Pneumonia is a serious infection of the lungs that can be deadly if not treated properly. It takes a significant effort from a Nurse to guide ongoing treatment accurately in the right direction and provide care for Patients. Complications from Pneumonia include Respiratory failure, Sepsis and lung Abscess just to state a few from many. This essay explores Pneumonia and how to treat it with regards to Ella Newman’s situation from a Nursing perspective. An outline of Pneumonia’s Clinical manifestations, Aetiology and pathophysiology whilst relating it to Ella’s observations is addressed in the first section. A holistic Nursing care plan which addresses her current and potential problems is illustrated in the second section. The documentation of an ISBAR handover to a Pulmonary Lab Nurse and services that she can use after she will be discharge from the hospital are in the final section.
Ella Newman is a 48 years old woman who was admitted to the hospital with a presenting condition of Pneumonia. Pneumonia is a lower respiratory tract infection which causes inflammation of the alveoli sacs due to the presence of bacterial or viral infection. The clinical manifestations of Pneumonia include, coughing, fever, sweating and shivering, difficulty breathing, feeling generally tired and unwell and a loss of appetite. These descriptions are evident in Ella’s observations as well. Firstly, her physical exam on admission was febrile (38.4 degrees Celsius.) She ambulates as tolerated however she tires easily as she has mild dyspnoea present upon exertion and experiences slight weakness. This indicates general tiredness and feelings of being unwell. Furthermore, observations have been made that Ella appears to be quite thin. This is an indication that she has suffered loss of appetite due to the current condition she has developed.
In Ella’s condition Pneumonia, the most common bacteria that causes it is called Streptococcus pneumonia. Other common pneumonia causes include mycoplasma organisms which are the smallest type of bacterium discovered till date and organisms such as fungi. Typically the respiratory system can resist these germs entering the body through filtration of the airway. However, there are certain conditions that impais immunity and create susceptibility to lung infection. This is commonly found in people whose immune system has been affected and not working properly. Risk factors for Pneumonia are age, underlying lung disease, immobilization, smoking, and malnutrition. Ella’s past history indicates a 12 year history of emphysema (a type of COPD that is chronic and characterized by problems with breathing and poor airflow), multiple hospitalizations for pneumonia in the past 2 years. Furthermore, the results from the Laboratory tests, such as X – Ray, Sputum Gram and Arterial Blood gasses are indicating she is positive for lung infection. Her age and the lifestyle she lives which includes smoking a pack of Cigarettes a day are factors which warrants what she is having is another episode of recurrent pneumonia.
Pneumonia is an excess of fluid in the lungs which results from the inflammatory process. When inhaling infectious organisms or agents that irritate the lungs it sets off inflammation. Inflammation becomes prevalent in alveoli, bronchioles, and interstitial spaces of the lungs. Hence an immune response presents within the alveoli spaces. An influx of white blood cells migrates to the lungs which causes oedema, and a local capillary leak. Fluid is now accumulating around the alveoli which thickens the walls and area, which makes gaseous exchange in circulation difficult. This can affect one or both lungs. This is evidenced by Ella’s respiratory findings as it identified the lungs to be coarse, whilst having productive cough present with thick yellow sputum. As a result, coughing many times to produce phlegm, cold and flu like symptoms. The use of accessory muscles are needed to be able to work the lungs harder which in is indicative in Ella’s findings as she relies on accessory muscles when breathing. Ella has coarse sounds in her lungs when auscultated which tells that there is fluid and oedema in the lungs. Furthermore, fever, chills, chest pain or pain is commonly experienced by clients with pneumonia. Inflammation occurs throughout the body as well.
Mrs. Newman acquired an ineffective breathing pattern related to the increased production of respiratory sputum as evidenced by cough together with sputum production and mild dyspnoea. Ella’s current condition is vulnerable to deterioration quickly. Hence in order to detect and prevent the worsening of her current condition early the Nurse will monitor her Vital signs 2/24, whilst assessing her depth of breathing, respiratory rate and especially for abnormal breathing patterns. The observations made throughout the shift showed no signs of improvement of readings to the normal range. A build – up of sputum in her airways that interfere with smooth airflow throughout her airways and lungs and mild dyspnea are evident in Ella’s case. Hence, with prompt from the nurse performing deep breathing and coughing exercises every hour will help in clearing up her airways. Throughout the shift the Nurse has observed that Ella has been expectorating little sputum, she complains that it is so thick that it is almost impossible for her to cough out. The Nurse will try to place Ella in a Semi Fowlers Position when appropriate. This position increases oxygenation via maximum chest expansion. Her breathing pattern did not deteriorate however signs of dyspnoea were evident. Auscultating lung sounds for abnormalities such as: wheezing, crackling and fluid sounds are to gauge the amount of sputum is within her lungs and to monitor her progress throughout treatment. With routine observation, secretions within her lungs were detected with no audible improvement. Providing Patient education regarding the harmful effects of smoking in relation to lung health and Pneumonia has caused client to voice out her concerns and express grief as she realized what her future entails if she continues her current path. Ella has not gone to smoke for the whole shift. Upon having a brief conversation with her she voiced that she understands the magnitude of the situation and expressed interest in smoking cessation therapy. Goals for the current interventions include Ella to be in normal parameters in breathing pattern and respiratory rate and signs of dyspnoea need to be minimal or eliminated.
