encourage pt to take deeper breaths.

Do pt teaching to explain

CONCEPT MAP
Collaborate with physician to administer antibiotics to resolve infection
administer supplemental O2 as needed to maintain adequate oxygenation help the client cough and deep breath at least q2hrs to clear airways and expand the lungs at the bases administer prescribed nebulizer breathing treatments to open airways

Saucier, Hali SNPLU 2/25/08

importance of lung expansion with pneumonia. sit pt up in bed (high fowlers) to decrease pressure on chest and allow for adequate lung expansion. Obtain an incentive spirometer for the pt to encourage deep breathing. Pt teaching on the importance of weight loss

Medical Diagnosis
Pathophysiology

Patients Story

Diagnostic Workup

Clinical Manifestation

Nursing Diagnosis

Etiology & Risk Factors

Expected Outcome

Pt. will achieve adequate ventilation

Ineffective breathing pattern r/t obesity and fatigue, AEB SOB, RR, depth of breathing, and pt reports difficulty taking deep breaths (4).

Pt will experience improved oxygenation

Impaired gas exchange r/t ed functional lung tissue
(4) AEB dyspnea, tachycardia, ed RR, and O2 of less than 92% on RA.

Secondary Diagnosis

Nursing Interventions

Patients Medications: (2).

For pneumonia: - Levofloxacin (Levaquin): anti-infective - Cefalosporin): anti-infective, 3rd generation. - Albuterol: adrenergic bronchodilator - Ipratropium (Atrovent): anticholinergic bronchodilator Other Medications: - Viramune: antiviral (plus one other antiviral that I forgot the name) - Insulin coverage for diabetes - Nystatin (candida) - Heparin sc (DVT prevention) - Warfarin (DVT prevention anticoagulant) - Furosemide (Lasix): edema - Acetaminophen (for pain) Discharge Planning: - communicate with LCT facility to update on pt discharge status - ensure pt has adequate ventilation/oxygenation before d/c. Arrange for portable O2 if needed. - Pt teaching on pneumonia prevention

My patient was a female in her 60s who lives in an assisted living rehab facility. She came to the hospital with chest pain, SOB, fever, and productive cough. She also had cellulitis in her lower extremities that was getting worse. She was admitted for 5 days to receive IV antibiotics. I cared for her on the 5th day, so she had few s/s of pneumonia. Pneumonia is an inflammation in the alveoli and the interstitium of the lung, usually caused by an infection (3). There are several different types, including community acquired, hospital acquired, aspiration, fungal, and opportunistic (1). This particular patient had what is called health-care associated pneumonia, because she had been living in an assisted living facility. However, I think it could also be considered opportunistic because of her compromised immune status. In pneumonia, the infective agent enters the lung (pseudomonas in this case), multiplies, and triggers inflammation. The alveoli fill with exudative fluid which impairs gas exchange. Exudate can consolidate and become difficult to cough up (3). Bacterial pneumonia is usually associated with a productive cough, whereas viral is not (1).

Pneumonia
Incidence: Health-care Associated Pneumonia occurs in about 5-15 cases out of every 1000 hospital admissions. HAP is the 2nd most common nosocomial infection after UTIs (1.)

Chest X-ray shows white shadows (parenchymal infiltrates (3). Culture and sensitivity. Gram-stain of sputum to differentiate bacterial from viral causes and gram + vs. -. WBC elevation (greater than 15,000/l (3).)

sudden onset of fever/chills SOB, increased RR Productive cough (bacterial) Pleuritic chest pain Confusion or stupor (due to hypoxia) Crackles, fremitus, bronchial breath sounds

- breast cancer
HIV (both of the above are 2 diagnoses that could have contributed to the development of pneumonia due to compromised immunity from HIV and from chemotherapy.) Diabetes Lymphedema and Cellulitis in lower extremities Hx of MRSA, Hep C, CHF, MI, A-fib

Risk factors: chronic illness immobility immunosuppression post-surgery/anesthesia

References:
1. Lewis S.L., Heitkemper M.M., Dirkesen S.R., OBrien P.G., & Bucher L. (2007). Medical surgical nursing: Assessment and management of clinical problems (7th ed.). St. Louis: Mosby Elsevier. 2. Deglin J.H., & Vallerand A.H. (2007). Daviss drug guide for nurses (10th ed.). Philadelphia: F.A. Davis Company 3. Copstead L.C., & Banasik J.L. (2005). Pathophysiology (3rd ed.). St. Louis: Elsevier Saunders. 4. Ackley B.J. & Ladwig G.B. (2006). Nursing diagnosis