NURSING CARE MANAGEMENT 103 RELATED LEARNING EXPERIENCE HEALTH TEACHING

Prepared by: Francisco,Karen Faye Guerrero, Renalyn Lopez, Myra Lopez, Ivy Mayuga, Deniece

Submitted to: Mrs. Nonalyn Andres R.N M.A.N

Reference:
http://www.umm.edu/patiented/articles/who_gets_pneumonia_000064_5.htmhttp://emedicine.medsc ape.com/article/234240-overviewhttp://meded.ucsd.edu/isp/1999/CAP/durat.html

I.

GENERAL AND SPECIFIC OBJECTIVE

General objectives:
This study aims to provide the nurses, future researchers, readers and general audiences to understand, learn and gain more knowledge regarding the case of our patient; that is CAP-MR.

Specific objectives:
To establish rapport with theclient and her family in order to develop therapeutic working relationship and gain trust for obtaining significant information;To discuss the etiology and symptomatology of the disease process; To present the diagnostic examinations and their implications; To present the drug studies of all the prescribed medications with the corresponding nursing responsibilities; To develop appropriate nursing care

II.

INTRODUCTION

You would think that in the light of modern medical treatment and wide availability of antibiotics, pneumonia would no longer kill us, right? Wrong! For adults, this occur mainly as a complication of other chronic diseases like lung cancer, COPD, tuberculosis, and other debilitating illnesses that leave them bedridden most of the time. Community-acquired pneumonia (CAP) is a disease in which individuals who have not recently been hospitalized develop an infection of the lungs (pneumonia). Pneumonia is an inflammation of the lower air passages and air sacs of the lungs resulting from infection of the parenchyma of the lungs.CAP is a common illness and can affect people of all ages. Community-acquired pneumonia (CAP) remains a major cause of death worldwide accounting for an estimated five (5) million deaths per year. In developed countries, the antimicrobial era has brought a 66% reduction

III.

DEFINITION

Community-acquired pneumonia (CAP) is one of the most common infectious diseases addressed by clinicians. CAP is an important cause of mortality and morbidity worldwide. A number of pathogens can give rise to CAP. Typical bacterial pathogens that cause the condition include Streptococcus pneumoniae (penicillin-sensitive and -resistant strains), Haemophilusinfluenzae (ampicillin-sensitive and -resistant strains), and Moraxella catarrhalis (all strains penicillin-resistant). These 3 pathogens account for approximately 85% of CAP cases. CAP is usually acquired via inhalation or aspiration of pulmonary pathogenic organisms into a lung segment or lobe.Less commonly, CAP results from secondary bacteremia from a distant source, such as Escherichia coli urinary tract infection and/or bacteremia.Aspiration pneumonia is the only form of CAP caused by multiple pathogens (eg, aerobic/anaerobic oral organisms).

IV.

INCIDENCES/STATISTICS

Between 5 and 10 million people get pneumonia in the United States each year, and more than 1 million people are hospitalized due to the condition. As a result, pneumonia is the fourth most frequent cause of hospitalizations. Although the majority of pneumonias respond well to treatment, the infection kills 40,000 - 70,000 people each year. Men with community-acquired pneumonia tend to fare worse than women. Men are 30% more likely than women to die from the condition, even if the severity of the illness is the same. Researchers say there may be some genetic reason for the disparity.

Outlook for High-Risk Individuals Hospitalized Patients. The death rate for community-acquired pneumonia can range from less than 5% in mildly ill outpatients to 10 - 30% in patients who need to be admitted to a hospital. If pneumonia develops in patients already hospitalized for other conditions, or those in a nursing home, death rates can be much higher. This is especially true for anyone who is on a ventilator . Older Adults. Community-acquired pneumonia is responsible for 350,000 - 620,000 hospitalizations in the elderly every year. Older adults have lower survival rates than younger people. Even when older individuals recover from CAP, they have higher-than-normal death rates over the next several years. Elderly people who live in nursing homes or who are already sick are at particular risk. Very Young Children. Small children who develop pneumonia and survive are at risk for developing lung problems in adulthood, including chronic obstructive pulmonary disease (COPD). Research sugg ests that men with a history of pneumonia and other respiratory illnesses in childhood are more than twice as likely to die of COPD as those without a history of childhood respiratory disease . Pregnant Women. Pneumonia poses a special hazard for pregnant women, possibly due to changes in a pregnant woman's immune system. This complication can lead to premature labor and increases the risk of death during pregnancy. Patients With An Impaired Immune System. Pneumonia is particularly serious in people with an impaired immune system. This is especially true for AIDS patients, in whom pneumonia causes about half of all deaths. Patients With Serious Medical Conditions. Pneumonia is also very dangerous in people with diabetes, cirrhosis, sickle cell disease, cancer, and in those whose spleen has been removed.

