Nursing Case Study - Clinical manifestation of pneumonia among older patient

Nursing
Student’s name:
Institutional:

Mr Hunter’s case study
1. Clinical manifestation of pneumonia among older patient
Pneumonia is the most common cause of infectious deaths especially in elderly and under 2
years (Berman et al 2015). It has been found that pneumonia is mainly caused by
microorganisms such as bacteria viruses and fungi. At times it has been seen that disease is
caused because lungs are being affected by bacteria and fungi. Symptoms can be more severe
in elderly as most of them have low immunity. The most common signs and symptoms in
adults above 65 years are chest pains when breathing or coughing, confusion or changes in
mental awareness, cough which may be productive and fatigue. Also fever(38 C), sweating⁰
and chills. Sometimes body temperature can be lower than normal. Furthermore, nausea,
vomiting, diarrhoea and shortness of breath may be present. The abnormal lungs sound like
crackles and rhonchi is another major clinical manifestation that can be considered by nurses.
This is as a result of phlegm secretions. Headache and confusion may also occur due to
decreased oxygen saturation in the brain and build-up of carbon dioxide resulting from
breathing difficulties.
In the given case study, Mr. Hunter has a history of viral influenza. Previously it was reported
that the patient had undergone treatment of oxygen therapy. It was seen that the patient is
suffering from breathing problem along with the discharge of rusty coloured sputum. Thus,
the above-mentioned symptoms will assist the nurse to predict that he is suffering from
pneumonia.
Pathophysiology
2. Discuss the pathophysiology of altered ventilation and diffusion related to pneumonia
The invading microorganisms causes an inflammatory response in the lungs causing the
blood vessel to become leaky and alveoli is filled with protein-rich fluid. This reduces the
surface area for oxygen and carbon dioxide exchange (Ando et al. (2015). This makes the
patient become oxygen deprived hence respond by faster breathing to increase oxygen intake
and increase carbon dioxide exhalation. Also increased mucus secretion in the lungs further
decrease gaseous exchange. Infection leads to increased production of white blood cells. The
fluid and debris from the large white blood cells fill the alveoli decreasing gaseous exchange

ad ventilation. Consolidation occurs when the normally hollow air filled spaces(alveoli)
solidify due to large quantities of fluid and debris. This usually a feature of bacterial
pneumonias. Viral and mycoplasma not result in consolidation. In the given case Mr Hunter
is predicted with pneumonia because the individual is suffering from constant breathlessness
and cough. It has been mentioned that Mr Hunter has already taken oxygen therapy to
increase the flow of oxygen. Even Hudson masks were used to stabilise the condition. In the
study, it has been mentioned that the nurse understood that Mr Hunter was suffering from
Pneumonia is a severe disease that targets lungs resulting in effects on alveoli. Some of the
significant sources of are bacteria and viruses. Primary infections are also caused by normal
flora and inhalation of microbes.
Process information
3. Difference between hospital, community and aspiration pneumonia
As per the viewpoint of Méndez et al. (2014), community-acquired pneumonia occurs outside
healthcare facilities. It is may be caused by bacteria (streptococcus pneumonia), bacteria like
organisms (mycoplasma pneumoniae), fungi and viruses(influenza). The symptoms of
community-acquired pneumonia are fever, sputum production, cough. The concerned disease
can be diagnosed by creating x-ray. It can be said that the concerned disease can be cured by
providing antibiotics.
Contrary to this hospital-based pneumonia can be caused in any age group. The concerned
disease is caused to an individual after coming in contact with the hospitalized patients. As
per the comment of Rogus‐Pulia et al. (2014), an individual who spends more than 72 hours
in a hospital can suffer from hospital-acquired pneumonia because of the hospital-based
organisms. This can be more serious as bacteria causing the pneumonia may be resistant to
antibiotics. Also the people who get are already sick. People on ventilators are at higher risk
of getting this type of pneumonia. The symptoms of hospital-acquired pneumonia are urinary
tract infection, high fever, cough, decreased blood pressure. In addition to this, it has been
observed that a patient suffering from hospital-acquired pneumonia can be treated by
providing antibiotic to them.
Aspiration pneumonia on the other hand is caused by pulmonary aspiration. Pulmonary
pneumonia is caused when an individual inhale, food, stomach acid and saliva in lungs.
Generally, it has been seen that the mentioned materials carry bacteria in lungs causing the

concerned diseases. The symptoms of aspiration pneumonia are Chest pain, shortness of
breath, discolouration of skin, fatigue.
As per the comment of Rogus‐Pulia et al. (2014), the patient aspiration needed to be treated
well to reduce the rate of future complications. Generally, the people who are above 65 are
prone to suffer from the concerned disease. Thus, it can be said that Mr. Hunter may also
suffer from the concerned disease because he is above 65 years of age. According to Jain
(2015), aspiration pneumonia can also cause lung cancer, neurological disorder and
Parkinson’s disease. In order to the diagnosis of aspiration pneumonia, the patient needs to go
for the x-ray to understand the condition of lungs. Even sputum culture needs to be done to
reduce the rate of future complications. Even a patient can be given steroids and vaccine to
treat the concerned disease. At times to recovery, early care receiver is given antibiotics and
injections (Froh & Huether).
Part 2
4. Nursing care required for pneumonia
A patient with pneumonia has some particular needs which a registered nurse should identify
and attend to them in order to ensure that the patient get total care. This needs may vary from
individual to individual and hence the nurse should carefully identify the needs as per the
patient. Nursing care required for Mr hunter include the following;
Ensure effective airway clearance: this can be done through airway suctioning if necessary,
teaching the patient on deep breathing exercise, frequent coughing, nebulization and
elevating the head of the bed. This will help clear secretions from the lungs and hence
enhancing better breathing.
Pain management: the nurse will achieve this through providing comfort (back rubs, position
change), chest splinting techniques during coughing episodes and analgesics administrations.
This will help alleviate pain and hence promoting the patient’s comfort.
Monitor vital signs: the nurse should check Mr Hunters vital signs every four hourly and
report any abnormal changes. Any changes may indicate that the patient is experiencing pain
especially when other reasons have been ruled out

