Clinical manifestation of pneumonia among older patient
Discuss about the Case Study of Mr Hunter.
Pneumonia is the most common cause of infectious deaths especially in elderly and under 2 years (Berman et al 2015). It has been found that pneumonia is mainly caused by microorganisms such as bacteria viruses and fungi. At times it has been seen that disease is caused because lungs are being affected by bacteria and fungi. Symptoms can be more severe in elderly as most of them have low immunity. The most common signs and symptoms in adults above 65 years are chest pains when breathing or coughing, confusion or changes in mental awareness, cough which may be productive and fatigue. Also fever(38?C), sweating and chills. Sometimes body temperature can be lower than normal. Furthermore, nausea, vomiting, diarrhoea and shortness of breath may be present. The abnormal lungs sound like crackles and rhonchi is another major clinical manifestation that can be considered by nurses. This is as a result of phlegm secretions. Headache and confusion may also occur due to decreased oxygen saturation in the brain and build-up of carbon dioxide resulting from breathing difficulties.
In the given case study, Mr. Hunter has a history of viral influenza. Previously it was reported that the patient had undergone treatment of oxygen therapy. It was seen that the patient is suffering from breathing problem along with the discharge of rusty coloured sputum. Thus, the above-mentioned symptoms will assist the nurse to predict that he is suffering from pneumonia.
Discuss the pathophysiology of altered ventilation and diffusion related to pneumonia
The invading microorganisms causes an inflammatory response in the lungs causing the blood vessel to become leaky and alveoli is filled with protein-rich fluid. This reduces the surface area for oxygen and carbon dioxide exchange (Ando et al. (2015). This makes the patient become oxygen deprived hence respond by faster breathing to increase oxygen intake and increase carbon dioxide exhalation. Also increased mucus secretion in the lungs further decrease gaseous exchange. Infection leads to increased production of white blood cells. The fluid and debris from the large white blood cells fill the alveoli decreasing gaseous exchange ad ventilation. Consolidation occurs when the normally hollow air filled spaces(alveoli) solidify due to large quantities of fluid and debris. This usually a feature of bacterial pneumonias. Viral and mycoplasma not result in consolidation. In the given case Mr Hunter is predicted with pneumonia because the individual is suffering from constant breathlessness and cough. It has been mentioned that Mr Hunter has already taken oxygen therapy to increase the flow of oxygen. Even Hudson masks were used to stabilise the condition. In the study, it has been mentioned that the nurse understood that Mr Hunter was suffering from Pneumonia is a severe disease that targets lungs resulting in effects on alveoli. Some of the significant sources of are bacteria and viruses. Primary infections are also caused by normal flora and inhalation of microbes.
Pathophysiology
Difference between hospital, community and aspiration pneumonia
As per the viewpoint of Méndez et al. (2014), community-acquired pneumonia occurs outside healthcare facilities. It is may be caused by bacteria (streptococcus pneumonia), bacteria like organisms (mycoplasma pneumoniae), fungi and viruses(influenza). The symptoms of community-acquired pneumonia are fever, sputum production, cough. The concerned disease can be diagnosed by creating x-ray. It can be said that the concerned disease can be cured by providing antibiotics.
Contrary to this hospital-based pneumonia can be caused in any age group. The concerned disease is caused to an individual after coming in contact with the hospitalized patients. As per the comment of Rogus?Pulia et al. (2014), an individual who spends more than 72 hours in a hospital can suffer from hospital-acquired pneumonia because of the hospital-based organisms. This can be more serious as bacteria causing the pneumonia may be resistant to antibiotics. Also the people who get are already sick. People on ventilators are at higher risk of getting this type of pneumonia. The symptoms of hospital-acquired pneumonia are urinary tract infection, high fever, cough, decreased blood pressure. In addition to this, it has been observed that a patient suffering from hospital-acquired pneumonia can be treated by providing antibiotic to them.
Aspiration pneumonia on the other hand is caused by pulmonary aspiration. Pulmonary pneumonia is caused when an individual inhale, food, stomach acid and saliva in lungs. Generally, it has been seen that the mentioned materials carry bacteria in lungs causing the concerned diseases. The symptoms of aspiration pneumonia are Chest pain, shortness of breath, discolouration of skin, fatigue.
As per the comment of Rogus?Pulia et al. (2014), the patient aspiration needed to be treated well to reduce the rate of future complications. Generally, the people who are above 65 are prone to suffer from the concerned disease. Thus, it can be said that Mr. Hunter may also suffer from the concerned disease because he is above 65 years of age. According to Jain (2015), aspiration pneumonia can also cause lung cancer, neurological disorder and Parkinson’s disease. In order to the diagnosis of aspiration pneumonia, the patient needs to go for the x-ray to understand the condition of lungs. Even sputum culture needs to be done to reduce the rate of future complications. Even a patient can be given steroids and vaccine to treat the concerned disease. At times to recovery, early care receiver is given antibiotics and injections (Froh & Huether).
Process information
A patient with pneumonia has some particular needs which a registered nurse should identify and attend to them in order to ensure that the patient get total care. This needs may vary from individual to individual and hence the nurse should carefully identify the needs as per the patient. Nursing care required for Mr hunter include the following;
Ensure effective airway clearance: this can be done through airway suctioning if necessary, teaching the patient on deep breathing exercise, frequent coughing, nebulization and elevating the head of the bed. This will help clear secretions from the lungs and hence enhancing better breathing.
