Focus Area Question 5—Nursing/Medical Care and Rationale
1. Identify and describe nursing interventions for a patient with bacterial pneumonia.
• Assess patient’s vital signs, including breath sounds, respiratory status, skin color, and SpO2 at least every four hourly. Early recognize of respiratory compromise allows intervention to prevent tissue hypoxia.
• Assess sputum and cough including color, amount, possible odor and consistency. This assessment allows evaluation of the effectiveness of respiratory clearance and the response to therapy.
• Encourage effective cough; teach with proper deep breathing exercises. Provide suctioning as ordered. Coughing is a reflex and a natural self-cleaning mechanism which can assists to maintain patent
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airways. Deep breathing exercise facilitates maximum expansion of the lungs and smaller airways. Coughing, deep breathing exercise, and suctioning help clear patient’s airway. • Administrations of medications as prescribed by doctors such as antibiotics and bronchodilators, and monitor their effects. Antibiotic can treat infection. And bronchodilators help maintain open airways but may have adverse effects such as anxiety and restlessness. If the infecting organism is resistant to the prescribed antibiotic, little improvement may be seen with treatment. • Provide adequate fluid intake of at least 2500 to 3000mls per day as ordered by doctor. A liberal fluid intake helps liquefy secretion, facilitating their clearance. • Administer oxygen as ordered. Oxygen therapy increases the alveolar oxygen concentration and facilitates its diffusion across the alveolar-capillary membranes, reducing hypoxia and anxiety. But for Patients with underlying chronic lung diseases should be given oxygen cautiously. • Elevate head of bed, make sure patient in Fowler’s or high-Fowler’s position and encourage frequent position changes and ambulation. The upright position promotes lung expansion; ambulation and position changes facilitate the movement of secretions. • Work with the healthcare provider and respiratory therapist to provide pulmonary hygiene measures, such as incentive spirometer, percussion, postural drainage, and vibration. These techniques help mobilize and clear secretions. • Monitor chest x-ray, arterial blood gas, pulse oximetry readings, report increasing hypoxemia and other abnormal results to dorctors. These changes may be early indicators of impaired gas exchange due to obstruction or airway narrowing and may facilitate necessary alterations in therapy. 2. Identify and describe medical interventions for a patient with bacterial pneumonia. Medications Prescribe antibiotics to treat the infection.
Antibiotic therapy is based on the results of sputum gram stain or specimens by lung aspirations which are from the site of infection (Grant, Campbell, Dowell, Graham, Klugman, Mulholland . . . Qazi, 2009). Topically, a broad-spectrum antibiotic such as a macrolide, a fluoroquinnolone or penicillin is ordered until the results of sputum culture and sensitivity tests are available (book).
Bronchospasm is responsive to bronchodilators and administration of bronchodilator to improve ventilation (McNally, Jeena, Gajee & Thula, 2007). Inflammatory response to the infection can cause bronchospasm and constriction, bronchodilators may be ordered to reduce hypoxia and improve ventilation.
An agent to “break up” mucus or reduce its viscosity may be prescribed to help liquefy mucus, making it easier to expectorate, such as acetylcysteine and guaifenesin.
Fluids
When mucous secretion are viscous and thick, increase fluid intake up to 2500 to 3000mls per day which can help liquefy secretions, and make them easier to cough up. Management of fluid and adjust dose based on the kidney function for patient with bacterial pneumonia (Thiem, Heppner & Pientka, 2011). Intravenous fluids and nutrition may be required if the patient is unable to maintain an adequate oral intake due to shortness of breath or
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weakness. Oxygen therapy Oxygen therapy is needed for patients who have low saturation of peripheral oxygenation to prevent hypoxaemia (Thiem, Heppner & Pientka, 2011).
Increasing the percentage of partial pressure of oxygen in the alveoli and enhances its diffusion into the capillaries. Supplemental oxygen therefore improves oxygenation of the blood and tissues in patient with pneumonia (Scott, Brooks, Peiris, Holtzman & Mulholland, 2008).
