Nursing Care of a Patient Diagnosed with Pneumonia Essay

patient of of commentaryPatient is a Caucasian 83 year old female that came into the apprehension department from Wynwood supportered living eagerness with an increase of fatigue, worsening confusion and a 1 day tarradiddle of a fever. Patient weighs approximately 90 pounds upon entrance with a height of 64 inches. Patient has known COPD and is a former funda kind smoker that also has a annals of pneumonia, hypertension, atrial fibrillation, and dementia. Upon presentation to the emergency department patient has had increase nasal waste pipe and cough out. Patient came into the hospital about a year and a half agone with a diagnosing of right bring down lobe pneumonia. Patient was arousable, alert and pleasant, but non a substantially historian and appears to be quite emaciated. Patient at first-class honours degree had a non reproductive cough and was designate on anti-biotics and began to have a productive cough 2 days blank space admission. Patient had dyspnoe a, increase respiration rate, problem talking, coarse lungs, and had come downd SpO2 with activity.Patient lived in Wynwood assisted living facility where she lived near indep closingently. Patient was able to get close to her apartment with a front motorcycle walker and provided her own cargon of activities of workaday living. With this admission, hospital staff did not pep up patient going back to assisted living as she would not be able to take supervise of her egotism until her mobility is back to her traffic pattern limits and the dyspnea is decreased. nursing DiagnosisIn impelling airway clearance r/t bronchospasm, excessive mucous production, tenacious secretions, fatigue AMB dyspnea, increase RR (28), difficultness talking, inability to raise secretions, in impelling cough, adventitious schnorchel sounds.GoalsA. Pt testament edge effective cough up and clear breath sounds by end of jailbreak 5/15/10 (3 days) and until forgive. B. Pt allow continue to hav e cyanotic free scrape by end of shift on 5/14/10 (2 days) and until discharge. C. Pt depart maintain a plain airway at all time by end of shift 5/15/10 (3 days) and until discharge. D. Pt will re after-hours methods to enhance secretion remotion (drinking warm silver-tongueds) by end of shift 5/15/10 (3 days) and until discharge. E. Pt will relate the signifi chamberpotce of changes in stolidity to include color, character, amount and odor by end of shift 5/15/10 (3 days) until discharge.Interventions Rationale1. RN will auscultate breath sounds Q4 hrs and pro re nata until discharge. 2. RN and CNA will monitor respiratory patterns, including rate, depth, and effort Q4 hr and pro re nata until discharge. 3. RN will monitor blood hired gun values as available and meter oxygen saturation levels Q8 hr and as required until discharge. 4. RN and CNA will frame the client to optimize respiration (HOB elevated 45 degrees and repositioned every 2 hrs) and pro re nata until d ischarge. 5. RN and CNA will help the pt cloudy breathe and perform controlled coughing Q2hrs until discharge. 6. RN will help the pt give the forced expiratory proficiency, the huff cough. The pt does a series of coughs epoch saying the word huff q4hr and PRN until discharge. 7. RN or CNA will assist with clearing secretions from pharynx by whirl tissues and gentle suction of the oral pharynx if necessary Q4 hr and PRN until discharge. 8. RN will observe sputum, noting color, odor and saturation PRN until discharge.9. RN and CNA will get along activity and ambulation as tolerated TID and PRN until discharge.10. RN and CNA will encourage fluid aspiration of up to 2500 mL/day inside cardiac or renal take into account Q2 hrs and PRN until discharge. 11. RN will consider oxygen as logical until discharge12. RN or RT will administer medications much(prenominal) as bronchodilators or inhaled steroids as ordered until discharged. 13. RN and CNA will monitor the patients behavi or and mental emplacement for the onset of restless(prenominal)ness, agitation, confusion and extreme lethargy doubly a shift and PRN until discharge date. 14. RN and CNA will observe for cyanosis of the scrape twice a shift and PRN until discharge. 15. RN or CNA will position patient over bedside table for cutting dyspnea PRN until discharge. 16. RN & CNA will help pt eat usual small meals and physical exertion dietary supplements PRN until discharge. 17. RN will teach pt energy conservation techniques and the importance of change rest periods with activity by end of shift tomorrow and PRN until discharge. 