Case Study: Nursing Care for Streptococcal Group A Pneumonia Patients

This case study examines Streptococcal Group A pneumonia in an 80-year-old male, Mr. Cahn, who resides in an aged care facility and presents with pneumonia symptoms after a stroke. The assignment requires a critical appraisal of the current best evidence for nursing care of the older person with pneumonia, including the pathophysiology of the disease, appropriate nursing interventions such as infection control measures (hand hygiene, covering mouth when sneezing, and isolation of personal items), and an evidence-based rationale for these interventions. It emphasizes the importance of monitoring the respiratory system, administering antibiotic therapy, providing patient education, and implementing chemoprophylaxis within the aged care facility. The interventions are supported by evidence-based practices, including the use of patient history, sample collection, and drug administration protocols. The study highlights the need for comprehensive assessment, drug administration knowledge, and adherence to nursing standards to ensure safe and effective patient care, with a focus on preventing the spread of infection and managing the disease effectively, especially in vulnerable populations such as the elderly.

Running head: STREPTOCOCCAL GROUP A PNEUMONIA
1
Streptococcal group A pneumonia
Student’s Name
University

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Streptococcal group A pneumonia
Introduction
Pneumonia is an infection of the lungs and is used as an umbrella for a group of
syndromes caused by a variety of organisms. In most cases, health care professionals classify
pneumonia based on its etiology, clinical settings and the pattern of parenchyma. Streptococcal
group A pneumonia is an infection with group A pneumonia that comprises of the vast majority
of the Lancefield group A streptococci (Pérez-Trallero, Marimón, Larruskain, Alons, &
Ercibengoa, 2011). The infection can spread through direct contact with mucus or sores on the
skin. According to the CDC, these infections cause over 500, 000 per year (Tamayo, Montes,
Vicente, & Pérez-Trallero, 2016). The infections for this disease are common in developing
countries although there are antibiotics.
The pathophysiology of pneumonia
Pneumonia is an infection of the lungs that is caused by different agents in the
environment. It is one of the leading causes of hospitalization. This condition develops from any
infectious organism that reaches the alveoli by evading the body defense mechanisms (Lawrence
& Fulbrook, 2011). These organisms overwhelm the macrophage leading to the production of
fibrin-rich exudate films causing alveolar spaces to stick together rendering them airless. This
inflammatory response results in a proliferation of neutrophils that damage the lung tissue
leading to fibrosis, pulmonary edema, and impairment of lung expansion. The inflammatory
response of the body in the development of a pleural effusion which is seen in about 40% of all
the pneumonia cases (Burkhardt, et al., 2010). When these changes happen in the body, the lungs
experience reduced gaseous exchange and this oxygen deprivation is seen increased respiratory

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and heart rate. Pneumonia can be community-acquired or hospital-acquired. Common acquired
occurs outside hospital settings or healthcare facilities while hospital-acquired pneumonia
develops after one has had a serious illness.
Streptococcus pneumonia can occur on its own or after having a cold or flu. When only
one lobe of the lung is infected, it is called lobar pneumonia. The type of pneumonia that Mr.
Cahn has is caused by Streptococcus pyogenes infections are seen in systemic signs like fever
with chills, myalgia, and loss of appetite. These signs may also vary from mild to severe based
on factors like germ infection, age and even the overall health of the patient (Akuzawa &
Kurabayashi, 2016). The condition can be evaluated through clinical evaluations of the signs and
symptoms and laboratory tests to determine the type of pneumonia and how to treat it. Patients
suffering from Streptococcus pneumonia are reported to have a strep throat that if untreated can
cause serious complications.
The diagnosis for Streptococcus pneumonia starts with a physical exam where the
clinician checks for signs like strep throat followed by rapid antigen test and throat culture.
Rapid antigen tests are based on a swab sample from the throat to detect bacteria (Luján, et al.,
2010). The throat culture test is done on a sample that is obtained through rubbing a swab over
the back throat and tonsils to get secretions and then cultured for checking the presence of
bacteria.
Patients who are long term careers of the bacteria can develop multiple episodes of
infection but are unlikely to spread the infection to others and they have a low risk of developing
complications. According to James, Baucells, Hally, Sánchez, & Aloy (2016), bacteremia is
responsible for 3.3% of cases in children and 0.6% in adults. The risk factors that are associated
with the problem include burns, intravenous drug use, surgery, diabetes, trauma, and cardiac

