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Reply for Shenay, week 3

1. Identify problems from the history. -- Patient has developed a productive cough consisting of thick yellow and blood-tinged sputum. She has a fever, feels fatigued and is experiencing pain with inspiration. These symptoms combined tell me she has an infection going on. The patient also has a very extensive smoking history, which makes her more susceptible to respiratory infections. 2. Explain the significance of physical findings. -- Her blood pressure and heart rate are elevated, which tells me she is having pain with her breathing. Her respirations are also abnormal which tells me that she is working hard to breath (labored). She does have a high fever, which shows she has an infection (the yellow and blood-tinged sputum also show that). Her oxygen level is low and shows that her issue is respiratory related. Her diminished breath sounds mean that there is air or fluid around her lungs. The rhonchi and crackles also mean there are secretions in the airway. Clubbing on the fingertips lets me know that there is something lung related going on. Typically, I think of lung cancer when I see clubbing, but I also know many other lung issues, such as pneumonia, can cause it. 3. Review lab and diagnostic testing.  How do the results support the pneumonia diagnosis? – The normal WBC range for an adult female is 4,500-11,000 and her WBC count is 18,000, which lets me know right away that there is an infection going on. Typically, a WBC count greater than 15,000 means some type of bacterial infection is the source. Her differential count, which is a breakdown of the different types of white blood cells shows that her neutrophils are normal, bands are elevated and that her lymphocytes are decreased. The increased band neutrophils and decreased lymphocytes (which is called lymphocytopenia) both mean there is an infection going on in the body. These labs support a pneumonia diagnosis because they all show that there is an infection going on. The labs along with the physical symptoms show me that her diagnosis is pneumonia. 4. What is the difference between hospital acquired and community acquired pneumonia? Hospital acquired pneumonia is pneumonia that is contracted by a patient within 48-72 hours of admission. Community acquired pneumonia is often caused by the streptococcus pneumonia bacteria and the associate is admitted into the hospital because of it. Which type of pneumonia does your patient have? – My patient has community acquired pneumonia also known as health care associated pneumonia because she lives in an assisted living facility. 5. What organisms are likely to be causing the pneumonia? – The pneumonia is most likely being caused by a bacterial infection. This type of bacteria is known as Streptococcus. According to the American Lung Association, the most common type of pneumonia is pneumococcal pneumonia, which affects over 900,000 Americans yearly. 6. List the various factors, or conditions, which predispose Mrs. Davenport to developing pneumonia? -- The patient recently stopped smoking after 35 years. She more than likely already has some respiratory issues going on because of the smoking, which makes her more susceptible to the pneumonia. She also has clubbing noted on the fingertips which means there is some type of lung issue going on. 7. Explain the pathogenesis of pneumococcal pneumonia? -- Developing pneumonia means that the pathogen reaches the alveoli and then the host defenses are overwhelmed. The bacteria then enter the lower respiratory tract. Choline is a major component in surfactant. When choline is incorporated into the cell wall it binds the bacteria to the receptor, which is a gateway for invasion. 8. Are there any disadvantages to obtaining a sputum culture and examination of sputum? – The only disadvantage I can think of with obtaining a sputum culture would be not getting enough for the sample. Since normally when we cough the saliva comes from our mouth the patient would be required to deep cough and bring the sample up from the lungs. 9. What antimicrobial agents would you expect the physician to prescribe for this patient? –Broad spectrum antibiotics would be prescribed until the sensitivity of the bacteria is known so a more targeted treatment can be determined. What is the duration of treatment?  Most patients with mild to moderate pneumonia will be treated with antibiotics for a course of five to seven days. When might the patient convert from IV to oral antibiotics? – It is recommended that patients be afebrile for approximately 48-72 hours and have no more than one unstable symptom before converting from IV to oral antibiotics. 10. What are some potential complications of Pneumococcal pneumonia? – Some potential complications could be bacteremia, which is when bacteria enter the bloodstream and spreads to vital organs, difficulty breathing, and fluid accumulation in the lungs. 11. Is prevention of pneumonia possible? – Yes! Prevention is possible. Vaccines are available to prevent some types of pneumonia. The CDC recommends a pneumonia vaccination for all babies and children younger than 2 and adults 65 and older. 12.  Choose 1 NANDA for Mrs. Davenport and list your top 3 interventions with rationale. – Ineffective airway clearance related to productive cough consisting of think, yellow sputum as evidenced by increased respirations and abnormal breath sounds. Interventions/Rationales • Assess rate and depth of respirations- Tachypnea and shallow respirations are frequently present due to discomfort or fluid in the lungs. • Elevate head of bed and change position frequently- Doing this will allow for chest expansion, which can promote lung secretions to be coughed up. • Force fluids to at least 2,000 mL/day- Fluids will help to break up thick secretions so patient is able to cough them up. References American Lung Association ®. (n.d.). Retrieved December 13, 2018, from https://www.lung.org/ Pneumonia. (2018, October 22). Retrieved December 13, 2018, from https://www.cdc.gov/pneumonia/index.html Novak, R., & Tuomanen, E. (1999, September). Pathogenesis of pneumococcal pneumonia. Retrieved December 13, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/10501308
1. Identify problems from the history. -- Patient has developed a productive cough consisting of thick yellow and blood-tinged sputum. She has a fever, feels fatigued and is experiencing pain with inspiration. These symptoms combined tell me she has an infection going on. The patient also has a very extensive smoking history, which makes her more susceptible to respiratory infections. 2.
Assignment ID
795387
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CREATED ON
10 December 2018
COMPLETED ON
11 December 2018
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10 December 2018
User posted an order for Nursing
10 December 2018
13 writers responded and offered to do the job for a price between $70 and $85
10 December 2018
User contacted writer Letmehelp
10 December 2018
User hired writer Letmehelp
11 December 2018
Writer completed order Reply for Shenay, week 3 for 1 day, meeting the deadline
11 December 2018
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11 December 2018
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