Question

The nurse is caring for a frail, 84-year-old male patient in the hospital after surgery to repair a bowel obstruction. The patient has a nasogastric (NG) tube to suction, through which all her scheduled drugs are given, oxygen at 1 liter/nasal cannula at night (home order), an indwelling urinary catheter, and a saline lock. The patient is weak and fatigued, has pain not relieved by IV opioids, and is reluctant to participate in any activities. 1. What is pathophysiology of pneumonia? 2. What risk factors does this patient have for developing pneumonia? 3. What actions does the nurse take to decrease the patient's risk for pneumonia? 4.Two days later, the NG tube is removed, and the patient is started on ice chips and other clear liquids. The patient swallows repeatedly when given sips of water. What action does the nurse perform? 5.The nurse does hourly rounds on the patient, and the patient's daughter states, “Something is just not right with mom.” What action should the nurse take first? 6.What other actions should the nurse perform? 7.The physician orders a chest x-ray, and the results show pneumonia. What actions by the nurse are most important?

Answer 1

Ans) 1) Pathophysiology of Pneumonia:

- Any infectious organisms that reach the alveoli are likely to be highly virulent, as they have already evaded the host’s physical defense mechanisms. Consequently, they may overwhelm the macrophages, resulting in production of a fibrin-rich exudate that fills the infected and neighbouring alveolar spaces, causing them to stick together, rendering them airless.

- The inflammatory response also results in a proliferation of neutrophils. This can damage lung tissue, leading to fibrosis and pulmonary oedema, which also impairs lung expansion.

- The inflammatory response can also lead to the development of a pleural effusion which is thought to complicate up to 40% of cases of pneumonia. These changes result in reduced gaseous exchange.

- As a result, vital organs become oxygen deprived and the respiratory effort required with each breath will be increased as a result of the disturbance in normal physiology. Respiratory and heart rate will increase in response to falling oxygen and rising carbon dioxide levels.

2) Risk factors does this patient have for developing pneumonia:

- Geriatrics more than 65 years
- Being hospitalized
- Weakened immune system
- Difficulty in swallowing and coughing
- Recent history of abdominal surgery

3)The pneumococcal vaccine is one of the most effective ways to prevent pneumonia
- Avoiding smoking is another important way to prevent pneumonia
- Elevating the head end to 30 – 60 degree
- Oral hygiene at least twice a day
- Administer oral fluids to liqudify the secretions
- Avoiding the use of normal saline lavages when suctioning.

4) Assess the patient for aspiration using an evidence-based aspiration screening tool and consult with the physician about formal speech therapy swallowing evaluation.

5 & 6) Obtain an oxygen saturation; assess other vital signs, including temperature; assess cognitive function; assess for pain; auscultate lung sounds; assess the quality and characteristics of urine; palpate the abdomen; assess the IV site; review the most recent laboratory values; document findings; and notify the physician.

7) Administer the prescribed antibiotics as soon as they are available, maintain oxygen saturation above 96%, monitor work of breathing, assist with effective coughing, provide fluids, and treat pain while being cautious to avoid respiratory depression and sedation.