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Contexts of Practice Health Alteration Case Study

   

Added on  2021-06-16

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Case Study 1CONTEXTS OF PRACTICE: HEALTH ALTERATION CASE STUDYBy (Name)CourseProfessor’s nameUniversity nameCity, StateDate of submission

CASE STUDY 2Assignment1)Mr Hunter is 89 years old. What are the specific considerations a Registered Nurse should understand in relation to the clinical manifestations of pneumonia in the older person?Antimicrobial selection: A registered nurse should understand that for elderly patients(in this case, Mr Hunter) with community-acquired pneumonia, the antimicrobial selection is similar to that of all adults with confirmed community-acquired pneumonia (Williams et al. 2017). So, recommendations for influenza and pneumococcal vaccines in individuals with advanced age are included as part of the recommendations provided on community-acquired pneumonia prevention (Sader et al. 2014). According to Williams et al. (2017),in the United States, of the major causes of demise in the elderly who are above 65 years, community-acquired pneumonia is ranked 5th. A distinct subpopulation of elderly individuals and residents of facilities that offer long-term care are at profoundly lofty level risk of developingpneumonia (Blot et al. 2014). Aetiology: In relation to Mr Hunter's case, a registered nurse should be able to understand the aetiology of pneumonia, in connection with its clinical manifestation in an elderly person. However, Troeger et al. (2017) note that determining the relative significance of different aetiologies of this disease in the older subpopulation is rather challenging. S. pneumoniae is the etiologic agent in approximately 48% of individuals above 60 years of age according to a Finnish study which involved 345 episodes of community-acquired pneumonia. In the same study, C. pneumoniae was responsible for 12% of the cases while M.pneumoniae was detected in 10% of the cases. H. influenza was responsible for 4% of the cases while respiratory viruses were detected in 10% of the cases (Lee et al. 2017). The incidence of pneumonia caused by gram-negative bacteria in the elderly subpopulation is

CASE STUDY 3rather uncertain and, information is scanty for nursing home residents. Usually, the detection of Mycoplasma and Legionella species is infrequent (Song et al. 2016).Risk factors: For pneumonia, according to Zhuge et al. (2018), independent risk factors include alcoholism, immunosuppression, bronchial asthma, heart disease, lung diseaseand advancing age. Other significant factors include difficulty swallowing and being male(Prina et al. 2015).2) Outline the pathophysiology of altered ventilation and diffusion in relation to Mr Hunter's pneumonia.According to Sa et al. (2017), the interrelation between ventilation and diffusion is a balance between oxygen entry into the alveoli and subsequently into blood. Ventilation is the process by which oxygen enters into the air sacks and the exit of carbon dioxide out of the alveoli. Diffusion in itself is the process by which oxygen gets into the blood from the air sacks as co2 replaces it in the alveoli (Sa et al. 2017). Thus, the carbon dioxide and oxygen levels are altered by these two processes. An alteration in these processes arises when there isa change in any of the two takes place (Liu et al. 2016). Sa et al. (2017) contends that there is a little but substantive increase in the degree of ventilation: diffusion mismatch which develops in pneumonia. The cause of this mismatch is unknown but hypothesises have pointed out to interstitial oedema which develops as a result of inflammation of the lung parenchyma, reduced gaseous exchange in large airways, regional differences in the way blood flows in the lungs, pulmonary haemorrhage and airway obstruction (Liu et al. 2016).3) What are the differences between community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and aspiration pneumonia?

CASE STUDY 4HAP: Also, referred to as nosocomial pneumonia. This is pneumonia contracted in thehospital by a patient, at least 48-72 hours after admission (Komiya, Ishii & Kadota). According to Pugh et al. (2015), usually, it is caused by a bacterial infection and hardly by a viral infection. Ewan et al. (2017) note that of all healthcare-associated pneumonia (HCAP), nosocomial infection comes second after urinary tract infections, accounting for 15-20% of the cases. Moreover, HAP is the major cause of demise of the nosocomial infections, particularly in the intensive care units. The signs and symptoms of HAP, particularly for elderly patients include confusion or mental changes, cough with greenish sputum, chills and fever, malaise, nausea, vomiting, lack of appetite, chest pain that is sharp and often getting worse with coughing and deep breathing, dyspnoea, fast heart rate and significant decrease in blood pressure (Ewan et al. 2017). A diagnosis of hospital-acquired pneumonia is based on the clinical presentation and the picture of the patient's x-ray film and, elevated leukocyte count (El-Rabbany et al. 2015). The differential diagnosis for HAP includes atelectasis, pulmonary embolism and congestive heart failure. Regarding its treatment, the initial therapy is usually empirical (El-Rabbany et al. 2015).CAP: This is a type of pneumonia contracted by persons with little or no direct contact with healthcare settings, particularly medical institutions. S. pneumonia is the most common etiologic agent identified with CAP. Other pathogens that are often responsible for CAP include atypical bacteria (M. pneumoniae, C. pneumoniae, Legionella species), H. influenza and viruses (Troeger et al. 2017). The signs and symptoms associated with this typeof pneumonia include a cough, fever, production of sputum, dyspnoea, pleuritic chest pain, tachycardia and tachypnea (Marti & Esperatti 2016).In diagnosing CAP, the patient’s clinicalpresentation and the picture of the patient's x-ray film are important. Antibiotics that have been empirically chosen are used in the treatment of CAP. For relatively healthy or young patients, this type of pneumonia has an excellent prognosis (Marti & Esperatti 2016).

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