Download Pneumonia patient - Allison Morrison

Patient S.T. Pneumonia
Running head: PNEUMONIA CASE STUDY: PATIENT S.T.
Pneumonia Case Study: Patient S.T.
Allison D. Morrison
Oakland University
1
Patient S.T. Pneumonia
2
Pneumonia Case Study: Patient S.T.
The pathology of pneumonia is that of an inflammatory reaction. The causal agent can be
infectious, or an inert physical or chemical stimulus. Included in this latter category is material
that is aspirated. Susceptibility is increased in those who are bedridden for extended periods of
time, malnourished or dehydrated individuals, and in those who are immunocompromised. The
most common cases of pneumonia are noted in adults, particularly elderly persons housed in
nursing homes. Histology of the lung parenchyma will reveal changes in the alveoli, interstitial
spaces and the bronchioles. Irritants activate the immune response and trigger migration of
leukocytes, histiocytes, and the local release of cytokines. Fibrin and fluid collect in the alveoli
to impair gas exchange. Poor oxygenation in the alveoli leads to hypoxemia which will decrease
perfusion of other tissues. As metabolic demand for oxygen unmet, persons will show signs of
tachypnea and tachycardia. If unchecked, this will progress to cardiac dysrhythmia, shock, and
multiple organ failure (Ignatavicius & Workman, 2002).
Patient, S.T., a 90 year old female, arrived in the hospital emergency room after suffering a
choking incident on a piece of peach at a nursing home. The nursing staff rescued her using the
Heimlich maneuver, but felt she needed follow-up examination at the hospital. Chest x-ray
revealed a fracture in the seventh rib, and right lower lung infiltrate. Diagnosis of the assessment
resulted in admission for aspiration pneumonia. Other underlying medical conditions of concern
included Alzheimer’s disease, cerebral vascular accident including right arm paralysis and facial
droop, and hypothyroidism. She was admitted to a medical-surgical unit for general observation.
Medications included intravenous prophylactic antibiotics, anticonjunctivitis antibiotics for
treatment of a nursing home contracted condition, and thyroid hormone therapy. S.T. lacked
dentures and due to a history of eating problems so a soft thickened diet was prescribed.
Patient S.T. Pneumonia
3
After 24 hours, patient S.T. was alert and oriented to person and place, but she was not
ambulatory. She showed no signs of pain from the rib fracture which might have occurred during
the treatment at the nursing home for the aspiration accident. A family member reported that the
patient was ambulatory at the nursing home and would to eat if fed by her loved ones. It was
noted on her chart to check for pocketing of food in her buccal pouch, and that the patient was
combative when given medications. She accepted one-half jar of baby food, and a few spoonfuls
of thickened juice. Medications were crushed. Her vital signs were within normal limits and
intravenous fluids were prescribed to maintain hydration. Laboratory tests did not indicate
bacterial infection but crackles in the right lower lung were recorded on the chart. By the second
day, her mental status deteriorated. Crackle lung sounds progressed to all quadrants alerting the
nurse to possible airway obstruction and increased hypoxia (Zampella, 2003). Mental status also
changed to that of agitation, restlessness, and increased confusion (Simmons & Simmons, 2004),
another indicator of potential respiratory distress. Blood pressure and heart rate increased, and
pulse oximetry dropped significantly. Based upon the dramatic deterioration of her respiratory
status, the physician discontinued the intravenous fluids, prescribed a diuretic, and placed S.T. on
10 liters of oxygen via a non-rebreather mask and ordered stat blood gases. She had to be
restrained to prevent her removal of the mask. Her oxygenation status returned to normal her
vital signs stabilized. The blood gas results showed no abnormalities. To avoid further episodes,
patient S.T. was transferred to a step-down unit for more careful monitoring. With her advanced
age and difficult mental status patient S.T. requires extra care to maintain nutrition, hydration,
and to clear the lung infiltration than what is available in a standard medical surgical unit.
Patient S.T. Pneumonia
4
References
Ignatavicius, D.D., & Workman, M.L. (2002). Medical-Surgical Nursing (4th ed.). Philadelphia:
Saunders.
Simmons, P., & Simmons, M. (2004). Informed nursing practice: the administration of oxygen to
patients with COPD. Medsurg Nursing, 13(2), 82-85.
Zampella, M.A. (2003). COPD: managing flare-ups, RN, 14, 14-22.