Patient Situation and Condition

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Pneumonia

Patient Situation and Condition

The patient is a 61 years old male that presents with vomiting overnight, recent flu,
generally unwell, afebrile. He has been generally unwell for 1 week with flu-like symptoms seen
by LMO- diagnosed viral infection, decreased oral intake. The patient has a cough induced
vomiting from 4 overnight with no diarrhea or abdominal pain. He denies other symptoms such
as headaches and dizziness, tightness of chest, and chest pain. He had a raised basal metabolic
rate, type 2 diabetes mellitus, right leg cellulitis, hypertension, and dyslipidemia and has not been
previously hospitalized.

Nursing Interventions
Subjective Assessment

A review of systems approach was used to assess the patient to develop appropriate goals
for management. On general assessment the patient was found to be afebrile and reported no
challenges with the performance of activities of daily living. He reported an elevation in the
basal metabolic rate and no recent changes in eating habits and mood. Mr. X had a regular pulse

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with no notable edema on the upper and lower limbs. He denied chest pain, palpitations, and
heart racing. He reported no skin bruising, rashes, delayed wound healing, bleeding or
discolorations. There were no changes reported in lesions and moles. The patient had no history
of tuberculosis. The patient reported no cough, dyspnea, or hemoptysis. He did not use any
corrective lens and reported no blurring of vision or any visual changes. The patient reported no
constipation, abdominal pain, hemorrhoids, black tarry stool or eating disorders.

Objective Assessment

On general assessment the client had a somber mood and appeared appropriately
groomed for the weather. His skin was moist and had no notable lesions or bruises. The ear
canals were patent. The nasal mucosa was pink. All the teeth were present and in good condition.
The oral and pharyngeal mucosa was pink and did not have exudates. The client had a regular
heart rate and rhythm as well as the S1 and S2. The pulse was 3+ with no edema noted on any
part of the body. No extra heart sounds or murmurs were heard on auscultation. The lungs were
clear bilaterally on auscultation and the wall of the chest and the trunk was symmetrical. Mr. X
had a regular respiratory rate and exhibited no labored breathing. The abdominal wall was
symmetrical with no swelling. Every quadrant of the abdomen had audible bowel sounds. On
palpation, the abdomen was not tender to touch. The urinary bladder was non-tender and not
distended.

Patient History

Mr. X drinks occasionally with friends and smokes but denied using illicit drugs. The
patient is a retired primary school teacher and currently lives with the wife. He has two children,
35 years and 31 years, both married and living with spouses in far-away towns. The father is was

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a known diabetic and hypertensive and the mother too suffered hypertension. There were no
histories of cancers and mental illnesses noted.

Laboratory Tests and Medications

The geriatric patient is on the following medications Amlodipine 1 tablet daily, Irbesartan
300mg, Atenolol 50mg, Aspirin- 100mg, Lipidil- 145mg, fish oil 100mg, and vitamin D. He
reported no known food or drug allergy. Below is a list of results from various laboratory
investigations.
Serum C-Reactive Protein
CRP- 57 mg/dl
Elevated CRP indicates inflammation, necrosis or infection
HB: 138g/l
WCC- 8.0
PLATELETS- 341
RCC-471
PCV- 0.40
MCV- 85PL
MCH- 29 Pg
MCHC-395 G/L
RDW- 11.7%
ESR- 40mmhr
ESR is mildly elevated

Special Tests

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Other tests that could be indicated to confirm the diagnosis of the patient include a
complete blood count to rule out bacterial infections and a chest x-ray (Bernoth and Winker,
2017). A chest x-ray could reveal a flattened diaphragm, overinflated lungs, bullae, or an
increased retrosternal space. These exclude other diseases such as pneumonia, pneumothorax,
and pulmonary edema.

Primary Diagnosis
Early Right Lower Lobe Pneumonia
Pathophysiology

Early right lower lobe pneumonia is an infection that is characterized by right lower lobe
inflammatory exudates in the confines of the intra-alveolar space causing a consolidation that
affects the continuous and large areas of the lung. The invading microbe multiplies and releases
toxins that precipitate the inflammation of the lobes of the lungs resulting in lung parenchyma
edema (Johnson and Chang, 2014). The edema leads to cellular debris accumulation,
solidification, and consolidation of the affected lobe. The acute phase of the infection progresses
in four stages. The process starts with lung congestion within the first 24 hours following
vascular engorgement. The second stage is red hepatization with red blood cell extravasations
due to the persistence of vascular congestion (Oloughlin, Browning, and Kendig, 2017). The
next phase is the grey hepatization stage marked by the disintegration of red blood cells. The
fourth stage is the resolution phase marked by complete recovery.
Nursing Diagnosis

Acute pain related to inflammation in chest tissues as evidenced by verbalization from the
patient

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Pain refers to experiences that distress individuals and are caused by stimuli that are
intense and damaging. Nurses’ roles are central in the pain management process in health care
institutions and institutions. The effective assessment of pain allows for the appropriate
formulation of nursing care plans to meet the needs of the patient. Different scores of pain
assessment are used in different regions and institutions. The levels of pain experienced by the
patients can be viewed in two ways. Paracetamol and aspirin are recommended analgesic for
prevention and treatment of mild and moderate pain. The medication works by inhibiting the
actions of cyclooxygenase enzyme thereby reducing the production of prostaglandins and
causing pain relief. Aspirin 100 mg per oral per day PRN was administered to the patient for pain
relief following an assessment of pain levels and determining that it was 6/10 suggesting that it
was moderate pain.
Impaired gas exchange related to lung disease as evidence by and an elevated heart rate of
105 beats per minute.
The patient is positioned at a semi-fowler position by the nurse to improve breathing.
The intended outcome of the nursing intervention is to improve gaseous exchange and relieve
pleuritic pain. The semi-Fowler’s position helps to increase the capacity of the thorax, promote
lung expansion, increase the full descent of the diaphragm and also prevent regurgitation of
abdominal contents. The position of the bed should also be regularly checked to prevent it from
slumping down. This is because a slumped position is likely to compress the abdomen and limit
the expansion of the lungs. In cases where one lung is affected, the proper positioning of the
patient in a semi-Fowler’s position would increase hydrostatic pressure and gravity that is
required for better perfusion and increased oxygenation.

