Bacterial Pneumonia Assignment Report

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

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CASE STUDY
The chosen case study is about Jim Cooper , a 69 years old man who had been presented
with a 1week history of productive cough and shortness of breath. The local GP had prescribed
him with an antibiotic. He has been sitting on the chair for the past few nights and had been
finding it to care for himself at home. He had been a local truck driver and had lost his wife
around 18 months ago. Patient had been a smoker in the past and had stopped smoking almost
five years back. Patient is a drinker and had admitted that drinking helped him to calm his
nerves. Jim had admitted that he had been feeling lonely for the past few months.
FIVE HEALTH CARE ISSUES
On thorough physical examination and the arterial blood gas results, five clinical issues has
been identified. The five health care issues are listed below-
 Shortness of breath
As manifested by the symptoms, the patient was experiencing one of the common symptoms of
COPD- shortness of breath. Shortness of breath in the patients can also be manifested his arterial
blood gas results, which shows that his oxidation saturation level is 88%, which is considerably
lower than the normal value (Prina, Ranzani and Torres, 2015.). Patients suffering from a
community acquired pneumonia are likely to suffer from the shortness of breath. In bacterial
pneumonia, due to the colonization of the bacteria in the lungs, the lung alveoli gets
inflammated. Hence the lungs become less elastic impairing the exchange of oxygen in the lungs.
Inflammation of the bronchi causes the passage of airways to be different.

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 Ineffective airway clearance – Airways narrows down due to the inflammation of the
airways and accumulation of excessive mucous in the airways makes airway passage
difficult (Jain, et al., 2015).
 Productive cough- cough is generated in response to the inflammatory response taking
place inside the body.
 GORD- According to Jain, et al., (2015), acid reflux has been found to be linked to
shortness of breath, as the acid from the stomach might creep into the esophagus and can
enter the lungs, especially during the night.
 Hypercholesterolaemia- The cholesterol level of the body needs to be increased, as the
risk of heart diseases increase soon after contracting a community acquired pneumonia.
 Poor skin the turgor- It is evident from the case study that lack of skin turgor has been
found due to dehydration.
The three main health care issues that are within the scope of nursing practice are as addressing
the issue of shortness of breath in the patient, occurrence of productive cough and ineffective
airway clearance.
THREE HIGHEST PRIORITY HEALTH ISSUES
The three priority health issues that has been identified are ineffective patterns of
breathing, production of sputum and ineffective clearance of the airways. The narrowing down
of the airways mainly occurs due to inflammation of the airways and the airway remodeling that
occurs in the airways due to inflammation (Komiya, Ishii and Kadota 2015). Purulent sputum
might contain puss, white blood cells, dead tissue and cellular debris. Addressing shortness of
breath is a challenging tasks, yet is needed by everybody. Shortness of breath has been
associated lower level of functionality and makes certain daily activities of living like eating,

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drinking and grooming difficult. It is again noted that the oxygen saturation of patient is quite
low, which may lead to hypoxia. Again, if the airway clearance s not done properly, it can
expose the lungs to infection. The narrowing of the airways might affect the breathing pattern.
Further damage to airways might cause brnchiestasis.
ROLE OF NURSES IN ADDRESSING THE TOP THREE PRIORITY PATIENT
HEALTH ISSUES
To restore effective breathing pattern
Nurses should assess and record respiratory rate in the patient at an interval of every four hours,
assess the arterial blood gas levels and observe for the breathing patterns. Breathing patterns
needs to be reviewed as this will help to monitor the oxygenation and the ventilation status
(Komiya, Ishii and Kadota 2015). Unusual breathing patterns needs to be observed due to the
fact that the respiratory patterns like Cheyne-stokes respiration is related to bilateral dysfunction
in the diencephalon. Again ataxic breathing is also related to failure of the respiratory points
present in the pons and medulla. Jim should be placed with proper the alignment to maximize the
breathing pattern. A sitting position helps in permitting excursion and expansion of the lungs.
Nurses can encourage sustained deep breaths by using techniques like highlighting slow
inhalation, holding and inspiration for a few seconds and passive escalation (Komiya, Ishii and
Kadota 2015). Nurses can encourage the patient towards diaphragmatic breathing for the
patients. Nurses will maintain a clear airways by encouraging the mobilization of the patient.
Nurses are accountable to stay with the patients during acute respiratory distress and helping
patients to cope up with the daily activities of living like encouraging in small and frequent
meals (Quinn et al.2016). Nurses can teach patients about pursed lip breathing, abdominal
breathing, perforation of relaxation techniques and prescribing medicines, ensuring that an

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accurate dose of medications are taken. Nurses can schedule activities in order to avoid fatigue
and provide enough rest periods.
To manage Productive cough
It is the duty of the nurses assess the effectiveness and the productivity of the cough. This
due to the fact that coughing is the most effective way to remove secretions. Thick and tenacious
ry to au occur in patients. Next, it is necessary to auscultate the lung fields in order to note the
areas where the airflow of the lungs have decreased (Quinn et al.2016). It is necessary to note for
the adventitious breath sounds like the crackles and the wheezes. Accumulation of the
consolidated fluid might decrease the rate of the airflow. Crackles, ronchi and wheezes can be
estimated to find out the intensity of the secretion and airway spasm and obstruction. Nurses
should note the color, odor and the viscosity of the sputum. Jim should be encouraged to do deep
breathing exercises. Proper splinting of chest and effective coughing in the upright position
needs to be taught. Elevation of the bed and changing of the position would help in lowering the
diaphragm (Jonkman et al., 2016). Deep breathing exercises and coughing should be encouraged
as coughing is a self-cleaning mechanism assisting the cilia to patent airways. It assists to
remove most of the secretions. Splinting helps in reducing discomfort Chest and the maintenance
of an elevated position assists coughing more effective (Jonkman et al., 2016). In case of thick
cough, suction can be introduced. It clears the airways in the patient mechanically. Nurses are
should be able to maintain enough hydration by forcing fluids to about 3000mL / day, keeping in
mind any contraindications. This is because of the fact, which warm liquids has been found to
improve expectoration of the secretions and fluid helps in maintaining hydration in the body and
to improve the ciliary action of the body to remove secretions and reducing the viscosity of the
secretions (Faverio et al., 2017). Nurses can teach patients to use nebulizers. Nebulizers

