Nursing Care for Pneumonia, Essay Example

Introduction

Recent data reveals that pneumonia is steadily becoming one of the primary causes of infection-related mortality especially among the aged (Helios 2006). Research abounds with the list of the possible factors that work together to result in pneumonia infection amongst elderly people, among them are reported incidents of a history of lung and heart disease, alcoholism and swallowing disorders. Unlike in younger patients, the elderly often suffer from pneumonia in a relatively more severe form, largely due to the laxity of the immune system and as well as effects of comorbidities that is associated with ageing (Reference). This point will be further discussed as this essay advances.

Given the case of the patient Jane Johnson and the age category of 59 years she clearly qualifies as an elderly patient and thus vulnerable to pathogens like streptococcus pneumoniae that can trigger pneumonia and its attendant complications. Under ordinary circumstances, a healthy person has an inbuilt mechanism that enables pathogens that enter the lungs to be expelled out as part of the general defense system. The defense system of the healthy human body is carried out through processes such as coughing, mucociliary removal, phagocytosis etc. The main channel of response is using the alveolar macrophages with the full complement of the immune system of the body.

In the case of people with high vulnerability such as the case of Jane Johnson any aggressive pathogen that comes into the body is not restricted in its invasion (Bill, 2003). The pathogen uses a strategy of incremental release of strong toxins and spread of massive inflammation coupled with a corresponding response from the immune system, yet that is still unable to keep the invasion from taking full effect on the organism of the individual.

Generally, pneumonia occurs as a result of inflammations of the parenchyma of the lungs in congruence with the alveolar edema and congestion which ultimately limits the gas exchange process. As stated above the primary cause of pneumonia has to do with the inhalation of a pathogen. There are instances where on the secondary scale pneumonia in a patient can be the result of the progressive spread of internal bacteria within the body of an individual.

The Case

Pneumonia is a lung disease. Pneumococcal pneumonia can infect the upper respiratory tract and can spread to the blood, lungs, middle ear, or nervous system. Pneumococcal pneumonia is caused by bacteria called Streptococcus pneumoniae. S. pneumoniae is also called pneumococcus. The elderly are especially at risk of getting seriously ill and dying from this disease. In addition, people with certain medical conditions such as chronic heart, lung, or liver diseases or sickle cell anemia are also at increased risk for getting pneumococcal pneumonia (http://www.medicinenet.com/)

In the given case study the following vital pathophysiological signs are to be considered to ensure efficient nursing care of the patient:

1-The body temperature of 39° C which indicates the presence of an infection in the body and comes about as a result of pyrogenic substances and pneumoccocal toxins that are released into the bloodstream during this particular infection. Thus, affecting the higher centers responsible for temperature control and also limiting the activities of Streptococcus pneumonia by the administration of antibiotics should normalize and stabilize the temperature.

2-A WBC (white blood count) of 12,000/ml- it indicates leucocytosis. This is one of the body’s response mechanisms in times of infection. A lot of white blood cells are released into the blood stream to combat the pathological process in the affected part of the body. Management should be aimed at bringing the white blood cells to levels between 4,000/ml and 9,000/ml.

3- A pulse rate of 90bpm: During any infection the heart rate increases as a compensatory reaction in order to deliver more white blood cells to the affected areas so that the pathological process can be liquidated. In this case an increased pulse is also a compensatory reaction due to lung disease.

4- A breath rate of 28 per minute which is somewhat labored is a sign of respiratory insufficiency. It is also a compensatory reaction due to lung disease. Its reduction to normal (between 16 and 20 bpm) levels is a vital sign in lung disease management.

5- The blood pressure needs to be maintained at levels below 140/90

6-The hemoglobin saturation of 85% indicates mild hypoxia and should be raised to 100%

Nursing Priorities in This Case

As gathered from the case story, the setting for patient Jason Johnson is the hospital largely because she is clearly within the higher risk group because she has a history that suggests the presence of other related chronic ailments that have direct and indirect significance to the pneumococcal pneumonia that she has been diagnosed of. Within the context of this case a number of factors have to be analyzed, understood and conceptualized to ensure that at the end of the whole process the fundamentally stated goals below are achieved within the framework of the case and all the history that comes with it.

• Ultimately, the patient receives an improvement or at least maintain the optimum respiratory functions;
• The patient should be managed effectively in a manner that will ensure that any form of complication will be critically avoided;
• Access relevant information pertaining to the prognosis of the disease as along side the recommended treatment prescribed;
• Finally, facilitate the process of recuperation.

The elderly are susceptible to different pathological processes due to decreased immunity. This is a result of predominance of degenerational processes in the tissues and organs in any an aging organism. This is important to consider during prescription of drugs for the given patient because the liver, responsible for detoxicating and elimination of certain drugs from the body is not working as efficiently as it is supposed to be doing under optimum conditions (Lim et al 2009). These considerations will help to avoid over dosages and drug accumulation.

In many ways depression is yet another factor that reduces the body’s immunity, consequently making people vulnerable or prone to bacterial, viral and most other forms microorganism invasion. In this case, it is deteriorated by the unfavorable social conditions (loneliness, comorbidity-seizure disorder, mild hypertension). This is to be considered in the patient/family teaching plan.

