Residential Factors For Childhood Pneumonia Essay Paper

Antimicrobial Selection

Discuss About The Residential Factors For Childhood Pneumonia.

Antimicrobial selection: A registered nurse should understand that for elderly patients (in this case, Mr Hunter) with community-acquired pneumonia, the antimicrobial selection is similar to that of all adults with confirmed community-acquired pneumonia (Williams et al. 2017). So, recommendations for influenza and pneumococcal vaccines in individuals with advanced age are included as part of the recommendations provided on community-acquired pneumonia prevention (Sader et al. 2014). According to Williams et al. (2017), in the United States, of the major causes of demise in the elderly who are above 65 years, community-acquired pneumonia is ranked 5^th. A distinct subpopulation of elderly individuals and residents of facilities that offer long-term care are at profoundly lofty level risk of developing pneumonia (Blot et al. 2014).

Aetiology: In relation to Mr Hunter’s case, a registered nurse should be able to understand the aetiology of pneumonia, in connection with its clinical manifestation in an elderly person. However, Troeger et al. (2017) note that determining the relative significance of different aetiologies of this disease in the older subpopulation is rather challenging. S. pneumoniae is the etiologic agent in approximately 48% of individuals above 60 years of age according to a Finnish study which involved 345 episodes of community-acquired pneumonia. In the same study, C. pneumoniae was responsible for 12% of the cases while M. pneumoniae was detected in 10% of the cases. H. influenza was responsible for 4% of the cases while respiratory viruses were detected in 10% of the cases (Lee et al. 2017). The incidence of pneumonia caused by gram-negative bacteria in the elderly subpopulation is rather uncertain and, information is scanty for nursing home residents. Usually, the detection of Mycoplasma and Legionella species is infrequent (Song et al. 2016).

Risk factors: For pneumonia, according to Zhuge et al. (2018), independent risk factors include alcoholism, immunosuppression, bronchial asthma, heart disease, lung disease and advancing age. Other significant factors include difficulty swallowing and being male (Prina et al. 2015).  Residential Factors For Childhood Pneumonia Essay Paper

According to Sa et al. (2017), the interrelation between ventilation and diffusion is a balance between oxygen entry into the alveoli and subsequently into blood. Ventilation is the process by which oxygen enters into the air sacks and the exit of carbon dioxide out of the alveoli. Diffusion in itself is the process by which oxygen gets into the blood from the air sacks as co2 replaces it in the alveoli (Sa et al. 2017). Thus, the carbon dioxide and oxygen levels are altered by these two processes. An alteration in these processes arises when there is a change in any of the two takes place (Liu et al. 2016).

Aetiology

Sa et al. (2017) contends that there is a little but substantive increase in the degree of ventilation: diffusion mismatch which develops in pneumonia. The cause of this mismatch is unknown but hypothesises have pointed out to interstitial oedema which develops as a result of inflammation of the lung parenchyma, reduced gaseous exchange in large airways, regional differences in the way blood flows in the lungs, pulmonary haemorrhage and airway obstruction (Liu et al. 2016).

HAP: Also, referred to as nosocomial pneumonia. This is pneumonia contracted in the hospital by a patient, at least 48-72 hours after admission (Komiya, Ishii & Kadota). According to Pugh et al. (2015), usually, it is caused by a bacterial infection and hardly by a viral infection. Ewan et al. (2017) note that of all healthcare-associated pneumonia (HCAP), nosocomial infection comes second after urinary tract infections, accounting for 15-20% of the cases. Moreover, HAP is the major cause of demise of the nosocomial infections, particularly in the intensive care units. The signs and symptoms of HAP, particularly for elderly patients include confusion or mental changes, cough with greenish sputum, chills and fever, malaise, nausea, vomiting, lack of appetite, chest pain that is sharp and often getting worse with coughing and deep breathing, dyspnoea, fast heart rate and significant decrease in blood pressure (Ewan et al. 2017). A diagnosis of hospital-acquired pneumonia is based on the clinical presentation and the picture of the patient’s x-ray film and, elevated leukocyte count (El-Rabbany et al. 2015). The differential diagnosis for HAP includes atelectasis, pulmonary embolism and congestive heart failure. Regarding its treatment, the initial therapy is usually empirical (El-Rabbany et al. 2015).

CAP: This is a type of pneumonia contracted by persons with little or no direct contact with healthcare settings, particularly medical institutions. S. pneumonia is the most common etiologic agent identified with CAP. Other pathogens that are often responsible for CAP include atypical bacteria (M. pneumoniae, C. pneumoniae, Legionella species), H. influenza and viruses (Troeger et al. 2017). The signs and symptoms associated with this type of pneumonia include a cough, fever, production of sputum, dyspnoea, pleuritic chest pain, tachycardia and tachypnea (Marti & Esperatti 2016). In diagnosing CAP, the patient’s clinical presentation and the picture of the patient’s x-ray film are important. Antibiotics that have been empirically chosen are used in the treatment of CAP. For relatively healthy or young patients, this type of pneumonia has an excellent prognosis (Marti & Esperatti 2016).  However, a good number of cases of pneumonia, particularly when the aetiological agent in question is S. pneumonia, S. aureus, Legionella or influenza viruses, are much serious and often fatal in sicker patients and the elderly subpopulation (Musher & Thorner 2014).

