Assessment and Care of a Patient with Pneumonia - Case Study Example

RUNNING HEAD: Assessment and Care of a Patient with Pneumonia Assessment and Care of a Patient with Pneumonia Client Inserts His/her Name Client Inserts Name of Institution Introduction Bacterial pneumonia is an infection of the lower respiratory tract which leads to its inflammation, caused by Steptococcus pneumonia (Spellberg & Talbot, 2010). Suffering from bacterial pneumonia, Steven certainly experiences sharp chest pain, productive cough, shortness of breath and fever as suggested by the diagnostic information about his ailment. This patient requires a nursing touch especially during his rest to support him to quickly recover. The nursing care chosen should be in line with what the patient requires (Ambrose, Bhavnani, Ellis-Grosse et al., 2010) as help, basing on the current conditions recorded about the patient. This essay focuses on the most appropriate interventions by the nurse attending such a patient and the rationale behind prioritization of these interventions. LOCATING THE PROBLEMS Problem I A close examination of such a patient will definitely suggest the most burning problem that needs a quick attention. The patient in this case is described as experiencing intermittent chest pains that are further aggravated by coughing and forceful deep breathing. This is viewed as a the main problem not only on the consideration of the patient’s current feelings but these pains greatly hamper effective deep breathing, coughing an effective airways clearance. This means that the patient neither gathers enough oxygen nor clears efficiently the used up airs from his lungs (Echols Tillotson, Song et al., 2008). From a sharper viewpoint, the reason as to why the patient records such high respiratory and heart rates is well explained by this problem. Smoking habit forms a major predisposing factor for chest pains occurrence (EUCAST, 2009; Jr. [eds.], 2007). A rate of 30/day is so high a rate. Smoking acts indirectly by increasing the heart rate (Echols et al., 2008). Blood pressure is raised in the process and this undoubtedly increases the heart workload leading to limited heart’s efficiency. This increased workload on the heart plus high carbon dioxide concentration in the blood caused by smoking may cause sharp chest pains. Initial high blood pressure is also a possible kick in the aggravation of chest pains (Echols et al., 2008). Literally, perhaps the patient had been smoking so much to counter the impact of divorce. The type of the work a patient has been previously involved in, for example in this case where the patient apparently does hard manual work that may lead to high heart rates, determine the level and the of chest pains. Intervention I In response to chest pains, a proper analgesia would be prescribed for the patient to relieve pain (Abrahamian, Deblieux & Emerman, 2008). 2 tablets every six hours of paracetamol is an appropriate dose (Jonathon, 2011). Paracetamol has been a multipurpose drug for ages but mostly used as a painkiller all over the world. It is known to reduce pain sensations and cooling fever (assistpainrelief.com). However, maximum care must be taken to avoid chronic paracetamol intakes (assistpainrelief.com). The reason behind this is that excessive intake of paracetamol may lead to harmful side effects. Specifically, excess of paracetamol becomes toxic which in turn becomes very harmful to most important body organs. Mostly, the drug seems harmless even when one exceeds the prescribed limit. This has been termed by some scholars as the hibernating character of paracetamol (Jonathon, 2011). Without proper medical monitoring, an overdose of paracetamol eventually initiates liver dysfunction which may result to liver failure depending on the level of overdose. Liver failure means death many a time. Therefore it becomes necessary to stick to the dosage prescribed as healthy. The effectiveness of paracetamol in a patient may be measured by observing change in the actions of the patient and temperature level (Jonathon, 2011). A temperature level must fall from the recorded 38.1oC to a lower level and this represents recovery from fever. Breathing and heart rates must reduce and this means that the patient will show less difficulty in breathing. Paracetamol works inhibiting production of prostaglandins, chemicals which transmit pain message to the brain. This way, the patient no longer feels the pain (assistpainrelief.com). This one bit makes paracetamol a better option over other prominent pain killers such as aspirin and non-steroidal anti-inflammatory drugs in that it does not at all interfere with the source of the pain (assistpainrelief.com) as the latter do. However, paracetamol only blocks synthesis of prostaglandins in the central nervous system with no effect on the peripheral tissues (assistpainrelief.com). Intervention II Given the state described of the patient in question, it does not require a genius to note that the patient is under critical condition, significantly denoted