Pain management: the nurse will achieve this through providing comfort (back rubs, position change), chest splinting techniques during coughing episodes and analgesics administrations. This will help alleviate pain and hence promoting the patient’s comfort.
Monitor vital signs: the nurse should check Mr Hunters vital signs every four hourly and report any abnormal changes. Any changes may indicate that the patient is experiencing pain especially when other reasons have been ruled out
Nutritional management: Identify the cause of reduced appetite and try to eliminate it. Provide small frequents meals that are preferred by the patient, schedule respiratory treatment at least one hour before meals to reduce effects of nausea associated with treatment.
Psychosocial support: The nurse should provide adequate psychological support to Mr hunter through counselling and education. Collaborative management should also be involved. Th caregiver needs to provide adequate care to the client so, that the feelings of stress get reduced. Contrary to this it has been noticed that depression and feeling of stress increase the chance of disease within an individual. In order to keep the patient healthy, the caregiver needs to treat the user like a family member.
Physical exercise: The caregiver needs to indulge the user in physical exercise because as per the view of Jain et al. (2015), physical exercise reduces the rate of pneumonia among the older people. It is said that the nurses need to show particular physical exercise to Mr Hunter to minimise the risk of Pneumonia.
Importance of monitoring the heart rate, Oxygen and fever
Heart rate should be monitored at least every 30 minutes to ascertain any abnormalities. Pneumonia can cause abnormal fast heart rhythms such as atrial fibrillation due to higher pressures in the blood vessels of the lungs which causes the right side of the hearth to dilate and this can throw off the hearth electrical system. Stress of being sick can lead to rise in adrenaline levels increasing heart rate. Also lower oxygen levels in blood due to breathing problems can also increase heart rate. Too high heart rate of over 100 beats per minute can lead to heart failure.
Nursing care required for pneumonia
Low oxygen saturation below 90% can lead to hypoxia. This can contribute to multiple organ failure as lack of oxygen in tissue can lead to necrosis. Vital organs such as the brain, kidney and the liver requires enough oxygen and hence if deprived can easily lead to organ failure.
Temperature above 38.5?C can be life threatening to a patient with pneumonia. Fever is mainly an indication of infection and hence any rise above the normal should be reported to the consultant for prompt treatment. Hyperthermia can lead to increased body metabolism hence increasing energy requirement. Also fluid requirement is increased.
Strategies to better the health condition of Mr Hunter
First the nurse should explain to the patient the importance using the mask regarding to his condition and also the outcomes of not using it as required. Mr hunter should also be encouraged to use the mask as it will help in maintaining effective breathing. If Mr Hunter still refuses to use the oxygen, involve the relatives to explain to him the implications of his decision.
Collaborative management should also be involved i.e. the counsellor, doctor, and other professionals to help manage the situation (Suzuki, 2014). The nurse can change the mode of oxygen administration by using other methods available in the facility which Mr Hunter is comfortable with.
The care provider needs to take certain steps to reduce the level of agitation of the individual. In the case study, it has been mentioned that Mr Hunter is agitated because he is facing discomfort after wearing the marks. Thus, the nurse needs to undertake specific steps like a discussion with the user to make him understand the usage of the mask. In addition to this it can be said that the provider need to discuss with the hierarchy regarding the patient’s’ discomfort so, that they can give some other alternative to Hunter (Postma, 2014).
Two Lessons learnt from the scenario
The two lessons that can be learned from the above scenario are as follows:
Holistic development: from the above study it has been seen that the main motive of the care provider is to develop holistic development of the patient. The patient needs to be engaged in all procedures and explanations to be made on each procedure to enhance his cooperation (Marti, 2015). It is needed to be said that an effective communication needs to be set between the other members of the health centre to develop a family feeling among the service provider and the client. The level of compatibility needs also to be considered to improve the holistic development of the user.
Effective treatment: From the case study I have learnt that the service provider needs to give the best possible treatment to the user so, that they can live a healthy life and reduce the future risk of the diseases.
What actions will you take in your future practice
because of what you have learned from this scenario?
Communication: As a nurse, I need to establish an effective communication system with the patients so that the individual can freely discuss the problem with me. Even the needs of the patients are to be met so that the level of satisfaction can be increased.
Knowledge: As a nurse, I need to gain some more knowledge about the disease. For instance, in this concerned case as a nurse I need gain more knowledge regarding pneumonia so that effective treatment can be provided to the patient to enhance faster recovery.
Understanding the psychology: As a service provider, I need to be capable enough to understand the psychology of the patients so, that I can tackle any situation efficiently. As a nurse, I need to understand the need for the patients to improve the holistic development (as influenced by Sjögren, 2014)
As per the standard of nursing the nurse need to be capable enough to treat the patient effectively. In addition to this, it has been observed that nurses need to look after the physical and emotional need of the individual. Effective communication needed to be set between the patient and nurse so, that the patient can reveal the issues that the individual is facing and the nurse can solve them (Dang, 2014).
The standards require also that the nurse should be able to monitor and evaluates the patient progress towards the expected goal or outcome. This should be done accordingly in that the nurse continuously revise the plan according to the patient response and the evaluation remarks noted down. The documentation should also be done in a way that it clearly communicates the priorities, goals and outcomes with the relevant persons (Nursing and Midwifery Board of Australia (2010))
Lastly, the nurse should be able to think critically in order to achieve quality health care. He/she should be able to make use of the best devices available in the facility in a way that it provides safe and quality services. He should also be able to make appropriate decisions where necessary when providing the care.
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