Patients With Pneumonia example essay topic

Client profile: This is an 87-year-old male patient admitted September 16, 2002 for increased work of breathing, dyspnea, COPD exacerbation and bi-lateral bronchopneumonia. I provided care on January 30, 2002, hospital day number nine for the patient. He has a history of COPD due to emphysema, atrial fibrillation, and chronic vertigo. Past surgeries include an aortic aneurysm repair, right hip replacement, and hernia repair. Medical diagnoses: Dyspnea - increased pulmonary pressure due to interstitial and alveolar edema results in poor gas exchange.

This results in shortness of breath causing the patient to become aware of "air hunger" which causes rapid, shallow respirations. My patient had the classic signs of difficulty breathing, use of accessory muscles, and increased of rate of respirations. According to Medical-Surgical Nursing by Lewis, Heitkemper and Dirksen, treatment includes oxygen therapy, pharmacological measures and physical techniques. The care of my patient included all three of these techniques. The presence of emphysema, COPD, and pneumonia all put my client at a higher risk for developing dyspnea because of the impaired pulmonary status and gas exchange ability of the patient. COPD - the presence of obstructed airflow caused by chronic bronchitis or emphysema.

Cigarette smoking is the major risk factor for developing COPD - my patient has been a smoker for 55 years. My patient's presenting signs and symptoms of rapid, shallow breathing, use of accessory muscles, arrhythmias, and wheezing all match textbook descriptions of COPD (Lewis et al). Treatment includes controlling and alleviating as much as possible the symptoms and complications of the disease and teaching the client to achieve optimal capability for performing ADL's. My client is receiving pulmonary rehabilitation, which is stated as an appropriate treatment in our textbook. The concurrent diagnoses of dyspnea, pneumonia and emphysema are not risk factors for the disease, but are part of the disease process. Pneumonia - an acute inflammation of the lung parenchyma usually caused by microorganisms.

The typical manifestations of pneumonia are sudden fever, chills, productive cough, pleuritic chest pain, pulmonary consolidation, dullness to percussion, bronchial breath sounds, and crackles. My patient exhibited the pulmonary consolidation, as exhibited on the chest x-ray, and wheezes heard upon auscultation of the lungs. Sputum cultures revealed MRSA as the organism responsible for the infection. Risk factors for developing pneumonia include smoking, prolonged immobility, chronic lung diseases, and upper respiratory tract infection among several others (Lewis et al).

My patient is a lifetime smoker, exhibits a sedentary lifestyle and has COPD all of which put him at a high risk for pneumonia. Most patients with pneumonia are treated using antibiotics; Levaquin is the antibiotic that has been prescribed to my client. Patients with a history of COPD are also started on pulmonary rehab, as is my patient. No surgical procedures have been performed on my patient (G.M.) Patient reports no pain Developmental Stage - Acquiring dignity while avoiding despair (Erik Erikson) Biophysical Assessment G.M. weighs 147 lb and is 5'9". He is married with two grown children, both of which live out of town.

The patient eats a regular diet and normally consumes 100% of his meals. He states he likes to eat potato chips frequently. During my care GM used bedside urinal with a four-hour average of 180-220 cc. The urine was clear and dark yellow with no unusual odors.

His bowel movements were regular. GM uses a walker and is able to perform ADL's without assistance. Patient has a visual and auditory deficit; his right eye is a prosthesis, his left eye has a corneal implant and he wears bi-lateral hearing aids. All other senses are intact. GM states that he has no problem in dealing with any of his relationships aside from the fact that he doesn't get to spend enough time with his children.

They do come to town for holidays and family get togethers, but this is the extent of the time they have together since my patient cannot drive to visit them. He feels that he tolerates stressful situations well. He is a member of the Southern Methodist Church. Physical Assessment The patient is alert and oriented - scores a 15 on the Glasgow Coma Scale. He appears to be well groomed and without signs of distress.

His mood is good-humored, but sedate. His speech is elevated due to hearing loss. G.M. weighs 147 lbs and is 5'9", temperature 97.2 oF, BP 120/60, respirations 20 with 93% SaO 2 on 2 L / nc. The head and face are normal in symmetry, color, and appearance. Sparse amounts of hair are distributed over scalp. No lesions or masses were noted.

The patient wears glasses and bi-lateral hearing aids. The right eye is a prosthesis and the left eye had a corneal transplant and is only slightly responsive to light. No swelling is present in any of the lymph nodes. Both ears are free from masses or lesions and are remarkable for hearing aids. The nose is clear and free from drainage, crusting, or lesions. The oral and nasal mucosa are pink and moist.

The mouth is clear of masses, lesions, or ulcerations. The patient wears an upper partial and has evidence of dental caries in lower teeth. The patient's neck is supple and non-tender without signs of tracheal deviation or swollen lymph nodes. Carotid pulses are strong but irregular and rapid. The upper extremities are warm and dry and appear normal in color and hair distribution. There are numerous hematomas from repeated needle sticks.

The patient has fragile and thin skin as evidenced by decreased turgor and amounts of subcutaneous tissue. Good capillary refill (.