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The nurse will maintain an oxygen administration device as prescribed and maintain the
oxygen saturation levels above 90%. The expected outcomes of this nursing intervention are that
the patient will maintain oxygenation levels of above 90% and partial pressure of oxygen above

  1. Supplementary oxygen helps to maintain the partial pressures of oxygen at an acceptable
    level in patients with the impaired gaseous exchange. Hypoxia stimulates hyperventilation in
    patients with chronic carbon dioxide retention. The patient should be closely monitored during
    the supplementary oxygen therapy to prevent an increase in oxygen partial pressures to
    unacceptable level thus resulting in apnea.
    Ineffective tissue perfusion related to poor respiratory functioning as evidenced by oliguria
    The nurse will submit the patient for diagnostic assessments as required. Various
    diagnostic tests are available depending on the cause of the condition. Doppler’s scan, vascular
    stress test, and angiograms could be helpful. The nurse will start by assessing for signs of
    ineffective tissue perfusion and for the possible contributing factors of impaired arterial blood
    flow. The nurse will administer intravenous fluids (Hartman’s solution) as ordered and check for
    optimal fluid balance. Adequate fluid intake optimizes cardiac output and filling pressure
    required for tissue perfusion. The goal of the nursing intervention is that by the end of the day,
    the patient will exhibit no signs of fluid retention and maintain adequate fluid balance.
    The nurse will promote early ambulation, active and passive range of motion movements.
    The expected outcome of this nursing intervention is that the patient will exhibit improved
    tolerance to activities after 24 hours of nursing intervention. Ambulation and exercise prevent
    venous stasis that could further compromise blood circulation. The nurse will also assist the
    patient with position changes. Assisting the patient with position changes from a supine to sitting
    position reduces the risk for orthostatic blood pressure changes. The nurse will also keep the

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patient warm. Keeping the extremities warm maintains vasodilatation thus improving blood flow
to the affected area.

Establishment of Goals

The goals for patient management in the case study include alleviation of pain, health education,
and the enhancement of compliance to treatment regimen.
Further testing: A computed tomography scan can show the distribution of emphysema within
the pulmonary cavity to help exclude other lung diseases (Sadana et al. 2016; Robson, 2017).
Allergy tests could also be conducted to rule out hay fever and asthma as the patient had a
positive family history of the two conditions.

Nursing Actions

The nursing interventions for the patient include educating him on the triggers of his
condition and how to manage it. The nurse also encourages compliance with medications to
ensure that the patient has the best possible clinical outcomes (Hargrove-Huttel, 2015; Farrell,
2017). The nurse is also responsible for the administration of medication and monitoring their
effects and also, managing any adverse effects from the drugs appropriately. The nurse will also
encourage ambulation to promote venous return and prevent pooling.
Medication Rx:
The following medications administered through drug therapy control her symptoms:
 Amlodipine 10mg per oral per day: the medication belongs to the class of calcium blockers that
reduces the blood pressure by relaxing the blood vessels vasculature
 Irbesartan 300 mg per oral per day: the medication is an antagonist of angiotensin 2 receptor that
reduces blood pressure by acting directly on the angiotensin-renin system.

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 Atenolol 50 mg per oral per day: the medication works by reducing the blood pressure by acting
directly on the beta 1 receptors.
 Aspirin 100 mg per oral per day: the medication is a non-steroidal anti-inflammatory drug that
inhibits cyclooxygenase activities leading to reduced production of prostaglandins (Byant et al.
2019; Brown et al. 2017). The medication also reduces the risk of developing angina pectoris or
cardiac arrest.
 Lipidil 145 mg per oral per day: The medication works by reducing the serum lipid levels
through the activation of peroxisome proliferator-activated receptor-alpha.
 Fish oil 100 mg per oral per day: the medication works by reducing triglyceride levels in the
serum and enhance the clearance of chylomicron and VLDL.
 Education: The patient is educated on the use of the medication and the potential adverse effects.
The education could be triangulated to include individual-based education as well as a focused
group discussed with other chronic smokers (Samuelson, Crawford, and Alexander, 2017; Kozier
et al. 2014). The patient will also be taught about the known triggers of pneumonia which
include smoke, pollen, and fumes.
Non-medication treatments: Smoking cessation could be recommended to improve the clinical
outcomes of the patient as well as deep breathing exercises (Bernoth and Winker, 2017; Eibich,
2015). Other recommended strategies that can act as alternatives for smoking cessation include
the prescription nasal spray containing nicotine.
Evaluation and Reflection- The patient was, however, very cooperative and adherent to
professional advice. I feel that the patient comprehended as patient voiced understanding of
teaching provided

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References

Bernoth, M., & Winker, D. (2017). Healthy aging and aged care. South Melbourne, Vic, Oxford
University Press
Bryant, B. J., Knights, K. M., Darroch, S., & Rowland, A. (2019). Pharmacology for health
professionals. Chatswood, NSW: Elsevier Australia
Brown, D., Buckley, T., Edwards, H., Seaton, L., & Lewis, S. M. (2017). Lewis’s medical-
surgical nursing: assessment and management of clinical problems.

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