Assignment on Pneumonia PDF
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Added on 2021-04-16
Assignment on Pneumonia PDF
Added on 2021-04-16
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Critical Care 1CRITICAL CAREby [NAME]CourseProfessor’s NameInstitutionLocation of InstitutionDate
Critical Care 2A Patient with PneumoniaQuestion 1Pneumonia is a disease caused by infections of the lungs as a result of bacterial or viral attacks. It causes a consolidation and collapse of the lungs thus interfering with respiration in patients. Anyone is at risk of suffering from pneumonia but the elderly and young children are more susceptible to this disease due to a weaker immune system (Ruuskanen et a., 2011, p. 1266). The symptoms of pneumonia among the elderly depend on their overall health and functional status. In the case study provided, we are told of the condition of Mr. Hunter who is an 89-year old man. There are specific considerations that a registered nurse must understand regarding the clinical manifestations of pneumonia among the elderly like in Mr. Hunter’s case. Below, we will discuss some of these considerations.It is important to note that the lungs and the nerves that connect to the lungs among the elderly are not always very reactive and responsive. The lungs are therefore weak and less sensitive thus making them more susceptible to pneumonia (Saguil and Fargo, 2012, p. 355). From the scenario presented, we are informed that Mr. Hunter has developed hypoxemia. The compliance of the chest wall progressively reduces as one gets older. The airway may start closing at small volumes due to a loss of the supporting tissues that surround the airways. As a result, the patient suffers a progressive decline in the volume of saturation of oxygen which may cause hypoxemia. It is also important to note that aging causes the inflexibility of the lungs thus leading to acollapse of the air sacks responsible for oxygenation. This is especially more common among theelderly suffering from pneumonia, as is the case of Mr. Hunter (Sue Eisenstadt, 2010, p. 18). The
Critical Care 3result is a development of a shortness of breath a condition known as dyspnea. Additionally, the elderly like the patient in our scenario have increased morbidity and mortality. This combined with his condition of pneumonia increases the risks of developing cachexia which can be described as unintentionally losing weight (Marrie, Bartlett and Thorner, 2013). Furthermore, due to the worsening situation of his chronic obstructive airways disease, he develops tachypnea as the body attempts to compensate for the low oxygen concentration that is said to be only 82%.The pleuritic pain that he develops is as a result of deep breathing and coughing. Due to the infection of the lungs as a result of pneumonia, his sputum becomes purulent which can be characterized by a color similar to rust. Question 2Pneumococcal pneumonia is a major cause of respiratory failure among the elderly thus causing several deaths if the situation is not addressed. The respiratory failure exists in two formsthat are the ventilatory failure and hypoxemic respiratory failure. The mechanical changes of the lungs due to pneumonia are the major causes of ventilatory failure. An inflammatory reaction normally takes place in the alveoli thus producing an exudate that fills alveoli (Wagner and West, 2012, p. 219). This filling, however, happens at a functional residual capacity that is slightly less than normal thus leading to a reduction in the volume of functional residual capacity. As a result, the total lung compliance is reduced and the work of breathing is increased hence interfering with ventilation and diffusion (West, 2012, p. 73). Additionally, the white blood cells migrate and fill the alveoli. Studies have further revealed that secretions and mucosal edema associated with pneumococcal pneumonia cause a partial occlusion of the alveoli and bronchi and thus the areas of the lungs are not adequately ventilated. The result is that the oxygen tension of the alveoli is
Critical Care 4reduced. This further reduces the dynamic compliance of the remaining ventilated lung which thus increases the work of breathing as shown by Mr. Hunter’s low saturation of oxygen. Additionally, the patient becomes breathless and tachypneic accompanied with an increase in thepleuritic pain during inspiration. A mismatch between ventilation and perfusion during the later stages of pneumococcal pneumonia causes hypoxemia as is evidenced by the scenario provided in our case study. The perfusion-ventilation mismatch occurs due to hypoventilation in the affected areas of the lungs (Petersson and Glenny, 2014). As a result, the venous blood that enters into the pulmonary circulation travels through the area of the lung that is under-ventilated and comes out poorly oxygenated via the left side of the heart. This mixing that occurs between oxygenated and poorlyoxygenated blood eventually lead to hypoxemia (Petersson and Glenny, 2014). Another factor that causes hypoxemia in pneumococcal pneumonia is the persistent pulmonary blood flow to theconsolidated lung. This persistence in the flow results from the failure of the mechanism of hypoxic pulmonary vasoconstriction. This, according to Hough (2013), affects the diffusion of oxygen from the alveoli to the blood (p. 8).Question 3Hospital-Acquired PneumoniaA patient develops hospital-acquired pneumonia within 48 hours of admission to the hospital. It is mostly caused by micro-aspiration of bacteria that attack the upper airways in the critically ill patients. It can also be caused by inhalation of aerosols that contain influenza virus or Aspergillus sp (Barbier et al., 2013, p. 217). Overall, the greatest risk factor for hospital-associated pneumonia is an endotracheal intubation that is combined with mechanical
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