V.

FACTORS

PREDISPOSING

-lifestyle -diet

PRECIPITATING
-sex -age -most probably been precipitated by inhalation of any among the infectious agents causing pneumonia.

Risk Factors for Community-Acquired Pneumonia (CAP) Chronic Lung Disease. Chronic obstructive lung disease (COPD), which includes chronic bronchitis and emphysema, affects 15 million people in the U.S. This condition is a major risk factor for pneumonia. Long-term use of corticosteroid inhalers may increase the risk of pneumonia in COPD patients. Patients with other types of chronic lung diseases, such as bronchiectasis and interstitial lung diseases are also at increased risk for getting pneumonia, and are more likely to have complications. People WithCompromised Immune Systems. People with impaired immune systems are extremely susceptible to pneumonia. It is a common problem in people with HIV and AIDS. A wide variety of organisms, including Myobacterium species, Histoplasmacapsulatum, Coccidioidesimmitis, Aspergillus species, cytomegalovirus, and Toxoplasma gondii, can cause pneumonia. Patients who are on corticosteroids or other medications that suppress the immune system are also prone to infection. Also, drugs that treat gastroesophageal reflux (GERD) may slightly increase one's risk for community-acquired pneumonia. Patients at high risk for pneumonia should take gastric acidsuppressing drugs only when necessary and at the lowest possible dose. This association is strongest with protein pump inhibitors (PPIs) such as Prilosec and Nexium. Reducing levels of germ-killing stomach acid may allow germs to spread in the upper gastrointestinal tract and move into the respiratory tract. The risk posed by these medications is highest in:
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Children Patients with asthma, COPD, and compromised immune systems The elderly

VI.

PATHOPHYSIOLOGY

Inhalation of the infectious agent causes it to transverse thru the upper respire airways.

Damaging toxins are being released and are multiplied within the system downwards causing a
disease called pneumonia or the inflammation and edema of the lungs.

Normal defense mechanisms occur such as the cough reflex, mucocilliary transport, pulmonary macrophage, fever, phagocytosis and increased metabolic demands.

If left untreated, this would result to accumulation of debris , fluids and exudates which consolidates the lung tissues , ending up in alveolar collapse, atelectasis, respiratory distress and a possible death.

Recovery usually involves focal organization of the lung by fibrosis, returning to normal structure and functioning by resolution through early detection and treatment regimen compliance.

VII.

SIGNS AND SYMPTOMS

Symptoms include malaise, cough, dyspnea, and chest pain. Cough typically is productive in older children and adults and dry in infants, young children, and the elderly. Dyspnea usually is mild and

exertional and is rarely present at rest. Chest pain is pleuritic and is adjacent to the infected area. Pneumonia may manifest as upper abdominal pain when lower lobe infection irritates the diaphragm. Symptoms become variable at the extremes of age; infection in infants may manifest as nonspecific irritability and restlessness; in the elderly, as confusion and obtundation. Signs include fever, tachypnea, tachycardia, crackles, bronchial breath sounds, egophony, and dullness to percussion. Signs of pleural effusion may also be present (see Mediastinal and Pleural Disorders: Symptoms and Signs). Nasal flaring, use of accessory muscles, and cyanosis are common in infants. Fever is frequently absent in the elderly. Symptoms and signs were previously thought to differ by type of pathogen, but presentations overlap considerably. In addition, no single symptom or sign is sensitive or specific enough to predict the organism. Symptoms are even similar for noninfective lung diseases such as pulmonary embolism, pulmonary malignancy, and other inflammatory lung diseases.

VIII. DIAGNOSTIC EXAMINATIONS

An important test for pneumonia in unclear situations is a chest x-ray. Chest x-rays can reveal areas of opacity (seen as white) which represent consolidation. Pneumonia is not always seen on x-rays, either because the disease is only in its initial stages, or because it involves a part of the lung not easily seen by x-ray. In some cases, chest CT (computed tomography) can reveal pneumonia that is not seen on chest x-ray. X-rays can be misleading, because other problems, like lung scarring and congestive heart failure, can mimic pneumonia on x-ray.[15] Chest x-rays are also used to evaluate for complications of pneumonia Sputum culture generally take at least two to three days, so they are mainly used to confirm that the infection is sensitive to an antibiotic that has already been started. A blood sample may similarly be cultured to look for bacteria in the blood. Any bacteria identified are then tested to see which antibiotics will be most effective. complete blood count may show a high white blood cell count, indicating the presence of an infection or inflammation. In some people with immune system problems, the white blood cell count may appear deceptively normal. Blood tests may be used to evaluate kidney function (important when prescribing certain antibiotics) or to look for low blood sodium. Low blood sodium in pneumonia is thought to be due to extra anti-diuretic hormone produced when the lungs are diseased (SIADH). Specific blood serology tests for other bacteria (Mycoplasma, Legionella and Chlamydophila) and a urine test for Legionellaantigen are available. Respiratory secretions can also be tested for the presence of viruses such as influenza, respiratory syncytial virus, and adenovirus. Liver function tests should be carried out to test for damage caused by sepsis.