STREPTOCOCCAL GROUP A PNEUMONIA 4
diseases. In extreme cases, this problem leads to the development of shock is high which is
normally a predictor for mortality (Ovetchkine, Bidet, Minodier, Frere, & Bingen, 2014). Despite
that, there are other complications like acute rheumatic fever, scarlet fever, and sometimes
pediatric autoimmune neuropsychiatric disorder in children.
The nursing interventions that would be appropriate for Mr. Cahn
The first nursing intervention is to reduce the spread of the disease to other patients
within the facility. This calls for cleaning hands properly and also offering prevention advice to
the patient by advising him to cover his mouth when sneezing so that the bacterial pathogens
cannot spread to other patients in the ward (Jain, et al., 2015). Personal items used by the patient
should not be mixed with the rest so that it does not spread. Since the disease is spread through
different modes, the nurse needs to control the infection and ensure that other patients are
protected. According to Freiberg, McIver, & Shirtliff (2014), Streptococcus pneumonia is
common in the elderly people since their immunity is low thus making them susceptible to the
disease. It also leads to other life-threatening complications like low blood pressure and kidney
failure to bacteremia. Thus the nursing intervention should focus on ensuring that there is no
spread to other patients. Since Cahn has been admitted in an aged care facility, the health care
team needs to understand the nature of patients they have and the risk factors that they possess.
Some of the risky medical conditions that make the symptoms worse include, HIV, diabetes,
cancer, heart disease, and heavy drug users. Some medications like a non-steroidal anti-
inflammatory drug (NSAID) are also risk factors that need to be determined so that the patients
can be keenly monitored for advanced signs and symptoms. These conditions can make the
disease fatal leading to death or any other problem.

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Another intervention that is needed is monitoring the respiratory system of the patient to
determine the changes in signs and symptoms being portrayed by the patient and collection of
samples for laboratory test. This entails lung sounds, monitoring the respiratory rate or vital
signs, oxygen saturation and sometimes sputum collection to be used for culture tests (Moore,
Allen, & Mailman, 2019). Pneumonia testing is mostly done through culture to determine the
specific organism that is causing the problem (Tamayo, Montes, Vicente, & Pérez-Trallero,
2016).All these lead to the test of the level of damage that the bacteria has done and the medical
interventions that will be done on the patient.
After the laboratory tests have been done, the nurse should liaise with the doctor for
antibiotic therapy which is supposed to be started immediately to prevent acute rheumatic fever
based on prescription of the doctor. The nurse is supposed to administer the medications as
prescribed by the doctor and ensure that the dosage is followed strictly (Stevens & Bryant,
2017). When administering the medications to the patient, the nurse needs to understand the
allergic reactions of the patient and at the same time monitor vital signs to determine the
response of the patient to the medication. Some patients also have the difficulty following
medication as prescribed which calls for the nurse to monitor the intake closely to increase the
effectiveness of the antibiotic therapy. Further, patients with life-threatening conditions like
Cahn who had a stroke require close monitoring to determine any side effects of the drug that
can increase the side effects of the antibiotics.
Nursing education is also an important intervention to the patient to assist in managing
the condition and even preventing future challenges. Education entails encouraging the patient
on vaccination options that can be used to prevent infection and leading a healthy lifestyle.
Medication support ensures that the bacteria does not develop resistance while lifestyle change

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focusses on limiting exposure to risky patterns of life. The patient needs education when in the
admission ward and during discharge so that he can learn the best way to control future
infections.
Appropriate infection control measures
According to the CDC, the best way to manage Streptococcal group A pneumonia is the
management of the case, contact with the infected patients and maintaining surveillances for
further cases. Long term care facilities have patients who live in one place with limited mobility
and contact with the outside world. This shows that they can easily infect each other at any time,
which calls for the need to manage the condition from within. Patients and people caring for
those infected need to understand that certain underlying illnesses and host factors are associated
with the risk of infection with the disease. Chemoprophylaxis has been widely advised in people
aged 65 years and above since they pose higher risks. The older have weak immune systems and
at the same time have an increased risk of death from the disease due to the nature of their body
as compared to other adult populations (Allen & Moore, 2010). This means that in this case, the
clinician needs to use drugs to ensure that those infected are treated immediately to control the
disease and prevent the spread. Since clustering of asymptomatic carriage is done for all
households, then it means that the whole aged care facility needs to be put on chemoprophylaxis.
The CDC recommends the use of any 1-3 regimens for the treatment of both the infected and the
uninfected to prevent and manage the outbreak within the facility. In the case of the aged care
facility that Mr. Cahn is admitted to, all the aged people need to be treated and informed on how
to watch out for the signs of the disease within thirty days.
The guidelines for chemoprophylaxis require that it is offered only to close contacts of a
confirmed case. Thus in the case of Mr. Cahn, the close contacts are the people in the aged care

