Nursing Case Study Pneumonia

Nursing Case Study Pneumonia

Pneumonia, also known as pneumonitis or Broncho pneumonia is an inflammation of the lungs caused by an infection. It is a health threat and a special concern for people with chronic illnesses and the aged.  It can affect one or both lungs. Different kinds of pneumonia pose different levels of threat from mild to fatal. Early recognition and treatment increases the chances of survival and therefore, it is crucial to learn how to manage it. The following nursing case study pneumonia sheds light on the condition.

What nursing assessments would be completed on a patient with pneumonia? And what are the pathological reasons for these assessments?

  1. Skin Assessment – looking at the color of the skin. Is our patient cyanotic? There are two types of cyanosis: Peripheral, which affects only extremities or fingers, and Central, which refers to lips, tongue, and core. Cyanosis is caused by excessive concentration of deoxyhemoglobin in the blood, caused by deoxygenation.

 

  1. Vital Signs – The sample patient had an oxygen saturation of 91%, below the expected range of 95 to 100. She had a high temperature. Her respirations were also high, which meant she was breathing faster to get more oxygen in. The work of breathing might be high because mucus production can obstruct airflow and decrease gas exchange. The body’s inflammatory response to the infection can also trigger mucus and bronchospasm. In addition, the heart rate in our patients is increased due to dehydration and fever.

 

  1. Auscultation – Patients with pneumonia will have coarse crackles or ronchi on auscultation. Ronchi resembles snoring and indicates obstruction or secretions in the larger airways.

 

  1. Percussion – Dull thuds will be the heart when the chest is tapped, indicating fluid in the lung or collapse of part of a lung.

 

  1. Palpation – Looking for decreased chest expansion or asymmetry.

 

  1. Hydration assessment – If a patient has a fever, they may be dehydrated. We would monitor fluid input and output.

 

  1. Pain assessment – A basic COLSPA to ensure that pneumonia causes the underlying pain and there isn’t pain somewhere else that might need to be addressed more urgently than pneumonia.

 

  1. Full history – Do they have a history of COPD? Do they smoke? How long have they been sick? Is the cough productive? If it is productive, what color is the mucus? How much does it smell?

 

Explain the pathophysiology of chest pain in pneumonia.

The chest pain is pleuritic: hurting when taking a deep breath. Caused by inflammation of the pleura.

 

 

 

 

 

How do we form a nursing diagnosis for pneumonia?

Signs of symptoms of a patient presenting with pneumonia:

Cough – may or may not be productive. Sputum can be green, yellow, or rust-colored.

Fever

Shaking

Chills

Dyspnoea

Tachypnoea (increased respiration)

Pleuritic chest pain

Nausea

 

Non-specific symptoms include:

diaphoresis (sweating)

anorexia

fatigue

myalgia

headache

 

Explain how PNEUMONIA is used as a mnemonic.

Productive Cough

Neuro changes in the elderly

Elevated labs

Unusual breath sounds (ronchi & crackles)

Mild to high fever

Oxygen-saturation is low

Nausea and vomiting

Increased resp and heart rate

Aching all over (myalgia)

 

In the Case Study, what is the nursing diagnosis for Mrs Jay based on the information provided?

Mrs. Jay has pleural pain, which increases when moving. Her pain score is 8 out of 10. In addition, Mrs. Jay has a temperature, her skin is warm and flushed, her respirations are shallow, and her respiration rate has increased. She has coarse crackles in the lower lobes, dullness on percussion, indicating fluid buildup and a productive cough producing rusty-brown sputum, and lower oxygen saturation on auscultation. All of these taken together indicate she has pneumonia.

 

What nursing interventions would be undertaken on a patient with pneumonia?

We would monitor the respiratory system, auscultating lung sounds, listenings for crackles and ronchil, completing percussion for the dull sounds that indicate a fluid build-up in the lungs, and palpitating for symmetry.

 

We would monitor vital signs to get a baseline for the patient’s condition. This will show us improvement or if the condition is getting worse.

 

We would take a sputum sample, and the tests are culture, sensitivity, and a gram stain.