Ella experienced a fluid Volume deficit related to fever, an increased heart rate and fluid and electrolyte imbalance as evidenced by loss of fluid through excretion of sputum, and confusion. Part of the nursing interventions includes to put Ella on Fluid Balance chart. It provides a precise indication of how much fluid she is deficient of and the amount of fluid the Nurse needs to implement for her to have sufficient fluid for recovery. Monitor Vital signs 2/24 watching closely for her temperature readings as the increased temperature leads to loss of fluid which causes dehydration. A daily assessment of Ella’s skin turgor provides the Nurse with information on whether she is dehydrated. Monitoring her neurological state to check her level of confusion as it is an indicator of dehydration, monitoring the abnormalities in her heart rate and blood pressure. An increased heart rate and lowered blood pressure indicates a condition is called hypovolemia which is a condition in which the liquid portion of the blood plasma is too low. It is caused by the loss of body sodium which can be due to dehydration. The expected outcomes are to attain good skin turgor with no signs of dehydration, Vital signs that progress steadily towards normal parameters. Through evaluation, no signs of dehydration were noted and an increase in Ella’s fluid intake was documented after 3 days of hospitalization. Her Skin turgor remains normal and no signs of confusion were noted.
She is at risk of developing Pressure injuries. A Pressure injury is a localized damage to the skin and underlying soft tissue usually over a bony prominence as a result of shear, friction or prolonged pressure. They are preventable however pose as being life threatening if it is not treated. Potential pressure injury risk related to immobility as evidenced by imbalanced nutrition, weakness and mild dyspnoea on exertion. Firstly, the Nurse can perform ongoing assessments of nutritional status after the current changes of diet they have proposed. Nutritional deficit should be detected early to rectify malnutrition. An Example includes a deficit of in Body mass index. To monitor her nutritional status progressing she would be weighed on an alternate days. Adequate nutrients will help prevent deterioration and promote healing of the pressure areas. Prevention methods such as usage of pillows and foam wedges are used to reduce pressure on extremities and bony prominences. The Nurse should ensure the use of Application of barrier cream and to keep skin dry. Having moisture on the skin creates a higher risk of pressure injury development. This will also occur when skin is in a dry condition, hence it is important Ella’s skin is managed at the correct condition. The Nurse can encourage and assist to ambulate about in the ward at least 3 times per shift or as tolerated to promote good blood circulation The desired outcome is Ella to increase her mobility and eliminate the risk to develop pressure sores. Through evaluation, after 3 days of hospitalization Ella is increased her mobility and her skin integrity is maintained with no signs of pressure injuries.
It has been observed that Ella is taking her recurrent phase of Pneumonia seriously and following her discharge plan she needs to take part in services, in order to improve her lung health. The Lung foundation Australia is a national charity that is highly dedicated to support anyone with an ongoing Lung disease. They are at the forefront of ensuring lung health of Australians are as healthy as possible through funding quality research and providing equitable access to evidence based care and information. Their website is an excellent hub for resources, referral and information regarding Lung conditions. They provide Patient support groups in a warm and informal environment to create an environment that people with Lung conditions are not alone or uncommon to confide their anxieties, stressors, stories and most importantly to support each other through. They incorporate guest speakers, exercise programs, social activities, and peer support regularly. This will aid in the psychological stressors that are present and evident in Ella’s case as it will decrease her risks of isolating herself, developing further mentally and socially unhealthy tendencies, and lower her stress levels and susceptibility to depression. A Pulmonary Rehabilitation program is another initiative the Lung foundation have brought upon that involves healthcare professionals to assist with the understanding of their lung condition to help improve their quality of life through information sessions and exercise training. As Ella has Emphysema for a prolonged period this 6-8 week program will focus on increasing physical functioning, education regarding breathing techniques and how to use her current medicine to pace herself with the activities throughout her day. The benefits include improved quality of life, increase of mood and motivation, improved ability to manage condition and more. The LungNet newsletter is a free resource which provides readers with articles regarding lung health and informs of the progress of Lung Foundation Australia. Quitline is another service that will help Ella to consider smoking cessation. Trained specialists are available to help meet Ella’s needs and to increase the chance of quitting smoking successfully. They can help her create a quit plan according to her needs and her lifestyle and they provide emotional support in order to succeed her goal.
