Question

Please only answer to questions 5 and 6.

Patient Profile:

Gladys Young is a 68 year old female that resides in an Independent Living facility with her husband. She presents to her primary care physicians office with complaints of fever, chills, nausea and vomiting. She also states that she has had some mild hemoptysis occasionally with her persistent coughing. She has recently completed treatment with Chemotherapy for Breast cancer and is concerned that she may have an infection. You are the nurse caring for her.

You complete the following assessment:

Subjective Data:

She is able to complete a sentence in its entirety, but she is persistently coughing during the history. She is a former smoker, she smoked ½ pack of cigarettes per day for 30 years and quit when she was diagnosed with breast cancer 6 months ago. She denies shortness of breath or chest tightness. She has not yet gotten her influenza vaccine, but did receive the Pneumovax vaccine last year. She has had problems with persistent coughing at night which has prevented her from getting a good night’s sleep for the past two weeks. She also states that she has been waking up soaked in sweat in the morning.

Objective Data:

• Temp – 38.6 C; HR – 132 beats/min; RR—28; BP – 168/87; O2 sat – 90% on Room Air
• Auscultation: Lungs with faint crackles at bases bilaterally. No wheezing present.
• Patient is flushed and warm to touch.

Answer the following questions:

1. What additional questions would you like to ask this patient?
   Nurse can ask if the patient has sputum while coughing ,the color of the sputum.Did the patient experience any pain while coughing.Is the patient feeling weak ?Is there is any difficulty in breathing? How long is the cough and is there any breath sounds while breathing.Did the patient experience fever ?Did she has appetite?
2. What do you think the patient’s diagnosis is and why?
   This patient is suffering from pneumonia.A variety of symptoms like low oxygen saturation (90), persistent coughing,fever,chills, vomiting,crackles, decreased breath sounds,increased respiration rate ,increased heartbeat suggest pneumonia.This patient also has blood in the coughed up mucus.She has fever and chills.She also has persistent cough,with rapid shallow breathing.All this suggest she has pneumonia.A chest radiograph can confirm the diagnosis.
3. What is the pathophysiology of this disorder, in your own words?
   •entry of bacterium (streptococcus pneumoniae) into the lungs
   •inflammatory response by the body
   •encapsulation of the abscess in the cavity
   •necrosis of the lung tissue and parenchyma
   •appearance of clinical signs and symptoms (productive cough and purulent sputum)
4. What are the clinical manifestations of this disorder? Which manifestations is this patient exhibiting?
   clinical manifestations:
   •cough
   •purulent sputum
   •hemoptysis
   •fever
   •chills
   •night sweats
   •shortness of breath
   •malaise
   •chest pain
   •irregular breath sounds
   
   clinical manifestations experienced by patient:
   •fever
   •chills
   •night sweats
   •cough
   •hemoptysis
5. What complications do you want to be aware of if the disorder is not appropriately treated?
6. What pharmacologic interventions do you expect will be ordered for this patient? What routes of administration will be best indicated for this patient? (Include mechanism of action, indication for use and desired outcomes)

Answer 1

5. COMPLICATIONS

Often, people who have pneumonia can be successfully treated and do not have complications. Complications from pneumonia are more common in children, older adults and people with other serious diseases

Complications of pneumonia that may be life threatening include

• Acute respiratory distress and respiratory failure, which are common complications of serious pneumonia
• Kidney, liver and heart damage, which happens when these organs dont get enough oxygen to work properly or whwn your immune system responds negatively to the infection
• Necrotizing pneumonia, a condition that develops when the infection causes the lungs tissue to die and form lung adscess. It also makes the pneumonia harder to treat. You may need surgery or drainage with a needle to remove the pus
• ;Pleural disorders: The tissues that cover the outside of the lungs may become inflammed, and the chest cavity around the lungs may fill with fluid and pus
• Sepsis, which happens when bacteria from the lungs gets nto the blood and causes inflammation throughout the body

6. PHARMACOLOGIC INTERVENTIONS

Treatment for pneumonia involves curing the infection and preventing complications. Specific treatments depends on the type and severity of the pneumonia, age, overall health etc

ANTIBIOTICS

These medicnes are used to treat bacterial pneumonia. It may take time to identify the type of bacteria causing the pneumonia and to choose the best antibiotic to treat it. If the symptoms dont improve, doctor may recommend different antibiotic.

First line antibiotics that may be selected include the macrolid antibiotics azithromycin or clarithromycin.

Other appropriate antibiotics may include fluoroquinolone antibiotics such as levofloxacin or combined therapy of beta lactam such as amoxicillin or amoxicillin/ clavulanate with a macrolide antibiotic

MOA: Azithromycin prevents bacteria from growing by interfering with their protein synthesis. It binds to the 50s subunit of the bacterial ribosome, thus inhibiting translation of mRNA.

COUGH MEDICINE

This medicine may be used to calm your cough so that you can rest. Because coughing helps loosen and move fluid from the lungs ,

FEVER REDUCERS/ PAIN RELIEVERS

You may take these as needed for fever and discomfort. These includes drugs such as aspirin, ibuprofen, and acetaminophen

MOA: Aspirin is a non selective and irreversibly inhibits both forms. It does so by acetylating the hydroxyl of a serine residue