IX.
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MEDICAL MANAGEMENT

Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your

medicine. Do not use any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.
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Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment. Antifungal medicine: This medicine helps kill fungus that can cause illness. Antiviral medicine: Antiviral medicine may be given to fight an infection caused by a germ called a virus. Antibiotics: This medicine is given to fight or prevent an infection caused by bacteria. Always take your antibiotics exactly as ordered by your caregiver. Keep taking this medicine until it is completely gone, even if you feel better. Stopping antibiotics without your caregiver's OK may make the medicine unable to kill all of the germs. Never "save" antibiotics or take leftover antibiotics that were given to you for another illness. Expectorants: Expectorant medicine helps thin your sputum (mucus from the lungs). When sputum is thin, it may be easier for you to cough it up and spit it out. This may make your breathing easier, and may help you get better faster. Fever medicine: This type of medicine is given to help lower your body temperature. Common medicines used to lower temperature include acetaminophen and ibuprofen. Lowering your body temperature may help you feel better. Steroids: Steroid medicine may help to open your air passages so you can breathe easier. Do not stop taking this medicine without your caregiver's OK. Stopping on your own can cause problems.

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X.
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NURSING CARE MANAGEMENT

Deep breathing and coughing: Your caregiver may want you to do deep breathing and coughing. Deep breathing helps to open the air passages in your lungs. Coughing helps to bring up mucus

from your lungs. Sitting up regularly or getting out of bed may help you breathe easier, and help you get better faster.
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Inhalers and nebulizers: Your caregiver may give you one or more inhalers to help you breathe easier and cough up mucus. An inhaler gives your medicine in a mist form so that you can breathe it into your lungs. This type of medicine may also be given using a nebulizer, or "breathing treatment machine". Using inhalers and nebulizers the right way takes practice. Ask your caregiver for more information about using inhalers and nebulizers correctly. Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if you get redness or sores on your skin. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire. Avoid spreading germs: You can decrease your chance of getting lung infections and other illnesses by doing the following:
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Wash your hands often with soap and water. Carry germ-killing hand lotion or gel with you when you leave the house. You can use the lotion or gel to clean your hands when there is no water available. Do not touch your eyes, nose, or mouth unless you have washed your hands first. Always cover your mouth when you cough. It is best to cough into a tissue or your shirtsleeve, rather than into your hand. People around you should also cover their mouths when they cough. Try to avoid people who have a cold or the flu. If you are sick, stay away from others as much as possible.

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Drink plenty of liquids: Men 19 years old and older should drink about 3 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Follow your caregiver's advice if you must limit the amount of liquid you drink. Liquids help thin your mucus, which may make it easier for you to cough it up. While you are sick, do not drink alcohol. Alcohol is found in beers, wines, vodkas, whiskeys, and other adult drinks.

Vaccines: Ask your caregiver if you should get vaccinated against the flu or pneumonia. The best time to get a flu shot is in October or November. You should get a flu shot every

year. The pneumonia shot is given to adults aged 65 years or older. People aged 19 to 64 years and at high risk for pneumococcal disease should also get the pneumonia shot. If you are 19 to 64 years old and get the pneumonia shot, you may need a second shot 5 years later. Ask your caregiver which vaccinations are right for you.
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Quit smoking: Do not smoke, and do not allow others to smoke around you. Smoking increases your risk of lung infections and CAP. Smoking also makes it harder for you to get better after having a lung infection. Talk to your caregiver if you need help to quit smoking. Rest: You may feel like resting more. Slowly start to do more each day. Rest when you feel it is needed.

XI.

HOME EDUCATION/ DISCHARGE PLANS

CONTACT A CAREGIVER IF:

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You are urinating less, or not at all. You cannot eat or have loss of appetite, nausea (upset stomach), or vomiting (throwing up). Your cough comes back, does not go away, or you begin to cough up blood. You feel very tired or weak, or are sleeping more than usual. You have fever and chills. Your heart or pulse beats more than 100 times in one minute. SEEK CARE IMMEDIATELY IF:

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You are confused and cannot think clearly. You have increased trouble breathing, or your breathing seems faster than normal. Your symptoms do not get better, or get worse.