by the presence of intermittent chest pains. With the help of a well trained nurse, humidified saline nebuliser (The European Committee on Antimicrobial Susceptibility Testing [EUCAST], 2009) would be a proper help to administer drugs directly into the tracheobronchial region or the alveoli in the lungs (Gastmeier et al., 2009). The drug is first nebulised and this means converting the drug into an aerosol mist and this is enhanced by passing a pressurised gas through it (Foglia, Meier & Elward, 2007). The appropriate equipment and the correct gas flow rate are the major things to that require gifted hands (The royal free hampstead, 2009) let alone the administering process itself (Gastmeier et al., 2009; The royal free hampstead, 2009). The drugs administered will be a mix (in line with applicability of mixing) to serve various purposes or singly. For example, bronchiodilators (say Salbutamol) to enhance easier breathing, antibiotics (say tobramycin) for healing any lung infections, analgesics (say opioids) for relieving chest pains, mucolytics (say sodium chloride 0.9% hypertonic saline) to thin the sputum and so on. An effective volume of nebuliser to be used will be estimated between 2.0 and 4.5 mls. Each dose will be sterilized using the proper and available techniques. If dilution of the fluid medicine becomes a requirement, a sterile ampoule of NaCL (0.9%) will be used. With the help of a mouth-piece (Foglia et al., 2007), which gives a direct route to the lungs (Masterton, Galloway & French, 2008), administration of the drugs the proceeds. The best thing with the method is that the patients is saved agony of struggling with painful breathing and gasping for air. It also becomes absolute method when the patient becomes completely drowsy and thus unable to breathe (Foglia et al., 2007).The royal free hampstead (2009) recounts on the suitability of the method for the typology of the patient in this question basing on a survey conducted on 11 patients who suffered chronic viral pneumonia in which the patients seemed not disturbed at all in the application process. Problem II Room air oxygen concentration of 92% is much lower [compared to the recommendation of a normal person (94-97%) let alone a highly oxygen demanding patient] and atmosphere-contaminated especially for inhalation by a person suffering from chronic respiratory diseases (Edwards, Peterson & Andrus, 2007). Bacterial pneumonia is a disease that is characterised by inflammation of alveoli in the lungs. This leads to the alveoli filling with fluid. The lungs lose their elasticity. Sometimes the lungs may collapse. These two conditions are no better in respect to taking in of oxygen and removal of carbon dioxide from the body. The implied difficulty in taking in of oxygen makes the patient develop a feeling of shortness of breath (Chawla, 2008) where in response the patient reciprocates with deep breaths and rapid breathing (Jr. [eds.], 2007). The cardiac rate is also heightened in an attempt to transport the blood as quickly as possible so as to convey the little available oxygen to various parts of the body for energy generation. Sadly, inasmuch as the patient heightens these rates, the body never gets satisfied as oxygen intakes are not as effective (Gastmeier et al., 2009). The end result is a continued state of rapid breathing and high heart rate and in this case, endless pain in the chest and subsequent low recovery rate altogether. There thus emerges a need to help the patient to gather as much oxygen as possible through various prescriptions of oxygen therapy (Ambrose et al., 2010). Intervention I When oxygen therapy is prescribed the first thing is to choose the best method of delivery (Fraser Health, 2009). In this case, nasal prong would work properly (Foglia et al., 2007). The rationale behind the adoption of nasal prongs is the simplicity and convenience in terms of handling and use. The system allows for the therapy to continue even when the patient is performing other activities like eating (Foglia et al., 2007). Furthermore, nasal prongs are available in various sizes and therefore a perfect fit is easy to locate (Edwards et al., 2007). The most suitable flow rate would be 2 litres per minute. This flow rate ensures sufficient oxygen supply, is comfortable to the patient and does not cause irritation of mucous membrane. However, the system requires some technical skills in application (Fraser Health, 2009). The first thing is to ensure that the nasal prongs are of the right size, comfortable to the patient such that there exists no complete seal during application. Effective as it is, most patients find it uncomfortable (Gastmeier et al., 2009). Discomfort is literally evident and includes the nasty feeling of gadgets entering the nasal cavity. Another disadvantage is the high chance of infection in the nasal internal membranes. Masterton et al. (2008) suggest that the mere continuous flow of the gas through the nasal cavity may certainly cause drying up of the nasal cavity, may be painful, irritating