This is the case of patient MCS, a 62 year old female who came to Ospital ng Guiginto with a chief complaint of productive cough with associated difficulty of breathing & intermittent fever. She was admitted on July 16, 2012. She was diagnosed with Pneumonia with manifestations of Asthma.
Pneumonia is an inflammation of the lung parenchyma commonly caused by microbial agents. Classically, pneumonia has been categorized as being bacterial or typical, atypical, anaerobic/cavitary, or opportunistic. Another classification scheme categorizes pneumonias as community-acquired (CAP), hospital-acquired (HAP or nosocomial), pneumonia in the immunocompromised host, and aspiration pneumonia. Those at risk for pneumonia often have chronic underlying disorders, severe acute illness, a suppressed immune system from disease or medications, immobility, and other factors that interfere with normal lung protective mechanisms.
The organisms that cause Pneumonia may vary. Community-acquired pneumonia may be caused by Streptococcuspneumoniae, Haemophilus influenzae, Legionella pneumophila, Mycoplasma pneumonia, Influenza viruses types A, B adenovirus, parainfluenza, cytomegalovirus and coronavirus, and C. pneumoniae. Hospital-acquired pneumonia could be caused by Psedomonas aeruginosa, Staphylococcus aureus, and Klebsiella pneumoniae. Pneumonia in the Immunocompromised host maybe caused by Pneumocystis carinii, Aspergillus fumigates, and Mycobacterium tuberculosis.Clients at risk of Pneumonia are the elderly, infants, substance abusers, cigarette smokers, postoperative clients or those on prolonged bed rest, clients with chronic illnesses such as Chronic Obstructive Pulmonary Disease, clients with Acquired Immune Deficiency Syndrome, and immunosuppressed clients. Pneumonia is manifested by sudden onset of fever with chills, shortness of breath and chest pain, signs of respiratory distress, cyanosis, fatigability, increased WBC level, and cough with greenish/yellowish sputum or rusty sputum. Diagnosis of pneumonia is made by several diagnostic tests. Chest x-ray is done to detect infiltrates, atelectasis, and consolidation. In aspiration pneumonia, films may be clear initially, but later show consolidation and other abnormalities. Sputum specimens for Gram stain and culture and sensitivity studies detect infectious agent. Arterial blood gas analysis evaluates oxygenation and acid-base status. Blood cultures detect bacteremia. Blood, sputum, and urine samples for immunologic tests detect microbial agents. Laryngoscopy/bronchoscopy determines if airways are blocked by solid material.
The treatment of pneumonia includes certain therapeutic and pharmacologic interventions. Oxygen therapy is used if patient has inadequate gas exchange. Avoid high oxygen concentrations in patients with COPD; use of high oxygen may worsen alveolar ventilation by removing the patient’s remaining ventilator drive. Mechanical ventilation may be necessary if adequate ABG values cannot be maintained. Intercoastal nerve block helps obtain pain relief. In aspiration pneumonia, clear the obstructed airway. Correct hypotension in aspiration pneumonia with fluid volume replacement. Pharmacologic interventions of choice are antimicrobials, cough suppressants, and analgesics.
The nurse must monitor the patient’s vital signs, unusual behaviors and changes in mental status. The nurse must also render supportive care – proper positioning, encouraging the patient to cough, providing suction as needed, proper splinting, encouraging increased fluid intake unless contraindicated, and employing chest wall percussion and postural drainage.
Notably, Pneumonia remains a leading cause of death worldwide. In 2006, it was the eighth-leading cause of death, accounting for about 55,000 deaths. It is estimated that 4 million cases of community-acquired pneumonia occur annually in the United States, of which 20 to 25 percent are severe enough to warrant...