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facility who may be sharing a room with him. The level of contact is traced back to seven days
before the infection and 24hrs after the infection to carter for the incubation period. This
medication needs to be administered immediately the disease in diagnosed preferably with 24hrs
to minimize the risk of spread and at the same time ensure that others do not become infected.
Close contact individuals need to be informed of signs and symptoms so that they can seek
immediate medical assistance before the signs become severe. However, the provision of
protocols for chemoprophylaxis vary from territory to territory and thus clinicians need to be
familiar with the local policies. In other cases, the infection can be postpartum or postsurgical
meaning that it develops from a challenged in managing the wound after surgery. Here, the
infection needs an epidemiological investigation by isolating the infected patient from the rest.
An evidence-based rationale for your interventions
The use of evidence based approaches require that nursing practitioners use quality
evidence in diagnosing and determining the problem being faced by patients. This means that the
first nursing standard is applied here where the nurse is supposed to conduct a comprehensive
and holistic assessment. Collection of the samples is important in testing the type of bacteria that
Mr. Cahn is suffering from which will inform the future medications for the patient. Through
collection of culture, the nurse ensures that this is tested to assess the nature of the patient (Al-
Youssif & Mohamed, 2013). Through use of patient history and collection of samples, the
nursing role ensures that the condition of the patient is well understood and documented to
determine the best antibiotic therapy.
Drug administration is one of the roles that nurses are charged with in medical settings.
This means that it is the professional responsibility of the nurse to ensure that they have
knowledge of the drugs to reduce medication errors. This implies that the nurse is supposed to

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use a medication chart in administering the medication so that each drug can be documented to
understand the progress of the therapy. Alexis & Caldwell (2013) adds that the nurse needs to
ensure that the right medication is administed by checking allergies and any reactions that the
patient had with previous medications. According to standard three of the Nurse practitioner
standards for practice by the Nursing & Midwifery Board Australia (2019), the nurse is supposed
to safely and efecteively perform evidence-informed interventions in the management of diseases
and prevention of illness. This implies that the nurse needs to applynevidence based approach in
administering the prescried kedications to the patient at all times.
Patient education is one of the core roles plays by the nurse to admitted patients and
during discharge which ensures that there are improved healthcare outcomes in the hospital.
Preventive care education focusses on assisting the patient to lead a better life that is free from
the risk factors that increase the exposure to bacteria. Since Cahn has previously experienced
stroke, it is important to ensure that he is informed on how to take care of himself and monitor
the changes in the body that relate to pneumonia infection. According to Walsh, Moore, Barber,
& Opsteen (2014) appropriate edcation of patients during hospiatization and discharge ensures
that they are able to follow the medications properly and at the same time increase the ability to
care for themselves. The outcome of this isredued costs which are seen in the ability of patients
to care for themselves and thus increase the health outcomes of the population.
Infection control focusses on putting measures in place to control the spread of the
disease to other patients with care facility. Since Cahn has been admitted in an aged care facility,
the nurse needs to put preventive measures in place to ensure that the disease does not affect
other people. This means that the nurse can also engage in primary care processes that assist
patients in leading a better life and improving the health outcomes. Thus the nurse puts measures

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in place for infection control through educating the patient and administering antibiotics to the
rest of the patients. The case of Streptococcal group A pneumonia is a preventable case that can
be achieved through antibiotic therapy for the infected and uninfected patients.
Conclusion
Streptococcal group A pneumonia infection in the aged populations need to be taken
carefully since they can lead to other severe effects. When such infections are detected with a
clinical or healthcare settings like in the case of Cahn, the first thing that needs to be done is to
carry out tests to determine the problem that the patient is facing. Once the patient has been
tested, antibiotic therapy needs to be started immediately so that the patient can be relieved of the
symptoms. Penicillin is the best drug for the treatment of this problem since it acts immediately
on the bacteria. However, there has been resistance by the bacteria which is the reason why
clindamycin is also prescribed to work together with penicillin to improve its effectiveness. In
some cases, patients who have other life-threatening conditions that can make it difficult for the
patient to respond to medication can be put on Intravenous immune globulin (IVIG) to manage
the symptoms. Thus the success of the treatment is based on intervention and effective control
measures that are used to manage the disease.

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