 

We would monitor arterial blood gas for hypoxemia, an abnormally low oxygen concentration in the blood.

 

Keep the patient hydrated — patients will lose extra moisture during the day if respiratory rate is increased. Before hydrating a patient, we need to check if they have a heart condition.

 

Administering medications as prescribed by their physician. O2 to treat hypoxaemia, analgesic for pain; antidiuretics for temperature; bronchodilators and steroids to open the airways; and appropriate antibiotic as prescribed.

 

Ongoing pain assessment.

 

What would you do next once you’ve completed the planned interventions for Mrs Jay’s pneumonia?

We would evaluate Mrs. Jay’s condition in relation to the planned and completed interventions to see if her condition has changed.

 

We would then complete new assessments to see what further treatment is required.

 

What are the risks for a patient with right lower lobe pneumonia?

Fluid accumulation – fluid can develop between the covering of the lungs and the inner lining of the chest. This is called a “pleural effusion.”

 

Abscess – a collection of pus in an area infected with pneumonia.

 

Bacteraemia – pneumonia infection spreads from the lungs to the bloodstream, from where it can spread to other organs. Bacteraemia can cause low blood pressure.

 

Cardiovascular events – increased risk of having a cardiovascular event during recovery. This risk can persist for several years post-recovery from pneumonia.

 

Death.

 

Identify the assessments related to the risks for a patient with right lower lobe pneumonia.

Temperature

Respiration

Pulse

Oxygen Saturation

Blood Pressure

 

Knowing the assessment findings, identify your planned intervention for a patient with right lower lobe pneumonia.

Monitor the respiratory system (auscultation, percussion, palpitation)

 

Monitor vital signs

 

Test a sputum sample

 

Monitor arterial blood gas for hypoxaemia

 

Keep the patient hydrated

 

Administer medications as prescribed: antipyretics for temperature, analgesics for pain, O2 treatment for hypoxaemia.

 

Ongoing pain assessment.

 

Encouraging deep breathing, coughing, and positioning.

 

Why are these interventions important in relation to patient safety and recovery?

Hydration softens the mucosa, making it easy to release it from the lungs and clear the alveoli. However, the patient is also losing excess water from increased respiration and sweating.

 

Encouraging deep breathing and coughing and position in high Fowler’s to help with breathing and clear mucus.

 

Administration of antipyretics and analgesia to assist with fever and pain.

 

Administration of antibiotics as prescribed to treat bacterial infection.

 

Administration of oxygen, 2 liters per minute, to improve oxygen saturation. This is to improve amounts of O2 circulating in the bloodstream, reaching the organs and tissues.

 

How will we evaluate these? And why is that evaluation important?

Regular reassessment and OBS checking are needed to evaluate any changes in results, such as O2 SATS being assessed again to see if oxygen administration increases the amount of oxygen circulating in the bloodstream.

 

What is the pathophysiology of pneumonia?

Pneumonia is a lower respiratory tract infection that causes inflammation of alveoli sacs. This affects gas exchange.

 

Bacteria, viruses, or fungi can cause it.

 

Bacteria id most commonly streptococcus

The virus is most commonly influenza

Fungi is less common

 

More likely to occur when immune defenses are low.

 

Alveoli become inflamed and fill with fluid, white blood cells, red blood cells, and bacteria.

 

Alveoli can’t transition carbon dioxide and oxygen, making patients hypoxic.

 

What are the four stages of pneumonia?

Stage 1: Congestion – alveoli fill with fluid and debris. This fluid consists of organisms that have multiplied and inflammatory cells. This causes capillaries in alveoli walls to become a thick and congested decreasing gas exchange.

 

Stage 2: Red hepatization – characterized by erythrocytes, neutrophils, red blood cells, and fibrin within the alveoli causing capillaries to dilate and engorge with blood.

 

Stage 3: Grey hepatization – Occurs 2 to 3 days after a red hepatization. Neutrophylls are packed into the alveoli, with few bacteria remaining in the alveoli causing compression of the capillaries and decreased blood flow.

 

Stage 4: Resolution – Macrophages enter the alveoli space and ingest the debris, causing normal lung tissue to be restored and gas exchange to be normalized.