Respiratory therapy
Respiratory therapy is to remove mucus from the lungs. This therapy may include deep breathing exercises, cough, suctioning, and incentive spirometry. Flexible Fiberoptic bronchoscopy is used to perform pulmonary toilet such as broncheoalvoelar washings, selective mucosal brushing and remove secretions (Bhadke, Munje, Mahadani, Surjushe & Jalgaonkar, 2010).
Chest physiotherapy
Chest physiotherapy including percussion, vibration, and gravity-assisted drainage, to reduce lung consolidation which also can prevent atelectasis (Pattanshetty & Gaude, 2010). It is not necessary for every patient, but it may be helpful for people who have other lung conditions, such as
bronchiectasis. McNally, L. M., Jeena, P. M., Gajee, K. & Thula, S. A. (2007). Effect of age, polymicrobial disease, and maternal HIV status on treatment response and cause of severe pneumonia in south african children: A prospective descriptive study. The Lancet,369(9571), 1440-51. Retrieved from http://search.proquest.com.dbgw.lis.curtin.edu.au/docview/199074970?accountid=10382 Grant, G. B., Campbell, H., Dowell, S. F., Graham, S. M., Klugman, K. P., Mulholland, E. K., . . . Qazi, S. (2009). Recommendations for treatment of childhood non-severe pneumonia. The Lancet Infectious Diseases, 9(3), 185-96. Retrieved from http://search.proquest.com.dbgw.lis.curtin.edu.au/docview/201567686?accountid=10382 Pattanshetty, R., & Gaude, G. (2010). Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: A randomized clinical trial. Indian Journal of Critical Care Medicine, 14(2), 70-76. doi: http://dx.doi.org.dbgw.lis.curtin.edu.au/10.4103/0972-5229.68218 Thiem, U., Heppner, H., & Pientka, L. (2011). Elderly patients with community-acquired pneumonia. Drugs & Aging, 28(7), 519-37. doi: http://dx.doi.org.dbgw.lis.curtin.edu.au/10.2165/11591980-000000000-00000 Scott, J. A., Brooks, W. A., Peiris, J. S. M., Holtzman, D., & Mulholland, E. K. (2008). Pneumonia research to reduce childhood mortality in the developing world. Journal of Clinical Investigation, 118(4), 1291-300. Retrieved from http://search.proquest.com.dbgw.lis.curtin.edu.au/docview/200539234?accountid=10382 Bhadke, B., Munje, R., Mahadani, J., Surjushe, A., & Jalgaonkar, P. (2010). Utility of fiberoptic bronchoscopy in diagnosis of various lung conditions: Our experience at rural medical college. Lung India, 27(3), 118-121. doi: http://dx.doi.org.dbgw.lis.curtin.edu.au/10.4103/0970-2113.68306
There are a variety of ways to treat a collapsed lung, and different methods are used depending on the severity of the situation. The ultimate goal of the treatment is to restore lung function by removing external pressure on the
It incorporates dietary advising, exercise training, and mental guiding. There are also numerous surgical treatment alternatives. For example, the removal of nasal polyps that block breathing, oxygen treatment to prevent pulmonary hypertension, endoscopy and lavage to suction mucus from airways, the surgical insertion of a feeding tube may be important to convey supplements while sleeping. In cases where life-threatening lung complexities arise, a lung transplant may be viewed as an option.
Sequeiros, IM, Jarad, NA. 2009. Home intravenous antibiotic treatment for acute pulmonary exacerbations in cystic fibrosis-Is it good for the patient?. Annals of Thoracic Medicine 4(3), pp. 111-114.
Aerosolized antibiotic used in this study that are proven to be effective are: amikacin, colistin, ceftazidime, gentamicin, tobramycin, sisomycin, and yancomycin. However, increasing antibiotic resistance patterns among intensive care unit pathogens, cultivated by empiric-broad spectrum antibiotic regimens, characterizes the variable concerns. Recent literature point that antibiotic use before the development of VAP is associated with increased risk for potentially resistant gran-negative infections and Methcillin-resistant Staphylococcus auereus (MRSA)
...spiratory infections. The patient must always be under continuous scrutiny since they can undergo aspiration or lack the ability to change from the passageway to their lungs versus their stomach and their spit travels to the lungs which, in turn, causes bronchopneumonia. The patient also does not have the facility to cough and so must undertake a treatment to shake up their body to eliminate the mucus from the lining of their lungs.
