Case study quiz 1 for PNA PDF

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Summary

PNA case study with system diagnosis sheet...

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ACTIVE LEARNING TEMPLATE: System Disorder STUDENT NAME

LaNette Rainey

DISORDER/DISEASE PROCESS

Pneumonia

REVIEW MODULE CHAPTER

23

Quiz Assignment #1

May 7th, 2020

Alterations in Health (Diagnosis) Community Acquired Pneumonia

Pathophysiology Related to Client Problem PNA is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses arises from altered or from aspiration of flora present in the oropharynx. PNA may also result from bloodborne organisms that enter the pulmonary circulation and are trapped in the pulmonary capillary bed. In this case, Mr Henry has chronic underlying disease that impairs his defense, paraseptal emphysema - is characterized by swelling and tissue damage to the alveoli.

Health Promotion and Disease Prevention Encourage smoking cessation Promote coughing and expectoration of secretions. Perform good handwashing hygiene to prevent the spread of the infection

ASSESSMENT

Risk Factors Smoking cigarettes disrupts the mucociliary and macrophage activity

Smoking cigarettes will produce mucous or bronchial obstruction and interfere with normal lung drainage. Underlying disorders – Mr Smith is diabetic and has paraseptal emphysema (is characterized by swelling and tissue damage to the alveoli.)

Advanced age – Mr. Smith is 70 – depressed cough and glottic reflexes

Expected Findings Orthopnea, confusion from hypoxia (O2 Sat 85% RA), coughing, fatigue, weakness, tachypnea, flushed face, dull chest percussion over area of consolidation, fever.

SAFETY CONSIDERATIONS

Laboratory Tests CBC, sputum culture and sensitivity exam (which he does not raise any sputum)

Diagnostic Procedures Chest X-ray and physical examination

PATIENT-CENTERED CARE

Nursing Care Place patient in high Fowler’s to maximize ventilation, encourage coughing to remove secretions, administer O2, monitor skin for breakdown around the nose

and mouth from the O2, provide rest periods when dyspnea occurs, encourage fluids. Medications Antibiotics example penicillin’s or cephalosporins

Client Education Take prescribed medications for treatment for PNA as ordered Rest as needed Practice good handwashing to prevent infection Obtain influenza and pneumonia immunizations Discontinue smoking

Complications Atelectasis – airway inflammation and edema leas to alveolar collapse and increase the risk for hypoxemia. Bacteremia (sepsis) – pathogen enters the bloodstream from the infection in the lungs. Acute respiratory distress syndrome.

Therapeutic Procedures Antibiotics only if it is not viral PNA. If it is viral, the treatment is supportive. Give hydration and antipyretic for the fever and tachypnea. For hypoxia, give oxygen. Antitussive for the cough. Assist with deep breathing coughing, frequent position changes, and early ambulation.

Interprofessional Care Rehab care to be consulted for Mr. Smith prolonged weakness

Harry Smith, 70 years of age, is a male patient who is admitted to the medical-surgical unit with acute community-acquired pneumonia. He was diagnosed with paraseptal emphysema 3 years ago. The patient smoked cigarettes one pack per day for 55 years and quit 3 years ago. The patient has a history of hypertension, and diabetes controlled with oral diabetic agents. The patient presents with confusion as to time and place. The family stated that this is a new change for the patient. The admission vital signs are as follows: blood pressure, 90/50 mm Hg; heart rate, 101 bpm; respiratory rate, 28 breaths/min; and temperature, 101.5°F. The pulse oximeter on room air is 85%. The CBC is as follows: WBC, 12,500; platelets, 350,000; HCT, 30%; and Hgb, 10 g/dL. ABGs on room air are: pH, 7.30; PaO2, 55; PaCO2, 50; and HCO3, 25. Chest x-ray results reveal right lower lobe consolidation, presence of apical bullae, flattened diaphragm, and a small pleural effusion in the right lower lobe. Lung auscultation reveals severely diminished breath sounds in the right lower lobe and absence of breath sounds at the base. The breath sounds in the rest of the lungs are slightly decreased. The patient complains of fatigue and shortness of breath and cannot finish a short sentence before the respiratory rate increases above the baseline and his nail beds and lips turn a bluish tinge and the pulse oximetry decreases to 82%. The patient is diaphoretic and is using accessory muscles. The patient coughs weakly, but he does not raise any sputum.

a.

What nursing assessment findings support the diagnosis of pneumonia? Mr. Smith has tachypnea, coughing, consolidation, 85% O2 on RA, SOB, confusion, weakness, Temp 101.5, abnormal breath sounds, hx of cigarette smoking, hx of paraseptal emphysema

b.

What diagnostic findings support the diagnosis of pneumonia?

Chest Xray report shows right lower lobe consolidation, the CBC labs shows and

elevation in WBC.

c.

Which anatomic structures in the respiratory system were initially involved?

It begins in the capillaries in when the surrounding alveolar walls become congested. This is an acute infection of the lower respiratory tract, the lungs become affected.

d.

How will the pneumonia affect Harry’s lung function?

The PNA affected both his ventilation and diffusion. Therefore, the blood cells cannot receive adequate oxygen to perform their job. The lungs will experience inflammation causing the air sacs, called alveoli, to fill up with fluid or pus. This can lead to trouble breathing, SOB, coughing, and coughing up yellow or brown mucus.

e.

Which damaging effects of tobacco some led to Harry’s impaired respiratory defense mechanisms? Smoking cigarettes disrupts the mucociliary and macrophage activity Smoking cigarettes will produce mucous or bronchial obstruction and interfere with normal lung drainage.

f.

What overall interventions should the nurse provide?

Removing secretions, encourage hydration, lung expansion maneuvers, deep breathing, promote rest and conserving energy, monitoring for delirium, apply O2, keep HOB elevated in semi fowler’s,...