October 7, 2010
Hospital Acquired Pneumonia
Hospital acquired pneumonia is currently the second most common nosocomial infection in the United States and is associated with high mortality and morbidity (Seymann, 2008). This paper is a case study of a 52 year old female who was in the hospital for a scheduled gastric bypass surgery. During a post-op test she aspirated dye thus beginning the process of her developing nosocomial pneumonia. The patient was discharged only to return to the emergency department the following day presenting with signs and symptoms of pneumonia. This paper will discuss her diagnosis, treatment, risk factors, nursing care, socioeconomic influences, and diagnostic testing. Primary Medical Diagnosis
Ms. G. was admitted to the hospital with the symptoms of shortness of breath, a low oxygen saturation, tachypnea, tachycardia, anxiety, nausea and vomiting, crackles in both right and left lower lobes of the lungs, pain, a low grade fever and was considered a fall risk. Her diagnosis was pneumonia. Pathophysiology
Pneumonia is an acute inflammation of the lungs that causes the alveoli and bronchioles of the lungs to become clogged with thick exudate (Smeltzer, Bare, Hinkle, & Cheever, 2010). The inflammation can be caused by various organisms, bacteria, fungi, viruses, and mycobacterium. A sputum culture is needed to identify the specific causative organism before antibiotics are started. (Smeltzer, et al). Pneumonia occurs when the upper airway fails to prevent infectious particles, irritants, or aspirated irritants from entering the sterile lower respiratory tract, whether from the patient’s own body such as gastric contents or from outside of the body such as aspirated food or some other fluid that enter the sterile lower respiratory tract (Smeltzer, et al). Because of the thick exudate produced, ventilation of carbon dioxide and diffusion of oxygen are impaired (Smeltzer, et al). White blood cells migrate to the inflamed areas filling the air spaces which in turn cause a ventilation-perfusion mismatch (Smeltzer, et al). Poorly oxygenated venous blood returning from the lungs returns to the left side of the heart and eventually results in arterial hypoxemia (Smeltzer, et al). Risk Factors
Because individuals with hospital-acquired pneumonia usually have underlying illnesses and are exposed to more dangerous bacteria, it tends to be more deadly than community-acquired pneumonia (Seymann, 2008). Those at risk include patients with a compromised immune system, are HIV positive, have been hospitalized for more than two days, reside in a nursing home, have COPD, diabetes, heart failure, are elderly, alcoholics or have other underlying disorders (Smeltzer, et al). Ms. G is a non-insulin dependent diabetic. Her system was compromised when dye was aspirated into her lungs after her gastric bypass surgery. Ms. G was hospitalized for more than 2 days. Stress was also a factor in that it impedes healing. Ms. G was taking Lipitor for high cholesterol and Fragmin to prevent clotting. She also takes Amaryl for her type II diabetes. She was using Nystop powder for a yeast infection under her right breast. She also has a history of duodenal erosions and excessive stomach acid for which she takes prevacid. All of her regular medications indicate that she falls under several risk factor categories. Social, Cultural and Religious Influences
A new report regarding the high death rate due to hospital acquired pneumonia was a an issue that could not be ignored by congress in light of the fact that it was published days before President Barack Obama convened a Health Care Summit in Washington last week (Zigmond, 2010). Publication of the article was a red flag indicating to experts that patient safety is not getting the much needed attention it deserves to help rectify the problem. The report stated that 48,000 died from...