My disease is Streptococcal pneumonia or pneumonia is caused by the pathogen Streptococcus pneumoniae. Streptococcus pneumoniae is present in human’s normal flora, which normally doesn’t cause any problems or diseases. Sometimes though when the numbers get too low it can cause diseases or upper respiratory tract problems or infections (Todar, 2008-2012). Pneumonia caused by this pathogen has four stages. The first one is where the lungs fill with fluid. The second stage causes neutrophils and red blood cells to come to the area which are attracted by the pathogen. The third stage has the neutrophils stuffed into the alveoli in the lungs causing little bacteria to be left over. The fourth stage of this disease the remaining residue in the lungs are take out by the macrophages. Aside from these steps pneumonia follows, if the disease should persist further, it can get into the blood causing a systemic reaction resulting in the whole body being affected (Ballough). Some signs and symptoms of this disease are, “fever, malaise, cough, pleuritic chest pain, purulent or blood-tinged sputum” (Henry, 2013). Streptococcal pneumonia is spread through person-to-person contact through aerosol droplets affecting the respiratory tract causing it to get into the human body (Henry, 2013).
...a are bronchodilators like anticholinergic, beta agonists, theophylline and oxygen, which are for the advance cases of the disease. In addition, the best treatment for people whom have emphysema is for them to stop smoking.
HENDERSON, Y (1998) A practical approach to breathing control in primary care. Nursing Standard (JULY) 22 (44) p41
Licensed practical nurses (LPN 's) fill an important role in modern health care practices. Their primary job duty is to provide routine care, observe patients’ health, assist doctors and registered nurses, and communicate instructions to patients regarding medication, home-based care, and preventative lifestyle changes (Hill). A Licensed Practical Nurse has various of roles that they have to manage on a day to day basis, such as being an advocate for their patients, an educator, being a counselor, a consultant, researcher, collaborator, and even a manager depending on what kind of work exactly that you do and where. It is the nursing process and critical thinking that separate the LPN from the unlicensed assistive personnel. Judgments are based
Hinkle, Janice, and Kerry Cheever. “Management of Patients with Chronic Pulmonary Disease." Textbook of Medical-Surgical Nursing, 13th Ed. Philadelphia: Lisa McAllister, 2013. 619-630. Print.
Hess Dean R., M. N. (2012). Respiratory Care: Principles and Practice 12th Edition. Sudbury, MA: Jones and Bartlett Learning.
Using medication will decrease all the pressure that is caused by fluid going around the lungs and heart. Pulmonary edema may be life-threatening, especially without urgent medical treatment and professional assistance. Curing this problem may also be follow the steps of supplement oxygen and medicine. The patient should then follow a low sodium diet to prevent this from being an occurring health problem. Oxygen therapy on a three to five-day treatment will cut down on the chances of having this health condition attacking the Pulmonary system. Follow -up appointments scheduled by a patient that had been diagnosed with Pulmonary edema is critical. Just based off the studies that this wet lung disorder is a chronic build up that is to be controlled and not necessarily cured. Controlling possible risk factors such as salt intake, smoking, cholesterol consumption and taking the prescribed medications will eventually help minimize symptoms and future episodes of edema. On the other hand, it is important to understand that a lot of treatment resolutions can come from self-care which include a low sodium diet and also supportive care which consists of an oxygen therapy treatment. Nevertheless, with a low sodium diet, this a type of diet that restricts salt and other types of sodium. With the oxygen treatment, patients with pulmonary
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
Patient will display adequate gas exchange as evidence by SaO2 values and respiratory rate consistent with baseline.
What is the central component of advanced practice nurses (APNs) direct clinical practice and patient/families?