 

What is community-acquired pneumonia?

Occurs outside the hospital or health facilities. Although organisms are picked up in everyday life, typical bacterial pathogens can cause the condition.

These include streptococcus.

 

Pneumonia can occur on its own or after you’ve had the flu.

 

What is hospital-acquired pneumonia?

Develops during a hospital stay. It can be serious because the bacteria causing it may be resistant to antibiotics. Usually caused by bacteria, so community- and hospital-acquired are the same condition, but the difference is how the illness is caused and develops.

A lack of mobility can also bring on Hospital-acquired pneumonia.

How can hospital-acquired pneumonia be prevented?

Hand hygiene.

Follow infectious precautions closely

Avoid invasive mechanical ventilation

Full Fowler’s position

Maintain gastric acidity

Hospital-acquired pneumonia happens

within 48 hours in a hospital

Scattered thru the lungs sounds like rhonchi. What is this

bronchopneumonia

We should get sputum culture first before starting

ATB

What is a sputum culture ordered for

to see what kind of organism we are dealing with

Blood cultures are taken to see if there is bacteremia. how do we take them

Two separate spots in 15 minutes

Anyone older than 65 is at increased risk for

pneumonia

What additional symptoms will we monitor beside the pneumonia

change in LOC, cough, cyanosis, I&O daily weight, shaking/chills, pain (chest or pluretic) monitor stools

What is a trough for

blood work is taken 30 minutes before med, and when ATB is at its lowest

What is the peak of a med

blood was taken after 1-2hrs when ATB has run thru IV, it when med is at highest peak to see level for MD to adjust the dose as needed

Why do we need to do a peak and trough for vancomycin

Ototoxicity and Nephrotoxicity (hearing and kidneys)

what else may we order when treating pneumonia

Mucinex, bronchodilators, steroids, Robitussin

What complications of pneumonia will we monitor for

pleurisy, Atelectasis

What diagnostic studies would be helpful in the diagnosis and treatment of pneumonia

ABGs, chest x-ray, CRP (reactive chemical protein), CBC with diff, chest CT, electrolytes

Impaired gas exchange r/t fluid and exudate accumulation at the capillary-alveolar membrane

Acute pain r/t inflammation and ineffective pain management and/or comfort measures and coughing

assess pain, pain meds as ordered, position patient

What should we include in discharge teaching

when to call MD, adequate dietary intake, maintains adequate hydration, take the entire course of ATB, rest and conserve energy, small frequent meals, hand hygiene

What should we teach patients regarding pneumonia and influenza vaccine Original Alphabetical

Hospital-acquired pneumonia happens

within 48 hours in the hospital

Scattered thru the lungs sounds like rhonchi; what is this

bronchopneumonia

We should get sputum culture first before starting

ATB

What is a sputum culture ordered for

to see what kind of organism we are dealing with

Blood cultures are taken to see if there is bacteremia. how do we take them

Two separate spots in 15 minutes

Anyone older than 65 is at increased risk for

pneumonia

What additional symptoms will we monitor beside the pneumonia

change in LOC, cough, cyanosis, I&O daily weight, shaking/chills, pain (chest or pluretic) monitor stools

what else may we order when treating pneumonia

Mucinex, bronchodilators, steroids, Robitussin

What complications of pneumonia will we monitor for

pleurisy, Atelectasis

What diagnostic studies would be helpful in the diagnosis and treatment of pneumonia

ABGs, chest x-ray, CRP (reactive chemical protein), CBC with diff, chest CT, electrolytes

Impaired gas exchange r/t fluid and exudate accumulation at the

capillary-alveolar membrane

Acute pain r/t inflammation and ineffective pain management and/or comfort measures and coughing

assess pain, pain meds as ordered, position patient

What should we include in discharge teaching

when to call MD, adequate dietary intake, maintains adequate hydration, take the entire course of ATB, rest and conserve energy, small frequent meals, hand hygiene

What should we teach patients regarding pneumonia and influenza vaccine

Get influenza vaccine yearly, get pneumonia vaccine >65 1x or other shot >65 and if more sickness get additional shot in 5 years

 

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