Question

Mr. Cowen calls his primary HCP to schedule an appointment. Before the appointment, Mr. Cowen goes to a local laboratory and has a series of blood tests drawn as prescribed by the HCP.  

At his appointment with the HCP, the nurse weighs Mr. Cowen.  He is 5 feet 9 inches tall and weighs 225 pounds.  Mr. Cowen's BP is 166/92 mm Hg with a large cuff in the right arm and 168/96 mm Hg in the left arm.  His heart rate is 84 beats per minute with a  regular rhythm, respiratory rate is 18, and he is afebrile.  His total cholesterol is 260 mg/dL.  During the health history assessment, the HCP learns that Mr. Cowen drinks at least four to six ounces of regular coffee per day and that his father has coronary artery disease and Hypertension.  Mr. Cowen denies feeling stress because of his job, relationship with his wife and family, or other factors. "I am a pretty laid back guy.  I am not worked up or excited about much.  I leave that worrying to my wife."  The HCP notes that Mr. Cowen carries the majority of his weight in his upper body.  He has an increased amount of subcutaneous fat around his waist and his abdomen.

The HCP prescribes Hydrochlorothiazide (HCTZ) daily for the client and askes the nurse to provide Mr. and Mrs. Cowen with instructions regarding the education and lifestyle modifications.  A follow-up appointment is scheduled for one month.

14.  Provide a rationale for each of the following prescribed components of Mrs. Harriets treatment plan: oxygen to keep the client's oxygen saturation greater than or equal to 95%, Ceftriaxone sodium, Albuterol, Acetaminophen, bed rest, 1800  calorie diet, increased oral (PO) fluid intake to 2 to 4 liters per day, coughing and deep breathing exercises and use of the incentive spirometer (IS).

15.  Mrs. Harriet was taking Dextromethorphan at home to help manage her cough.  The HCP did not prescribe continued use of the Dextromethorphan during hospitalization.  Explain this omission.

16.  If it was learned that Mrs. Harriet has a past medical history of chronic obstructive lung disease (COPD), how would the HCP's prescription that oxygen is delivered to keep the client's oxygen saturation greater than or equal to 95% be changed?

17.  Identify three priority nursing diagnoses that should be included in Mrs. Harriet's plan of care.

18.  You are the nurse providing discharge teaching to Mrs. Harriet.  Briefly discuss what you will recommend to her regarding seeking follow-up care, lifestyle considerations, and how to help prevent Pneumonia in the future.

Answer 1

14. O2 Delivery

The gas exchange of the lung alveoli mostly impaired in Pneumonia (which causes consolidation and impaired gas exchange), the person may experience severe breathing difficulty. Oxygen supplementation is one way to help patients who cannot breathe adequately on their own

Ceftriaxone

As pneumonia is an infection, antibiotic therapy should be started as soon as possible. Sometimes this can be before the causative organism has been determined, however, the type of antibiotic can be changed if necessary, the main aim with antibiotic therapy is to be started immediately. Depending on the severity of the pneumonia, this can be in either an intravenous or oral form

Albuterol

Albuterol is a bronchodilator, it helps to increase the air entry into the lungs and also helps to remove the mucus secretion

Acetaminophen

It is an antipyretic drug, which helps to reduce the fever caused by pneumonia infection. Fever is the one of the common symptoms of pneumonia

Increased Oral Fluid Intake 2-4 liters per day

Adequate hydration is important for the expectoration of secretions and will also help with any associated hypotension. The individual may also have an increased fluid loss occurring if they are febrile and continue to have an increased respiratory rate, therefore urinary output should also be monitored as this can flag deterioration in the patients condition

Nutrition - 1800 cal/day

Another factor of treatment that can be easily overlooked is nutrition. People with severe pneumonia may also be experiencing nausea and therefore have a decreased appetite. And this is right at the time when they need a higher calorie intake to fight the infection, remembering that when a person has an infection, their calorific requirements increase

Coughing and Deep breathing Exercise

It helps to remove the mucous secretion and enhances the air entry and reduces the chance of lung consolidation

Use of Incentive spirometer

Incentive spirometry is commonly used to break up fluid that builds up in the lungs in people with pneumonia.

15. Use of Dextromethorphan

Dextromethorphan is a cough suppressant, if it is used in pneumonia, it will lead to mucus accumulation and further complications in pneumonia. In pneumonia, coughing is more promoted to remove the secretions

16. The Oxygen saturation recommended in COPD patient is 88 - 92%, So the oxygen administration should be changed from the previous set goal to keep above 95%

17. Three Nursing Diagnoses in Pneumonia

1. Ineffective Airway Clearance
2. Impaired Gas Exchange
3. Ineffective Breathing Pattern

18. The discharge may include

Manage your symptoms:

1. Rest as needed. Rest often throughout the day.
2. Drink liquids as directed. Ask how much liquid to drink each day and which liquids are best for you.
3. Do not smoke. Avoid secondhand smoke.
4. Use a cool-mist humidifier. A humidifier will help increase air moisture in your home.
5. Keep your head elevated.