Hospital Acquired Pneumonia Essay

Brief Narrative about Patient: (What brought patient to the hospital?)Using (OLDCART)
Patient was admitted to the hospital via Assisted Living Facility. She has Hospital Acquired Pneumonia and is having acute confusion episodes. She cannot describe any pain, but says “ow” when she is being examined. She is aware of herself, but is not oriented to time or place.

Subjective:
Patient states “Ow” during examination

Objective:
Temp: 97.5, Pulse: 66, BP: 142/71, Resp: 20, O2: 98% Room air
Medical diagnosis of Hospital Acquired Pneumonia
Medical history includes atrial fibrillation, hypertension, hyperglycemia, pulmonary infiltrates, Leukocytosis, anemia, confusion
Patient has had 2 hip replacements and knee replacements
Chest x-ray: Infiltrate in the periphery of the left midlung and throughout left lower lung. Patchy infiltrate is observed in the medial aspect of the right lung base.
CT Scan results: Extensive pulmonary parenchymal infiltrate. Dense consolidating infiltrate in both upper lobes which has increased in extent. Trace amount of pleural effusion present.
Moderate fall risk according to Morse Fall Scale
Moderate risk on Braden Scale
Medications: Albuterol, Lasix, Levaquin, Pepcid AC, Diflucan,
Depo Medrol
Input: 40 mLs
Output: 0
3+ Pitting edema in lower extremities
Medical Diagnosis and definition with Pathophysiology:

Hospital- Acquired Pneumonia is pneumonia occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization.
This infection causes significant morbidity and it increases the risk of death. There are 4 characteristic stages. Congestion occurs due to an outpouring of fluid into the alveoli. Red hepatization is when there is massive dialation of the capillaries and the alveoli are filled with organisms, neutrophils, RBC’s and fibrin. The gray hepatization stage is when blood flow decreases and leukocytes and fibrin consolidate in the affected part of the lung. The last stage is called resolution and it is when healing occurs without complications. The exudates is lysed and is processed by the macophages (Lewis,
2011).

Therapeutic Regimens:
Specific treatments depend on the type and severity of your pneumonia, and the age and overall health of the patient. Some options include: Antibiotics, to treat bacterial pneumonia. It may take time to identify the type of bacteria causing your pneumonia and to choose the best antibiotic to treat it. Symptoms often improve within three days, although improvement usually takes twice as long in smokers. If your symptoms don 't improve, your doctor may recommend a different antibiotic, Antiviral medications, to treat viral pneumonia. Symptoms generally improve in one to three weeks, Fever reducers, such as aspirin or ibuprofen.
If you need to be placed on a ventilator or your symptoms are severe, you may need to be admitted to an intensive care unit. (Mayo Clinic, 2013).

IV fluids should be started to maintain adequate fluid replacement, but I & O must be monitored to ensure the patient does not have fluid overload.

Assessment
Related to the nursing DX chosen

Subjective
Objectives and cultural data collected related to each nursing DX.
Nursing Diagnosis
Priority of order

Related to

(3)As manifested by
Plan (Goals)
Needs to be measurable, realistic and time
Will be including and related to knowledge/Behavior and health status ( must including short term and long term)
6 Interventions
(with Rationales) In priority of order

Evaluation
Result of interventions and evaluation of goals
Met /Not met or Partially met and Why?
Recommendation?
Subjective:
Patient having trouble breathing and eating.

Cultural:
Patient is a widow
Patient is Baptist
Patient has one child who does not live nearby.

Objective:
Acute Confusion
Respirations: 20
Non-ambulatory
Hemoglobin: 10.6
Hematocrit: 33
WBC: 15.2
X-Ray report: Infiltrate in both lungs.
Chest CT Scan: Extensive pulmonary parenchymal infiltrate, pleural effusion

___________________
Subjective:
Patient breathing heavily.

Cultural:
Patient is a widow
Patient is Baptist
Patient has one child who does not live nearby.

Objective:
Respirations: 20
Non-ambulatory
Hemoglobin: 10.6
Hematocrit: 33
WBC: 15.2
X-Ray report: Infiltrate in both lungs.
Chest CT Scan: Extensive pulmonary parenchymal infiltrate, pleural effusion

#1) Impaired gas exchange related to decreased functional lung tissue as evidenced by rhonci and crackles present bilaterally in lungs.

ND #1:
The patient will:

1) Demonstrate improved ventilation and adequate oxygenation by the end of the day.

2) Maintain clear lung fields and remain free of signs of respiratory distress throughout my shift.

3) Rest without becoming agitated due to poor oxygenation throughout my shift.
Assess: respiratory rate, depth and ease of respiration because a study demonstrated that when the respiratory rate exceeds 30 breath/minute a significant respiratory alteration exists (Ackley, 2014).

Do: Auscultate breath sounds every 1 to 2 hours and listen for diminished breath sounds, crackles and wheezes since the presence of crackles and wheezes may alert the nurse to airway obstruction (Ackley, 2014).

Collaborative: A respiratory therapy team should be consulted in order to use appropriate breathing treatments.

Medications:
Albuterol, Levoquin, Lasix

Teach: client to deep breathe and to perform controlled coughing because controlled coughing uses the diaphragmatic muscles which make the cough more productive(Ackley, 2014).

Safety: Watch for signs of psychological distress since the patient might become confused and attempt to stand or pull out PICC line.

ND #1:
Met / Not Met/Partially met and Why:

a) Knowledge
- Not met, patient is not alert and oriented to understand what is going on with her. b) Behavior
-Not met, patient is too confused to follow any type of deep breathing instructions. c) Health Status
-Patient is showing slight improvement since she was admitted to the ICU.

#2) Ineffective breathing pattern related to inflamed bronchial passages as evidenced by respiratory rate of 20 breaths per minute.

ND #2:
The patient will:
1) Demonstrate a breathing pattern that supports normal blood gas results by the end of my shift.

2) Report ability to breathe comfortably within 2 days.

3) demonstrate ability to perform pursed lip breathing and controlled breathing as soon as she regains orientation.
Assess: the patient’s pattern of respiration since a normal respiratory pattern is regular in a healthy adult (Ackley, 2014).

Do: monitor oxygen saturation continuously using pulse oximetry because an oxygen saturation level of less than 90% indicates oxygenation problems (Ackley, 2014).

Collaborative: Refer the client to appropriate services, such as a respiratory therapy, as needed because when appropriate referrals are missed or delayed, clients often experience poor outcomes (Ackley, 2014).

Medications: Albuterol, Levoquin, Lasix

Teach: the patient to slow their respiratory rate because this can reassure the patient and can be beneficial in decreasing anxiety (Ackley, 2014).

Safety: Position the client in an upright position because an upright position facilitates lung expansion (Ackley, 2014).

ND #2:
Met / Not Met/Partially met and Why:

a) Knowledge
Not met, patient is not alert and oriented to understand what is going on with her. b) Behavior
-Not met, patient is too confused to follow any type of deep breathing instructions. c) Health Status
-Patient is showing slight improvement since she was admitted to the ICU.

References APA Format

Ackley, B., & Ladwig, G. (2014). Nursing diagnosis handbook; an evidence-based guide to planning care. (10th ed.). Maryland Heights, MO: Mosby Elsevier.

Mayo Clinic. (2013, 01 19). Acute Pancreatitis. Retrieved from http://www.mayoclinic.com/health/acute=\-pancreatitis/DS00161/DSECTION=causes

Skidmore-Roth, L. (2013). Mosby’s drug guide for nursing students. (10th ed.). St. Louis, MO: Mosby Elsevier.