Dilantin is indicated for the control of generalized tonic-clonic (grand mal) and complex partial (psychomotor, temporal lobe) seizures and prevention and treatment of seizures occurring during or following neurosurgery.

Phenytoin serum level determination is necessary for optimal dosage adjustments. The clinically effective serum level should be between 10-20 mcg/mL. Changes in dosage (increase or decrease) should not be carried out at intervals shorter than seven to ten days. Once-a-day dosage with 300 mg of extended phenytoin sodium capsules may be necessary. Studies comparing divided doses of 300 mg with a single daily dose of this quantity indicated absorption, peak plasma levels, biologic half-life, difference between peak and minimum values, and urinary recovery were equivalent. Once-a-day dosage offers a convenience to the individual patient or to nursing personnel for institutionalized patients and is intended to be used only for patients requiring this amount of drug daily (Lim et al 2009). A major problem in motivating noncompliant patients may also be lessened when the patient can take this drug once a day. However, patients should be cautioned not to miss a dose, inadvertently.

Side Effects

Central Nervous System: The most common manifestations encountered with phenytoin therapy are referable to this system and are usually dose-related. These include nystagmus, ataxia, slurred speech, decreased coordination, and mental confusion. Dizziness, insomnia, transient nervousness, motor twitchings, and headaches have also been observed. There have also been rare reports of phenytoin-induced dyskinesias, including chorea, dystonia, tremor, and asterixis, similar to those induced by phenothiazine and other neuroleptic drugs.

A predominantly sensory peripheral polyneuropathy has been observed in patients receiving long-term phenytoin therapy.

Gastrointestinal System: Nausea, vomiting, constipation, toxic hepatitis, and liver damage.

Hemopoietic System: Hemopoietic complications, some fatal, have occasionally been reported in association with administration of phenytoin. These have included thrombocytopenia, leukopenia, granulocytopenia, agranulocytosis, and pancytopenia with or without bone marrow suppression. While macrocytosis and megaloblastic anemia have occurred, these conditions usually respond to folic acid therapy. Lymphadenopathy including benign lymph node hyperplasia, pseudolymphoma, lymphoma, and Hodgkin’s disease have been reported.

Immunologic: Hypersensitivity syndrome (which may include, but is not limited to, symptoms such as arthralgias, eosinophilia, fever, liver dysfunction, lymphadenopathy, or rash), systemic lupus erythematosus, periarteritis nodosa and immunoglobulin abnormalities.

Recommended Management Strategy

• The patient, Jane Johnson should be given an the required oxygen therapy that can also enable the oxygen inflow to be effectively monitored to determine its concentration levels also to guarantee that the arterial oxygen tension will remain at PaO2 at greater that 8kPa whilst also maintaining the saturation of oxygen at SpO2 between the range of 94-98%;
• Nutritional supplements should be strongly considered as a vital process of the therapeutic process;
• Mobility should be incorporated into the entire process with the view of increasing the pace as and when the patient exhibits better signs along the treatment process;

Monitoring Strategy

• The regular monitoring of the following indicators should be part of the regular process during the treatment process. They are: respiratory rate; temperature, blood pressure, oxygen saturation and respiratory pulse.
• Inspired oxygen concentration should be monitored within regular intervals of at least twice daily;
• The patient should be given adequate review within a time period close to 24 hours within the scheduled period of discharge from the hospital. The temperature range that will support the need for a discharge should have the following indicators temperature range of 37.8 degrees Celsius, respiratory rate of 24/min, oxygen saturation of 90%, heart rate of 100/min.

Reference

Bill Paterson (2003). Nursing care plan for hospitalised patients with Pneumocystis carinii pneumonia. Retrieved on October 23, 2009 from http://www.ciap.health.nsw.gov.au/hospolic/stvincents/1990/a02.html

Centers for Medicare & Medicaid Services (2008). Acute In Patient PPS, Overview. Retrieved November 1, 2008 from http://www.cms.hhs.gov/AcuteInpatientPPS/.

Fuhrmans, V. (2008). Insurers Stop Paying for Care Linked to Errors: Health Plans Say New Rules Improve Safety and Cut Costs; Hospitals Can’t Dun Patients. The Wall Street Journal, Health Article, January 15, 2008. Retrieved October 16, 2009 from http://online.wsj.com/article/SB120035439914089727.html?mod=home_personal_journal_left.

Helios Klinikum Emil von Behring,  & Helios Klinikum Emil von Behring, (2006). Treatment of  pneumonia in elderly Patients. Expert Opinion on Pharmacotherapy. Vol. 7, No. 5, Pages 499-507

Laport, N., Sermeus, W., Vanden Boer, G., & Van Herck, P. (2008). Adjusting for Nursing Care Case Mix in Hospital Reimbursement: A Review of International Practice. Policy, Politics, & Nursing Practice Vol. 9 No. 2 p. 94-102. Retrieved November 21, 2008 from Cinahl database.

Kathryn L McCance & Sue E Heuther (1997). Pathophysiology: The Biologic Basis for Disease in Adults and Children, third edition, Oxford University Press.

W S Lim, S V Baudouin, R C George, A T Hill, C Jamieson, I Le Jeune, J T Macfarlane, R C Read, H J Roberts, M L Levy, M Wani, M A Woodhead (2009). BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Journal of the British Thoracic Society. Vol. 64, Issue III.