Pneumonia is caused by S. pneumoniae or pneumococcus and is most common in people younger than 60 without co-morbidity and in those older than 60 with co-morbidity (Brunner & Suddarth year). The patient is 72 years old and has a co-morbidity of emphysema and chronic bronchitis. The client has a 25-year history of smoking. The pathophysiology of the patient’s diagnosis, bronchopneumonia, has impaired host defenses particularly the bronchial structures of his lungs. This condition initially began when the normal flora has been altered due to tobacco substances based on the patient’s history of smoking.
When this happens, an inflammatory reaction occurs in the alveoli, which produce exudates that interfere with the diffusion of oxygen and carbon dioxide. The white blood cells, mostly neutrophils, migrate into the alveoli and fill up the normally air-containing spaces. The secretions and mucosal edema causes partial occlusion of the bronchi or alveoli. The areas of the lungs are not sufficiently ventilated due to the occlusion that causes the client to have emphysema and inflammation of the bronchioles.
The patient experiences hypoventilation or a ventilation-perfusion mismatch occurs in the affected area of the lung. Venous blood entering the pulmonary circulation passes through the under ventilated area then exits to the left side of the heart poorly oxygenated. The combination of unoxygenated and oxygenated blood eventually leads to arterial hypoxemia. Explain the significance of laboratory data, and/or special diagnostic studies or procedures The patient had diagnostic work up including chest x-ray examination, complete blood count and arterial blood gas analysis.
The chest x-ray result showed bilateral pulmonary infiltrates interpreted as patches and irregular areas of density. These areas are fluid present in both lungs. The complete blood count showed a count of 18. 4, which is beyond the normal range of 4. 3 to 10. 8 cells per liter. Leukocyte count is higher than the normal value since the patient’s body needs to fight pathogens by phagocytosis and immune response. The low count of RBC indicates low blood oxygen level due to hypoxemia.
The low count of hemoglobin is due to less oxygen that binds with the iron portion to form oxyhemoglobin. Hemotocrit is found to be high due to the lung disease and the client’s history of being as chronic smoker. The ABG analysis showed that the client’s pH is within normal range. The low partial oxygenation level of 74% and a high partial carbon dioxide of 51. 2% means that there is an impaired respiratory function and airway obstruction. Explain the rationale for each physician order.
The physician ordered the patient to undergo several diagnostic tests including chest x-ray, sputum culture, arterial blood gas (ABG) analysis, and complete blood count (CBC). The chest x-ray is used to evaluate the lungs and other structures within the chest for symptoms of disease. The sputum culture is needed to determine fungus in a sputum sample. The doctor can now prescribe medications once a specific microorganism is found. Pulse oximetry or arterial blood gas analysis is done to determine the need for oxygen and evaluate the effectiveness of the therapy.
The patient can eat any diet as long as he can tolerate the kind of food given. Bronchopneumonia is a condition of the respiratory system and is not related to the digestive system that explains why the doctor placed him on a diet as tolerated order. Nurse on duty should obtain the vital signs such as temperature, pulse, respiratory rate and blood pressure every 4 hours to know the condition of the client. The client was diagnosed as having bronchopneumonia that oxygen saturation is also monitored every 4 hours. Vital signs serve as baseline data.
In this way, the health care team will know whether the medical intervention and nursing intervention help alleviate and manage the condition of the patient, upon comparison of the vital signs taken every 4 hours. The hypertonic solution D5NS has a higher osmolarity than serum. It was infused at a rate of 125 ml. per hour. Oxygenation is important for patients with pulmonary infections such as bronchopneumonia. Hypoxemia is present thus oxygen was administered to the patient at 2 liters per minute via nasal cannula. Medical management
The medical management given to the patients is the administration of several drugs. Xopenex (levalbuterol tartrate) is administered in a dose of 0. 63 mg via small volume nebulizer (SVN) every 6 hours. It is a fast-acting medicine to treat narrowing of the airways or bronchospasm caused by asthma and chronic obstructive pulmonary disease or COPD. Solu-medrol (methylprednisolone) 40 mg is given via IVP every 12 hours. It belongs to a class of drugs called steroids or anti-inflammatory drugs. It prevents the release of substances in the body that cause inflammation.
Levaquin (levofloxacin) is given 500 milligrams every 24 hours. It has an enhanced activity against S. Pneumoniae (Bartlett et al. , 2000; American Thoracic Society, 2001). Guaifenesin is in a class of drugs called expectorants. It is used to relieve chest congestion and works by thinning the mucus secretion found in the air passages that make coughing easier for the patient and clear the airways. The patient took Guaifenesin with a dose of 600 mg every 12 hrs. A pain reliever called Tylenol given to the patient at a dose 500 mg 1 or 2 tablets every 4 hours fever or pain.
The patient has fever due to respiratory infection and inflammation thus Tylenol was prescribed by the doctor. 4. In priority order, identify the three primary nursing diagnoses; for each nursing diagnosis develop a goal statement with one specific measurable outcome; for each nursing diagnosis state 4 specific nursing interventions; for each nursing diagnosis evaluate whether outcome is achieved, in progress or not achieved; for each nursing diagnosis make recommendations for discharge teaching and/or referral. Use the Care Plan Form for this information.