Nutritional management: Identify the cause of reduced appetite and try to eliminate it.
Provide small frequents meals that are preferred by the patient, schedule respiratory treatment
at least one hour before meals to reduce effects of nausea associated with treatment.
Psychosocial support: The nurse should provide adequate psychological support to Mr hunter
through counselling and education. Collaborative management should also be involved. Th
caregiver needs to provide adequate care to the client so, that the feelings of stress get
reduced. Contrary to this it has been noticed that depression and feeling of stress increase the
chance of disease within an individual. In order to keep the patient healthy, the caregiver
needs to treat the user like a family member.
Physical exercise: The caregiver needs to indulge the user in physical exercise because as per
the view of Jain et al. (2015), physical exercise reduces the rate of pneumonia among the
older people. It is said that the nurses need to show particular physical exercise to Mr Hunter
to minimise the risk of Pneumonia.
Judgment
5. Importance of monitoring the heart rate, Oxygen and fever
Heart rate should be monitored at least every 30 minutes to ascertain any abnormalities.
Pneumonia can cause abnormal fast heart rhythms such as atrial fibrillation due to higher
pressures in the blood vessels of the lungs which causes the right side of the hearth to dilate
and this can throw off the hearth electrical system. Stress of being sick can lead to rise in
adrenaline levels increasing heart rate. Also lower oxygen levels in blood due to breathing
problems can also increase heart rate. Too high heart rate of over 100 beats per minute can
lead to heart failure.
Low oxygen saturation below 90% can lead to hypoxia. This can contribute to multiple organ
failure as lack of oxygen in tissue can lead to necrosis. Vital organs such as the brain, kidney
and the liver requires enough oxygen and hence if deprived can easily lead to organ failure.
Temperature above 38.5 C can be life threatening to a patient with pneumonia. Fever is⁰
mainly an indication of infection and hence any rise above the normal should be reported to
the consultant for prompt treatment. Hyperthermia can lead to increased body metabolism
hence increasing energy requirement. Also fluid requirement is increased.

Part 3
6. Strategies to better the health condition of Mr Hunter
First the nurse should explain to the patient the importance using the mask regarding to his
condition and also the outcomes of not using it as required. Mr hunter should also be
encouraged to use the mask as it will help in maintaining effective breathing. If Mr Hunter
still refuses to use the oxygen, involve the relatives to explain to him the implications of his
decision.
Collaborative management should also be involved i.e. the counsellor, doctor, and other
professionals to help manage the situation (Suzuki, 2014). The nurse can change the mode of
oxygen administration by using other methods available in the facility which Mr Hunter is
comfortable with.
The care provider needs to take certain steps to reduce the level of agitation of the individual.
In the case study, it has been mentioned that Mr Hunter is agitated because he is facing
discomfort after wearing the marks. Thus, the nurse needs to undertake specific steps like a
discussion with the user to make him understand the usage of the mask. In addition to this it
can be said that the provider need to discuss with the hierarchy regarding the patient's'
discomfort so, that they can give some other alternative to Hunter (Postma, 2014).
Reflection
7
a) Two Lessons learnt from the scenario
The two lessons that can be learned from the above scenario are as follows:
Holistic development: from the above study it has been seen that the main motive of the care
provider is to develop holistic development of the patient. The patient needs to be engaged in
all procedures and explanations to be made on each procedure to enhance his cooperation
(Marti, 2015). It is needed to be said that an effective communication needs to be set between
the other members of the health centre to develop a family feeling among the service provider
and the client. The level of compatibility needs also to be considered to improve the holistic
development of the user.

Effective treatment: From the case study I have learnt that the service provider needs to give
the best possible treatment to the user so, that they can live a healthy life and reduce the
future risk of the diseases.
b) What actions will you take in your future practice
because of what you have learnedfrom this scenario?
Communication: As a nurse, I need to establish an effective communication system with the
patients so that the individual can freely discuss the problem with me. Even the needs of the
patients are to be met so that the level of satisfaction can be increased.
Knowledge: As a nurse, I need to gain some more knowledge about the disease. For instance,
in this concerned case as a nurse I need gain more knowledge regarding pneumonia so that
effective treatment can be provided to the patient to enhance faster recovery.
Understanding the psychology: As a service provider, I need to be capable enough to
understand the psychology of the patients so, that I can tackle any situation efficiently. As a
nurse, I need to understand the need for the patients to improve the holistic development (as
influenced by Sjögren, 2014)
c) Standard of Nursing
As per the standard of nursing the nurse need to be capable enough to treat the patient
effectively. In addition to this, it has been observed that nurses need to look after the physical
and emotional need of the individual. Effective communication needed to be set between the
patient and nurse so, that the patient can reveal the issues that the individual is facing and the
nurse can solve them (Dang, 2014).
The standards require also that the nurse should be able to monitor and evaluates the patient
progress towards the expected goal or outcome. This should be done accordingly in that the
nurse continuously revise the plan according to the patient response and the evaluation
remarks noted down. The documentation should also be done in a way that it clearly
communicates the priorities, goals and outcomes with the relevant persons (Nursing and
Midwifery Board of Australia (2010))
Lastly, the nurse should be able to think critically in order to achieve quality health care.
He/she should be able to make use of the best devices available in the facility in a way that it

provides safe and quality services. He should also be able to make appropriate decisions
where necessary when providing the care.
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