NURS1005A Case Study: Nursing Care for Hospital-Acquired Pneumonia

This case study focuses on a 78-year-old patient presenting with hospital-acquired pneumonia, emphasizing the nursing considerations, important health issues, and nursing interventions required for effective care. The study identifies ineffective airway clearance and impaired gas exchange as primary health concerns. Nursing interventions include assessing respiratory depth and chest movements, auscultating lung fields, elevating the head of the bed, administering medications like mucolytics and bronchodilators, and performing suction to clear airways. For impaired gas exchange, interventions involve monitoring respiratory rates, skin color, mucous membranes, nail beds, temperature, and heart rate, alongside providing patient comfort. The case study underscores the importance of preventing cross-contamination and sterilizing breathing devices to ensure timely patient recovery from this potentially fatal condition. References to relevant research articles are provided to support the nursing interventions and rationale.

CASE STUDY ON HOSPITAL ACQUIRED PNEUMONIA
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Hospital acquired pneumonia
INTRODUCTION
Hospital acquired pneumonia is an acute infection of the lower respiratory system and it is often
acquired 48 hours after a patient is admitted at the hospital. The key signs and symptoms include
dyspnea, productive cough and fever (Kalil et al., 2016, p. 2) .It is also associated with chest
pains and diminished resonance. In this assignment, there is a case study who presented with the
condition. She was 78 years old and the notable sign and symptom on assessment was the
difficulties in breathing. In this assignment, the nursing considerations, the important health
issues in the case study and the nursing interventions for the problem will be highlighted.
NURSING CONSIDERATION
To prevent further infections, the nurses should ensure appropriate disinfection or sterilization of
respiratory therapy devices using absolute alcohol .The nurse should also ensure that the patient
reduce aspirations and finally prevent cross contamination through the hands of the healthcare
workers.
IMPORTANT HEALTH ISSUES
In this case study, there were two important health issues identified .Since the patient said that
she cannot breathe well, the two likely health problems include ineffective airway clearance and
impaired gas change. There is need for necessary nursing interventions therefore to achieve the
desired outcome for the two problems.

NURSING INTERVENTIONS
Ineffective airway clearance is the inability by the patient to clear secretions and obstructions
from the respiratory tract so that the airway is clear. This health problem is shown by dyspnea or
cyanosis (Kesinger et al., 2015, p. 398). The desired objective in this problem is to enable the
patient exhibit a patent airway with clear sounds of breathing. Another goal is to clear dyspnea
and cyanosis.
The nurse should assess the depth of the respirations as well as the chest movements. The nurse
should also auscultate the lung fields while noting the areas with decreased airflow as well as
crackles or wheezes(Lacy et al., 2015, p. 98) .The rationale for this nursing intervention to
establish if there is fluid accumulations so that they can be removed by use of medications. This
is because reduced airflow is as a result of areas that have consolidated fluids. This can also be
accompanied by bronchial breath sounds, crackles or rhonchi and wheezes especially on
inspiration.
Elevating the head of the bed and changing the position of the patient frequently is another
important nursing intervention (Pugh, Grant, Cooke, & Dempsey, 2015, p. 2).The rationale for
this nursing intervention is to lower the diaphragm and this will allow expansion of the chest that
will lead to aeration of the lungs and this will mobilize the expectoration of the accumulated
secretions.
The nurse should also administer medications such as mucolytic, expectorants and the
bronchodilators. The rationale for this intervention is to reduce the bronchospasm and mobilize
the secretions (Sandrock & Shorr, 2015, p. 3). Analgesics can also be used to improve the cough

efforts. Suction is also an important nursing intervention. The rationale for this nursing
intervention is to stimulate coughs so that the patient can clear the airways.
For impaired gas exchange, the nursing intervention involves assessing the respiratory rates, the
depth and ease of breathing. The rationale for this nursing intervention is to estimate the degree
of lung involvement as well as the underlying general health status. This is because respiratory
distress depend on the degree of lung involvement.
The nurse is supposed to monitor the color of the skin and mucous membranes and the nail beds.
The rationale for this nursing intervention is to monitor or check for cyanosis (Sopena et al.,
2014, p. 39). Cyanosis in the nail beds indicate vasoconstriction while cyanosis of mucous
membranes and earlobes indicate systemic hypoxemia.
The nurse should monitor the temperature, heart rate and rhythm and aid the patient by providing
comfort. The objective of this intervention is to reduce fever which arise due to bacterial
infection especially pneumonia and influenza since it increases the metabolic rates and the
oxygen requirements of the cells.
CONCLUSION
Hospital acquired pneumonia is an airborne infection that take place at least 48 hours after
admission to the hospital. The major symptoms include dyspnea fever and productive cough. The
nursing consideration is to ensure that there is no cross contamination by the hands of the
healthcare workers and sterilization of breathing devices. The nursing problems associated with
this condition include impaired gas exchange and ineffective airway clearance that is due to
accumulation of fluids in the airways .The nursing interventions basically involves
administration of medicines such as mucolytic, monitoring cyanosis and placing the patient in a

position with elevated head so as to lower the diaphragm and expand the chest to allow effective
breathing. This condition is sometimes fatal and the nurses should therefore work ensure to
ensure the patient recovers on time.

References
Kalil, A. C., Metersky, M. L., Klompas, M., Muscedere, J., Sweeney, D. A., Palmer, L. B., …
Brozek, J. L. (2016). Management of Adults With Hospital-acquired and Ventilator-associated
Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and
the American Thoracic Society. Clinical Infectious Diseases, 63(5), e61-e111.
doi:10.1093/cid/ciw353
Kesinger, M. R., Kumar, R. G., Wagner, A. K., Puyana, J. C., Peitzman, A. P., Billiar, T. R., &
Sperry, J. L. (2015). Hospital-acquired pneumonia is an independent predictor of poor global
outcome in severe traumatic brain injury up to 5 years after discharge. Journal of Trauma and
Acute Care Surgery, 78(2), 396-402. doi:10.1097/ta.0000000000000526
Lacy, M. K., Stryjewski, M. E., Wang, W., Hardin, T. C., Nogid, B., Luke, D. R., …
Barriere, S. L. (2015). Telavancin Hospital-Acquired Pneumonia Trials: Impact of Gram-
Negative Infections and Inadequate Gram-Negative Coverage on Clinical Efficacy and All-
Cause Mortality. Clinical Infectious Diseases, 61(suppl 2), S87-S93. doi:10.1093/cid/civ536
Pugh, R., Grant, C., Cooke, R. P., & Dempsey, G. (2015). Short-course versus prolonged-course
antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database of
Systematic Reviews. doi:10.1002/14651858.cd007577.pub3
Sandrock, C. E., & Shorr, A. F. (2015). The Role of Telavancin in Hospital-Acquired Pneumonia
and Ventilator-Associated Pneumonia. Clinical Infectious Diseases, 61(suppl 2), S79-S86.
doi:10.1093/cid/civ535
Sopena, N., Heras, E., Casas, I., Bechini, J., Guasch, I., Pedro-Botet, M. L., … Sabrià, M.
(2014). Risk factors for hospital-acquired pneumonia outside the intensive care unit: A case-

control study. American Journal of Infection Control, 42(1), 38-42.
doi:10.1016/j.ajic.2013.06.021