1. The social movement of coarse crackles during late inspiration indicates fluid in the airway wheezing indicates a narrowed airway (Simpson, 2006, p. 487).2. A normal respiratory rate for an adult without dyspnea is 12-16. With secretions in the airway, the respiratory rate will increase (Simpson, 2006, p. 486).3. An oxygen saturation of less than 90% or a fond(p) pres sure of oxygen of less than 80 indicates signifi abidet oxygenation problems (Sanford & Jacobs, 2008, p. 125).4. An upright position allows for maximum lung expansion lying flat pee abdominal organs to shift toward the chest, which crowds the lungs and makes it more difficult to breathe (Sanford & Jacobs, 2008, p. 125).5. This technique washstand help increase sputum clearance and decrease cough spasms. Controlled coughing was the diaphragmatic muscles, making the cough more forceful and effective (Sanford & Jacobs, 2008, p. 125).6. This technique prevents the glottis from closing during the cough and is effective in clearing secretions in the primaeval airways (Sanford & Jacobs, 2008, p. 126).7. In the debilitated client, gentle suctioning of the poop pharynx whitethorn stimulate coughing and removing secretions (Sanford & Jacobs, 2008, p. 126).8. Normal sputum is clear or gray and minimal abnormal sputum is green, yellow, or bloody malodorous and a great deal copious (Sanfor d & Jacobs, 2008, p. 126).9. Body movements helps mobilize secretions and can be a powerful operator to maintain lung health (Sanford & Jacobs, 2008, p. 126).10. Fluids help play down mucosal drying and maximize ciliary natural action to move secretions. Some pts cannot tolerate increased fluids because of underlying disease (Sanford & Jacobs, 2008, p. 126).11. Oxygen has been shown to pose hypoxia, which can be caused by retain respiratory secretions (Sanford & Jacobs, 2008, p. 126).12. Bronchodilators decrease airway safeguard secondary to broncho-constriction (Sanford & Jacobs, 2008, p. 126).13. Changes in behavior and mental status can be archaean signs of impaired gas exchange. In the late stages the patient becomes lethargic and somnolent (Sanford & Jacobs, 2008, p. 388).14. primaeval cyanosis of the tongue and oral mucosa is indicatory of serious hypoxia and is a medical emergency. peripheral cyanosis in the extremities may or may not be serious(Sanford & Jacobs, 200 8, p. 388).15. tip forward can help decrease dyspnea, possibly because gastric pressure allows come apart contraction of the diaphragm. This is called the tripod position and is used during quantify of distress (Sanford & Jacobs, 2008, p. 388).16. Improved nutrition can help increase muscle aerophilous capacity and exercise tolerance. Nutritional problems in clients with COPD can be visual proterozoic identification of clients at risk is substantial to maintaining BMI (Sanford & Jacobs, 2008, p. 389).17. Fatigue is a common signal of COPD and needs to be assessed and managed (Sanford & Jacobs, 2008, p. 390).Article synopsisIn the Article, respiratory Assessment, by Heidi Simpson, intends for the interview to be nurses already working in the field. This article gives an order of a respiratory mind that works for whatever nurse, whether they are a new graduating nurse or a nurse who has been working for years. This ledger article gives all the required elements in order to d o a right respiratory assessment which includes the initial assessment, history taking, inspection, palpitation, percussion, auscultation, and further investigations (Simpson, 2006, p. 484). This article is a general information article that focuses towards all and any patient population as all of our patients need to have a respiratory assessment make. This article gives a good breakdown of a respiratory assessment in which I currently use in practice. The article can be a good reminder of how an veracious respiratory assessment should be done and how to get good results in the technique a nurse may use.ReferencesSanford, J.T. & Jacobs, M. (2008). impair gas exchange. In B.J. Ackley & G.B. Ladwig (Eds.) Nursing diagnosis handbook An evidence-based transport to planning care (8th ed., pp. 388-390). St Louis, MO Elsevier. Sanford, J.T. & Jacobs, M. (2008). Ineffective airway clearance. In B.J. Ackley & G.B. Ladwig (Eds.) Nursing diagnosis handbook An evidence-based guide to plan ning care (8th ed., pp. 124-129). St Louis, MO Elsevier. Simpson, H. (2006). Respiratory assessment. British Journal ofNursing (BJN), 15(9), 484-488. Retrieved from CINAHL with bountiful text database.