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Risk Factors

Aspiration pneumonia: This type occurs when saliva, vomit, liquids, food or liquid is breathed via the air passages to the lungs, instead of being swallowed through the oesophagus into the stomach (Dibardino & Wunderick 2015). The risk factors for aspirating these things into the lungs include being comatose, alcoholism, being less alert because of illness, drugs or other causes, old age, general anaesthesia, challenges with swallowing and poor gag reflex in semi-conscious or unconscious people often after brain injury or stroke (Muller 2015). Dibardino and Wunderink (2015) note that the symptoms for aspiration pneumonia include chest pain, fatigue, coughing up dark/greenish and foul-smelling sputum, fever, wheezing, shortness of breath, breath odour, problems swallowing and excessive sweating. Its treatment depends on the severity of pneumonia itself and, how ill an individual was before the aspiration (Dibardino & Wunderink 2015). As Muller (2015) notes, a ventilator is sometimes needed to support breathing. The patients are given antibiotics and for the patients with swallowing difficulties, other feeding methods are used to reduce the aspiration risks (Muller 2015).

Explain the nursing care required by a patient with pneumonia. Provide a rationale for all elements of the care provided that reflects the particular needs of Mr Hunter.

For all patients with pneumonia, nursing care would include supportive measures to eliminate hypoxemia like humidified oxygen therapy, ventilator support for respiratory failure, adequate intake of fluids and a diet with high caloric content (Nuti et al. 2015). According to Richards et al. (2017), nursing interventions such as bed rest and analgesic administration to relieve sharp chest pain are included. Nuti et al. (2015) assert that the nursing care plans for pneumonia include impaired gas exchange, acute pain, ineffective airway clearance, activity intolerance, deficient knowledge, hyperthermia, the risk for imbalanced nutrition, risk for deficient fluid volume, risk for infection, ineffective breathing patterns among others.

The consultant has asked to be informed if Mr Hunters heart rates rise above 100, oxygen saturations fall below 90% and his temperature rises above 38.5c. in the context of a patient with pneumonia, explain the rationale/s for monitoring the specific parameters requested by the consultant.

Heart rate: Ponikowski et al. (2014) suggest that it is necessary to monitor this parameter because the heart rate can rise in case of any significant disease of the lung.  Adrenaline levels surge as a result of the stress of being sick. Also, low oxygen levels in the blood lead to an increased heartbeat. Furthermore, pneumonia is capable of pushing the heart into rhythms that are abnormally fast including atrial fibrillation or atrial flutter (Restrepo & Reyes 2017). Residential Factors For Childhood Pneumonia Essay Paper The appearance of these two abnormalities is due to high pressure in the blood vessel of the lungs causing dilation of the right side of the heart which possibly throws off the electrical system of the heart (Ponikowski et al. 2014).

Outline The Pathophysiology Of Altered Ventilation And Diffusion In Relation To Mr Hunter’s Pneumonia.

Oxygen saturation levels: Pneumonia can be described as an inflammation of the parenchyma of the lung often caused by pathogens (Liu, Peng & Hua (2015). These aetiological agents are mainly bacterial and viral agents. Liu, Peng and Hua (2015) contend that these inflammatory alterations in the lungs impair the normal gaseous exchange process leading to its clinical presentation. So, hypoxaemia is a major contributor to pneumonia associated mortality

Body temperature: Monitoring body temperature in pneumonia is essential in the sense that symptoms usually vary depending on whether the patient’s pneumonia is viral or bacterial. In bacterial pneumonia, the patient’s body temperature rises as high as 105?F. This pneumonia causes profuse sweating increase pulse rate and rapidly increasing breathing (Ota et al. 2016).

6) Explain (1) strategy you would use to ensure Mr Hunter understands the implications of his decisions to refuse the oxygen and (2) the actions you would take to manage the situation.

Understand the Mr. hunter’s point of view: My first line of questioning Mr Hunter will focus on what he thinks about oxygen therapy. I will try and understand where he comes from and why he feels that the decision he has already made is the right one, putting in mind that patients often baulk from treatment because of issues of communication as Pirinen et al. (2015) suggest. Perhaps Mr Hunter does not understand why what is being done to him or why he needs oxygen therapy. This will give me an opportunity to teach him about his condition and how he would benefit from oxygen therapy.

I will find out why Mr. Hunter does not want the procedure. I will explore his thought process on the decision he is making and try to clarify the consequences of his decision. I will discuss with him these concerns, ranging from him not thinking that oxygen therapy is necessary to his underlying fears. I will bring them to light and talk to Mr Hunter about them and make sure that his decision is informed and negotiate a solution that is acceptable.