and may also lead to drying of one’s lips. The worst of all is the routine cleaning activity of the tubing. In fact, the recommendation is that the tubes entering the nasal cavity should be cleaned twice a day, at least (Gastmeier et al., 2009). After reception and assimilation by the lungs, oxygen combines with the haemoglobin in the blood and is transported to various parts of the body. First, the brain works well with clean blood (oxygen rich blood). The brain sends message to the heart that oxygen content in the blood is sufficient and thus the high heart rate recorded in the patient reduces (Foglia et al., 2007). Oxygen is also required, as a reactant, to break the various food materials to generate fuel for the body. This adds to the patient’s energy to breath in more oxygen and enough nutrients to repair the defects in the lungs. The patient will find it easier to breath and the breathing rate drops. Intervention II Another way of countering the respiratory problem for any patient is by altering his or her position. The way the sleeping of the patient is described (especially the clothing) plus the pale perhaps after-sleep look suggests that Steven has been sleeping for quite long time. For such a patient, positions that maximize his or her respiratory functioning and at the same time reduce the physical effort inputs would be the best option (Gastmeier et al., 2009). Semi to high fowlers’ position is often the most comfortable for the patient. This position enhances various activities carried out on the patient, for example, during feeding the patient, the head-high position greatly helps the feeding attendee through the action of gravity keeping the food in position in the mouth of the patient and avoiding spillages. This is of extreme importance when it comes to patients with chronic stages of the disease (Masterton et al., 2008). Swallowing is also aided to some extent by gravity, enhanced in the high fowlers’ position. This position also allows the patient to control the expansion of the lungs better. This is extremely important especially when the disease is characterized by collapsed lungs. Indeed, any movements will allow for the expansion of the lungs and subsequently ease in breathing (Mizgerd, 2008) and thus reduced pain. Regular changing the position of the patient serves as the only mode of exercise practical on the patient’s condition (Chawla, 2008). Even when the patient can stand on his own, it is better to encourage positions that allow lungs expansion (Mizgerd, 2008), for example, leaning against a wall. If the patient shows interest in sitting as opposed to other positions, the sitting position comfort index must be first confirmed. Then, the patient sits in a position that maximizes lungs expansion (say an arm chair) preferably while slightly leaning forward. The condition of our patient in this case therefore requires a person who can decide what pattern and how regular the patient may move. The frequency of changing these positions is better when kept low. Conclusion The diagnostic information and the current status description of the patient indicate that the patient experiences sharp pains and shortness of breath. Any interventions that lead to his chest pain reduction and suppress the shortness of breath scenario (Mizgerd, 2008) as discussed above would certainly offer a helping hand in enhancing a quick recovery of the patient. Being a smoker, divorced and working in an industry that suggests mechanical labour are observations that indicate that perhaps the patient experiences stressful life that may aggravate his agony even further. This suggests that the patient would enjoy company (Abrahamian et al., 2008) and require exercises that in turn will help him relax and recover rather quickly. References Abrahamian, F.M., Deblieux, P.M., & Emerman, C.L. (2008). Health care-associated pneumonia: Identification and initial management in the ED. Am J Emerg Med 26, 1–11. Ambrose, P.G., Bhavnani, S.M., Ellis-Grosse, E.J., & Drusano, G.L. 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Clin Microbiol Rev 20, 409–425. Fraser Health. (2009). Hospice palliative care program symptom guidelines: Dyspnea. Retrieved from http://www.fraserhealth.ca/Services/HomeandCommunityCare/HospicePalliativeC are/Documents/Dyspnea.pdf Gastmeier, P., Sohr, D., Geffers, C., Ruden, H., Vonberg, R.P., & Welte, T. (2009). Early- and late-onset pneumonia. Antimicrob Agents Chemother 53, 2714–2718. Jonathon, H. (2011) Paracetamol is a Multi Purpose Medicine [online]. Retrieved from http://ezinearticles.com/?Paracetamol-is-a-Multi-Purpose-Medicine&id=886500 Jr., eds. (2007). Current Medical Diagnosis and Treatment. (46th Ed). New York, NY: McGraw- Hill. Masterton, R.G., Galloway, A., & French, G. (2008). Guidelines for the management of hospital- acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for An- timicrobial Chemotherapy. J Antimicrob Chemother 62, 5–34. Mizgerd, J.P. (2008. Lung infection- a public health priority. 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