assessment, determining if the pain is constant, what it feels like, and whether anything makes it better or worse. Additionally, the nurse should inquire about the cough. Specifically, the nurse should ask how long the patient has had the cough, if anything makes it better, and if she has ever had a similar symptom, such as during the two occasions when she had COVID-19. The nurse should also ask the patient if she has ever been diagnosed with or treated for hypertension as her blood pressure reading is slightly elevated at this visit.

3. Symptoms of pneumonia that the patient is exhibiting include cough with expectoration, tachycardia, lethargy, fever, and elevated WBC count. The earache may be related to pneumonia as it can sometimes spread to the ears, resulting in an otitis media infection, but it is not a common symptom associated with the condition. The negative COVID-19 test indicates that the patient does not have COVID-19, but it does not tell us anything about pneumonia. The blood pressure elevation may be occurring for several reasons including underlying hypertension or stress and is not specific to pneumonia.

4. The provider has ordered an x-ray, so the nurse should contact radiology to make sure that gets done in a timely manner. The nurse has applied supplemental oxygen, so it is important to re-evaluate the patient’s oxygenation status and increase oxygen as needed. The nurse should maintain close proximity to the patient in case of respiratory distress or arrest and provide emotional support to both the patient and son.

5. The nurse should obtain a sputum sample and send it to the lab for testing. As tolerated, the nurse will start to back off the oxygen, closely monitoring to ensure the patient maintains adequate oxygenation status. The nurse (with help from the interpreter) will provide education to the patient about prescribed medications.

6. Because the patient does not speak English, the nurse will have to rely on the interpreter to ensure understanding of provided information. Health literacy, an individual’s ability to obtain, understand, and apply basic health information and services to make informed health decisions, is important, especially for patients with language or other barriers. The nurse should collaborate with the interpreter to have the patient “teach back” the information to ensure understanding.