# Situation: A 72-year-old woman is brought from home to the emergency room with fever, productive cough, and right-sided pleuritic chest pain for 2 days. A chest X-ray shows consolidation of the right lower lobe. She has hypertension controlled with amlodipine and has no known drug allergies. Her findings are: alert and oriented to time, place, and person; respiratory rate 31/min; blood pressure 104/58 mmHg; heart rate 108/min; blood urea nitrogen (BUN) 18 mg/dL (urea 6.4 mmol/L). What is her CURB-65 score?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629780  
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> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 72-year-old woman is brought from home to the emergency room with fever, productive cough, and right-sided pleuritic chest pain for 2 days. A chest X-ray shows consolidation of the right lower lobe. She has hypertension controlled with amlodipine and has no known drug allergies.

Her findings are: alert and oriented to time, place, and person; respiratory rate 31/min; blood pressure 104/58 mmHg; heart rate 108/min; blood urea nitrogen (BUN) 18 mg/dL (urea 6.4 mmol/L). What is her CURB-65 score?

## 보기

1. 3 **✔ 정답**
2. 1
3. 2
4. 4

**정답: 1**

## 해설

CURB-65 gives 1 point each for confusion, urea above 7 mmol/L (BUN above 19 mg/dL), respiratory rate of 30/min or more, systolic pressure below 90 mmHg or diastolic pressure of 60 mmHg or less, and age 65 years or older. She scores for respiratory rate (31/min), diastolic pressure (58 mmHg), and age (72 years), for a total of 3. She is not confused, her BUN is below the cut-off, and heart rate is not part of the score.

## 심화 해설

Scoring the CURB-65

The CURB-65 tool assigns 1 point for each of five findings present at initial assessment. The components are Confusion, Urea (blood urea nitrogen), Respiratory rate, Blood pressure, and Age ≥65 years. A higher total score indicates greater mortality risk and guides decisions about outpatient management, hospital admission, or intensive care.

For this patient, each criterion is evaluated against the defined thresholds.

| CURB-65 component | Cut-off for 1 point | Patient value | Point assigned |
| --- | --- | --- | --- |
| Confusion | New disorientation or AMS | Alert and oriented x3 | 0 |
| Urea (BUN) | Urea >7 mmol/L (BUN >19 mg/dL) | BUN 18 mg/dL (urea 6.4 mmol/L) | 0 |
| Respiratory rate | ≥30/min | 31/min | 1 |
| Blood pressure | SBP

## 임상 시나리오

CURB-65 Scoring in the ERRapid Severity Assessment for Community-Acquired Pneumonia
The CURB-65 score predicts mortality in pneumonia. Each criterion met adds 1 point: Confusion, Urea > 7 mmol/L, Respiratory rate ≥ 30/min, Blood pressure (SBP < 90 mmHg or DBP ≤ 60 mmHg), and Age ≥ 65 years.

For this patient, points are assigned for tachypnea (RR 31/min), diastolic hypotension (DBP 58 mmHg), and age (72 years), totaling 3 points. This score indicates a high risk, warranting hospital admission.

CautionThe blood pressure criterion is met if either the systolic OR diastolic value crosses its threshold. A normal systolic pressure does not negate a low diastolic pressure. Also, heart rate is not a component of the score.

## 핵심 개념

- **CURB-65** — A clinical prediction tool for pneumonia severity, scoring Confusion, Urea, Respiratory rate, Blood pressure, and Age ≥65.
- **Tachypnea** — Abnormally rapid breathing. In CURB-65, a respiratory rate of 30 breaths per minute or more scores one point.
- **Diastolic Hypotension** — Low diastolic blood pressure. In CURB-65, a diastolic pressure of 60 mmHg or less scores one point.
- **Pleuritic Chest Pain** — Sharp chest pain that worsens with breathing, often associated with pulmonary conditions like pneumonia.
- **Consolidation** — A radiological finding where lung air spaces fill with fluid or tissue, commonly seen in lobar pneumonia.

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