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humidify the airways for thinning out the secretions and facilitating liquefaction and
expectoration of the secretions. Nurses can also taught or help patients in performing other
respiratory physiotherapy like use of the incentive spirometer, postural drainage, percussion.
This is due to the fact that chest percussion helps in loosening up the secretions in the smaller
airways that cannot be removed by suctioning and coughing. Again, incentive spirometry can be
effective to improve deep breathing exercises (Andreassen et al.2017).
Role of nurses in ineffective airway clearance
In order to relax the muscles of the airways, nurses should administer medicines like
mucolytics, expectorants, bronchodilators and analgesics in order to remove the chest discomfort
and pain. Bronchodilator can be given by the nurses in order to improve the efforts in coughing,
but should be used cautiously as it can decrease the efforts of coughing and depress the
respiratory patterns (van der Maaden et al. 2016). Registered nurses can also allow the use of
humidified oxygen as increasing the humidity will reduce the viscosity of the secretions. It is
evident from the arterial blood report of the patient, the oxygen saturation level has been found
to be quite low. The humidifiers has to be used for avoiding bacterial growth (Hollaa et al.,
2017). Oxygen saturation has to be maintained at 90 % or more than that. Patient can be assisted
with bronchoscopy and thoracentesis if it is indicated. Supplemental oxygen can be given to the
patient if required if the need for supplemental oxygen is anticipated. This will helps in provision
of full aeration.
In conclusion, it can be said that three of the most important clinical priority of Jim is
ineffective airway clearance, ineffective breathing patterns and formation of excessive sputum in
the airways. The paper has provided a large number of strategies in order to cope up with the
three clinical priorities. This paper has explained a large number of ways to assist the patients.

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REFERENCES
Andreassen, S.L., Liaaen, E.D., Stenfors, N. and Henriksen, A.H., 2014. Impact of pneumonia on
hospitalizations due to acute exacerbations of COPD. The clinical respiratory journal, 8(1),
pp.93-99.
Faverio, P., Aliberti, S., Bellelli, G., Suigo, G., Lonni, S., Pesci, A., and Restrepo, M. I. 2014.
The management of community-acquired pneumonia in the elderly. European journal of internal
medicine, 25(4), 312-319.
Hollaar, V.R., van der Putten, G.J., van der Maarel-Wierink, C.D., Bronkhorst, E.M., de Swart,
B.J., de Baat, C. and Creugers, N.H., 2017. Nursing home-acquired pneumonia, dysphagia and
associated diseases in nursing home residents: a retrospective, cross-sectional study. Geriatric
Nursing, 38(5), pp.437-441.
Jain, S., Self, W.H., Wunderink, R.G., Fakhran, S., Balk, R., Bramley, A.M., Reed, C., Grijalva,
C.G., Anderson, E.J., Courtney, D.M. and Chappell, J.D., 2015. Community-acquired
pneumonia requiring hospitalization among US adults. New England Journal of Medicine,
373(5), pp.415-427.
Jonkman, N.H., Westland, H., Trappenburg, J.C., Groenwold, R.H., Bischoff, E.W., Bourbeau,
J., Bucknall, C.E., Coultas, D., Effing, T.W., Epton, M.J. and Gallefoss, F., 2016. Do self-
management interventions in COPD patients work and which patients benefit most? An
individual patient data meta-analysis. International journal of chronic obstructive pulmonary
disease, 11, p.2063.
Komiya, K., Ishii, H. and Kadota, J.I., 2015. Healthcare-associated pneumonia and aspiration
pneumonia. Aging and disease, 6(1), p.27.

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Lee, J.S., Giesler, D.L., Gellad, W.F. and Fine, M.J., 2016. Antibiotic therapy for adults
hospitalized with community-acquired pneumonia: a systematic review. Jama, 315(6), pp.593-
602.
Liao, Y.M., Tsai, J.R. and Chou, F.H., 2015. The effectiveness of an oral health care program for
preventing ventilator‐associated pneumonia. Nursing in critical care, 20(2), pp.89-97.
Manabe, T., Teramoto, S., Tamiya, N., Okochi, J., and Hizawa, N. 2015. Risk factors for
aspiration pneumonia in older adults. PloS one, 10(10), e0140060.
Prina, E., Ranzani, O.T. and Torres, A., 2015. Community-acquired pneumonia. The Lancet,
386(9998), pp.1097-1108.
Quinn, B., Baker, D.L., Cohen, S., Stewart, J.L., Lima, C.A. and Parise, C., 2014. Basic nursing
care to prevent nonventilator hospital‐acquired pneumonia. Journal of Nursing Scholarship,
46(1), pp.11-19.
van der Maaden, T., van der Steen, J.T., de Vet, H.C., Hertogh, C.M. and Koopmans, R.T., 2016.
Prospective observations of discomfort, pain, and dyspnea in nursing home residents with
dementia and pneumonia. Journal of the American Medical Directors Association, 17(2),
pp.128-135.