Nursing Management 1

Nursing Management of a Patient with Pneumonia Melanie Rose Avila Dorothy Cabatuan Our Lady of Fatima University

Nursing Management 2

Nursing Management of Patient with Pneumonia

M.R a 76 year old male, with no medical history of hypertension and no previous hospitalization. He was diagnosed with Nosocomial Pneumonia . The patient has no evidence of infection at the time of the admission. The onset of the pneumonia symptoms is more than 48hours after the admission. The patient has a fever, peripheral leukocytosis, and a persistent infiltrate on the chest xray. Nosocomial Pneumonia also called as Hospital-Acquired Pneumonia accounts for approximately 15% of hospital acquired infection and is the leading cause of death in patient with such infection (File 2007). It tends to be more serious, because a patient's defense mechanisms against infection are often impaired during a hospital stay. In addition, the types of germs present in a hospital are often more dangerous than those encountered in the community. The patient is associated with endotracheal intubation and mechanical ventilation.

Nursing Management 3 Pathophysiology Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacterium, fungi and viruses. Normally the upper airway prevents potentially infectious particles from reaching the sterile lower respiratory tract. Pneumonia arises from normal flora present in the patients whose resistance has been altered or from aspiration of flora present in the oropharynx. Patients often have an acute or chronic underlying disease that impairs host defenses. Pneumonia may also result from blood borne organisms that enter the pulmonary circulation and are trapped in the pulmonary capillary bed. Pneumonia affects both ventilation and diffusion. An inflammatory reaction can occur in the alveoli, producing an exudates that interferes with the diffusion of oxygen and carbon dioxide. White blood cells, mostly neutrophils, also migrate into the alveoli and fill the normally air-filled spaces. Ares of lung are not equally ventilated because of secretions and mucosal edema that cause partial occlusion of the bronchi or alveoli, with a resultant decrease in alveolar oxygen tension. Pneumonia occurs in patient with certain underlying disorder such as heart failure, diabetes, alcoholism, COPD, and AIDS. Certain diseases also have pathogens. Pneumonia varies in its signs and symptoms including Cough that produces greenish, mucus like pus like sputum, Shortness of breath, Fever, Headache, Chest pain that Increases by coughing or by breathing deeply, body malaise and Vomiting and an uneasy feeling of nausea. (MS Book, Brunner&Suddarth)

Nursing Management 4 History M.R a 76 year old male has no medical history of hypertension and no previous hospitalization. The patient is a passive smoker.Three months prior to admission patient experienced no bowel movement for two weeks. This was not associated by abdominal pain, abdominal distinction, no fever until ten weeks prior to admission, the patients condition persisted poor associated with abdominal pain. Patient sought consult and had ultrasound of the whole abdomen. A gall bladder stone was detected. Patient was advised surgery but optioned to temper to an institution. Hence, this administration and was diagnosed with sepsis secondary to nosocomial pneumonia, resolving; ARS secondary to ATN resolving acute calculous cholecytitis, choledocholithiasis S/P ERCP with CBD stone in May 2011.

Nursing Physical Assessment M.R was lying in bed unconscious. The patients temperature was 38.9 Celcius, Cardiac rate was 119, Respiratory rate was 20, Blood Pressure was 80/60. Oxygen saturation in room air was 95%, and the patients level of care was level 4. The patient has an IV hepblock on his left arm. The patients skin was cool to touch and with blisters in his arms and legs, he has bedsore below his buttocks. The patients bowel sounds were hypo active and stated no bowel movement as of July 9, 2011. The urine output was 100cc. The patient appeared unconscious and with some

Nursing Management 5 general weakness. The patient uses ventilator to help him breath as ordered by the doctor. Related Treatments The patient has no allergies to latex, iodine and adhesives. The patient has an IV hep block on his left vein, with 1 liter of D5W isotonic solution. According to Brunner, once it is administered, the glucose of is rapidly metabolized. It is used mainly supply water and to correct on increased serum osmolality. About 1 lietr of D5W provides fewer than 200kcal. The patient is taking medication of Cilastatin 500mg thru IV. It is for infection caused by susceptible organisms. The patient is taking levofloxacin 750mg once daily. It is also treatment of wide infections including lower respiratory tract infection. The physician also prescribed paracetamol 1300mg every 4 hours for fever and human albumin 25%, IV once daily for increase oncotic pressure in case of oncotic deficiency. Since the patients undergo surgery, the physician ordered Tramadol 40mg IV, 8 hours every pain. It is for severe acute or chronic pain during surgery procedures. Since the patient is unconscious, all the medication routes are thru intravenous. According to Kozier, the parenteral administrations of medication are absorbed more quickly than oral medications. The primary purpose of giving IV medications is to initiate a rapid systemic response to medication. The drug is immediately available to the body. It is easier to control the actual amount of drug delivered to the body by using the IV method and it is also easier to maintain drug levels in the blood for therapeutic response.

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Nursing Care Plan M.Rs nursing diagnosis is ineffective airway clearance related to infection secondary to nosocomial pneumonia. The patient has elevated temperature, blood pressure of 80/60, respiratory rate of 20, and cardiac rate of 114. The patient experienced no bowel movement for two weeks. The patient is a passive smoker. Chest x-ray confirmed pneumonia. The main goal is to maintain airway patency and move sputum out of the way.

Nursing intervention for the patient is to monitor respirations and breath sounds, noting rate and sounds indicative of respiratory distress or accumulation of secretions. Auscultate breath sounds and assess airway movement to ascertain status and note progress. Monitor vital sign, blood pressure ad pulse changes. Observe for signs of respiratory distress. Monitor chest x-ray, abg, pulse oximetry readings. To evaluate the status of oxygenation, ventilation and acid base balance. Administer prescribed medications for infections.

Nursing Management 7 Recommendation

The pneumococcal vaccine is one of the most effective ways to prevent pneumonia. Smoking cessation is another important way to prevent pneumonia.

Infection control measures can help to prevent the spread of any type of infection, including pneumonia. Infection control is most commonly practiced in healthcare settings, but is useful in the community as well. Simple practices such as frequent hand washing with soap and water or alcohol-based hand rubs can be effective.

Because pneumonia is spread by contact with infected respiratory secretions, people with pneumonia should limit face-to-face contact with uninfected family and friends. The mouth and nose should be covered while coughing or sneezing, and tissues should be disposed of immediately. Sneezing/coughing into the sleeve of one's clothing (at the inner elbow) is another means of containing sprays of saliva and secretions and has the advantage of not contaminating the hands.

Nursing Management 8 References

Smeltzer, Suzzane C. , Brunner and Suddarths Textbook of medicalSurgical Nursing. P. 554-564 Mims, 127th edition 2011 Kozier and Erbs, Fundamentals of Nursing p. 839