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Nursing - Reply for Casondra, Personal Statement

1. Identify problems from the history. It is assessed that she has a productive cough, fever and general malaise, pain in her chest that is worse upon inspiration, 35 year history of smoking, and living in an assisted living facility. 2. Explain the significance of physical findings. As mentioned above, all of these findings are significant. The sputum being yellow suggests infection and blood tinged makes me think there is significant tissue damage or possibly some fluid in her lungs. The worsening pain on inspiration points towards pleuritis or inflammation within the lung which is also an indication of a respiratory infection. Her body is obviously working hard and not compensating very well as evidenced by her hypertension, tachycardia, tachypnea, fever and low oxygen saturations indicate she is not getting enough oxygen. All of these signs and symptoms paired with lung sounds of rhonchi and crackles indicate pneumonia. 3. Review lab and diagnostic testing. How do the results support the pneumonia diagnosis? Usually in bacterial pneumonia you will see leukocytosis and typically when the white blood cells increase you will also see an increase in neutrophils. Sometimes if it is a severe or fatal form of pneumonia you can see leukocytopenia. You would definitely expect the chest x-ray to show infiltrates in the lower lungs since you heard crackles, rhonchi, and productive cough, low oxygen saturation since those alveoli can’t exchange gases very well. 4. What is the difference between hospital acquired and community acquired pneumonia? Which type of pneumonia does your patient have? In order to have hospital acquired pneumonia the patient would have had to be admitted to the hospital for at least 48 hours and not be incubating at the time of admission. Since this patient was admitted with pneumonia I would have to say she has community acquired. 5. What organisms are likely to be causing the pneumonia? “Streptococcus pneumoniae– the most common cause of acute community-acquired pneumonia; affects all age groups; typically causes lobar pneumonia” (Roberts, 2018). 6. List the various factors, or conditions which predispose Mrs. Davenport to developing pneumonia? Some predisposing factors for this patient is the history of smoking for 35 years, she lives in assisted living, and her age 7. Explain the pathogenesis of pneumococcal pneumonia? The way I understand it is Choline, which is naturally occurring in one’s surfactant, serves as the “lock and key” for pneumococcus to gain access to the cell. Choline also allows multiple proteins to dock on the cell which helps the bacteria survive in the mucosa (Novak & Tuomanen1999). 8. Are there any disadvantages to obtaining a sputum culture and examination of sputum? I don’t believe there are any disadvantages to obtaining a sputum sample from Mrs. Davenport. In fact if may aid with the treatment plan. 9. What antimicrobial agents would you expect the physician to prescribe for this patient? What is the duration of treatment? When might the patient convert from IV to oral antibiotics? “If a Gram stain of sputum at admission shows pneumococci, ceftriaxone is the preferred drug, unless the patient is extremely ill, in which case vancomycin should be added until the susceptibility of the infecting organism is known” (Musher, 2018). As far as the duration goes, from all of the resources I have read it varies. Most however, say 10-14 days total, with about the last 5 days being oral antimicrobials. 10. What are some potential complications of Pneumococcal pneumonia? Some complications of pneumonia are parapneumonic effusions, lung abscess, empyema, and respiratory failure 11. Is prevention of pneumonia possible? There are definitely some things people can do to lessen their chances of getting pneumonia such as getting your influenza and pneumonia vaccines, staying away from sick individuals, good ventilation especially if you are living in a community type living arrangement, keep yourself healthy and practice good hygiene. 12. Choose 1 NANDA for Mrs. Davenport and list your top 3 interventions with rationale. I would choose altered gas exchange as evidence by her low saturations, lung sounds, and chest x-ray. My interventions and rationales for this nursing diagnosis are to Promote airway clearance-making sure the airway is clear will promote optimal gas exchange. I would do this by using chest physiotherapy, incentive spirometer, flutter valve and possibly suction.Encourage coughing and deep breathing- coughing and deep breathing helps open the alveoli and promotes expectoration therefore increasing gas exchange. Administer supplemental oxygen as required- because the alveoli are congested oxygen doesn’t get exchanged very well therefore providing supplemental oxygen with help that gas exchange.
1. Identify problems from the history. It is assessed that she has a productive cough, fever and general malaise, pain in her chest that is worse upon inspiration, 35 year history of smoking, and living in an assisted living facility. 2. Explain the significance of physical findings. As mentioned above, all of these findings are significant.
Assignment ID
795389
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CREATED ON
10 December 2018
COMPLETED ON
11 December 2018
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10 December 2018
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10 December 2018
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11 December 2018
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