▲ – encourage pt to take deeper breaths. Do pt teaching to explain
CONCEPT MAP
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
Saucier, Hali SNPLU 2/25/08
▲ – 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
● Pt. will achieve adequate ventilation
● Pt will experience improved oxygenation
Medical Diagnosis
Pathophysiology
Patient’s Story
Diagnostic Workup
Clinical Manifestation
Nursing Diagnosis
Etiology & Risk Factors
● Expected Outcome
Secondary Diagnosis
▲ Nursing Interventions
Patient’s Medications: (2). Ineffective breathing pattern r/t obesity and
Impaired gas exchange r/t ↓ed functional lung tissue
fatigue, AEB SOB, ↑RR, ↓depth of breathing, and pt reports difficulty taking deep breaths (4).
(4) AEB dyspnea, tachycardia, ↑ed RR, and O2 of less than 92% on RA.
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 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 consolidate and become difficult to cough up (3). Bacterial pneumonia is usually associated with a productive cough, whereas viral is not (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/µl (3).)
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.)
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
Risk factors: chronic illness immobility immunosuppression post-surgery/anesthesia
(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
For pneumonia: - Levofloxaci n (Levaquin): anti-infective - Cefalospor in): anti-infec tive, 3 rd generation. - Albuterol : adrenergic bronc hodilator
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Ipratropiu m (Atrovent): anticholinergic bronchodilator Other Medications: Viramu Viramune: ne: anti antivir viral al (plus (plus one one other other antiviral that I forgot the name) Insuli Insulin n cove coverag ragee for for diabe diabetes tes Nyst Nystat atin in (can (candi dida da)) Hepari Heparin n sc sc (DV (DVT T prev prevent ention ion)) Warf Warfar arin in (DVT (DVT pre preve vent ntio ion n anticoagulant) Furose Furosemid midee (Lasix (Lasix): ): edema edema Acet Acetam amin inop ophe hen n (for (for pain) pain) Discharge Planning: commun communica icate te with with LCT facili facility ty to to update on pt discharge status ensu ensure re pt has has ade adequ quat atee ventilation/oxygenation ventilation/oxygenation before d/c. Arrange for portable O2 if needed. Pt teach teaching ing on on pneumo pneumonia nia prev prevent ention ion
References: 1. Lewis S.L., Heitkemper M.M., Dirkesen S.R., O’Brien 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). Davis’s (2007). Davis’s drug guide for nurses (10th ed.). Philadelphia: F.A. Davis