First and foremost, I have learnt that none of us should be subject to the kind of treatment that we do not at all wish to receive even though there is a lot more to story that just saying no to treatment. Secondly, I have learnt that by trying to see the patient’s side of view about a situation and using my communication skills, I can help my patients to overcome any fright; I can assist them to make the best possible decisions for their care. I have learnt that if the patient’s decision involves refusing care, then I as a nurse must come to an acceptance of the patient’s decision, regardless of how much I would disagree with the patient.

1. b) What actions will you take in your future practice because of what you have learned from this scenario?

Differences Between Community-Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) And Aspiration Pneumonia.

From this scenario, I have learnt that as a nurse, communication is the most fundamental thing to consider when a patient refuses care. In my future practice, as much as we need to respect the wishes of our patients, I will take every necessary step to save the life of my patients. In case I will encounter such a scenario in my future practice, I will need to assure my patient that they understand the decisions they are making and what the consequences of their choice mean. I believe that this will give me an opportunity to teach the patient. Also, this will give me a chance to learn to accept patients’ wishes which go against my training.

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1. c) In your reflection identify which of the NMBA Registered Nurse Standards for practice relate to what you have learnt and how your practice will change.

Standard 2; A registered nurse takes part in professional and therapeutic relationships: I have learnt that the practice of registered nursing is grounded on positive engagement in effectual professional and therapeutic relations including shared generosity in terms of mutual respect and trust in professional relations (Birks et al. 2016). As a nurse, I will establish, sustain and conclude relations in a way that will differentiate the barriers between personal and professional relationships. In my practice, I will communicate effectively and respectively; upholding individual dignities, cultures, values, rights and beliefs. I will offer support and direct persons to resources with the aim of optimising healthcare-related decisions. I will actively foster a learning and safety culture that would include engaging not only the healthcare professionals but also others, in order to exchange knowledge and skills which support person-centred care and I will lead or take part in a collaborative practice.

References

Birks, M, Davis, J, Smithson, J, & Cant, R 2016, ‘Registered nurse scope of practice in Australia: an integrative review of the literature’, Contemporary Nurse, vol. 52, no. 5, pp.522-543, doi: 10.1080/10376178.2016.1238773

Blot, S, Koulenti, D, Dimopoulos, G, Martin, C, Komnos, A, Krueger, WA, Spina, G, Armaganidis, A & Rello, J 2014, ‘Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients’, Critical care medicine, vol. 42, no. 3, pp.601-609, doi: 10.1097/01.ccm.0000435665.07446.50

El-Rabbany, M, Zaghlol, N, Bhandari, M & Azarpazhooh, A 2015, ‘Prophylactic oral health procedures to prevent hospital-acquired and ventilator-associated pneumonia: a systematic review’, International journal of nursing studies, vol. 52, no. 1, pp. 452-464, doi: 10.1016/j.ijnurstu.2014.07.010

Ewan, V, Hellyer, T, Newton, J & Simpson, J 2017, ‘New horizons in hospital acquired pneumonia in older people’, Age and ageing, vol. 46, no.3, pp.352-358, doi: 10.1177/205064061773505

Nursing Care Required By A Patient With Pneumonia.

Kalil, AC, Metersky, ML, Klompas, M, Muscedere, J, Sweeney, DA, Palmer, LB, Napolitano, LM, O’grady, NP, Bartlett, JG, Carratalà, J & El Solh, AA 2016, ‘Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society’, Clinical Infectious Diseases, vol. 63, no. 5, pp.e61-e111, doi: 10.1093/cid/ciw353

Komiya, K, Ishii, H & Kadota, JI 2015, ‘Healthcare-associated pneumonia and aspiration pneumonia’, Aging and disease, vol. 6, no. 1, p.27, doi: 10.14336/AD.2014.0127

Lee, N, Walsh, E, Sander, I, Stolper, R, Zakar, J, Rosa, GDL, Wyffels, V, Myers, D & Fleischhackl, R 2017, ‘October. Impact of Timing of Diagnosis of Respiratory Syncytial Virus (RSV) Disease on Hospital Length of Stay (LOS) in Adults: Final Analysis from a Retrospective Chart Review Study’, In Open Forum Infectious Diseases (Vol. 4, No. suppl_1, pp. S577-S578). US: Oxford University Press, doi: 10.1093/ofid/ofx163.1509

Liu, PH, Tu, ML & Liu, SF 2016, ‘The Application of Early Use of Airway Pressure Release Ventilation on a Patient with Unilateral Pneumonia’, A Case Report, vol. 15, no. 1, pp.49-55, doi: 10.6269/JRT.2016.15.1.05

Liu, W, Peng, L, & Hua, S 2015, ‘Clinical significance of dynamic monitoring of blood lactic acid, oxygenation index and C-reactive protein levels in patients with severe pneumonia’, Experimental and therapeutic medicine, vol. 10, no. 5, pp.1824-1828, doi: 10.3892/etm.2015.2770

Marti, AT & Esperatti, EM 2016, ‘Community-acquired pneumonia’, In Respiratory infections (pp. 110-128). CRC Press, Available on: https://www.taylorfrancis.com/books/e/9781420080353/chapters/10.3109%2F9781420080353-10 . Residential Factors For Childhood Pneumonia Essay Paper