Pneumonia

 Pneumonia

Mr. Jeremia Jere a miner at from Konkola Coppermine Plc is admitted to your medical ward with history a of dry cough and chest pains. On examination, a diagnosis of lobar pneumonia is made.

State five (5) other signs and symptoms of lobar pneumonia other than those mentioned above 15%

Mention five (5) causes of pneumonia 10%

Describe the management of Mr. Jere while in hospital till discharge 50%

Explain five (5) complications of pneumonia. 25%

SOLUTIONS/ ANSWERS.

a) State five (5) other signs and symptoms of lobar pneumonia.

Nasal flaring due to poor ventilation and labored breathing

Dyspnea due to poor ventilation as a result of inflammation in the lung

Cyanosis due to hypoxia

Chest pains (stabbing in nature) due to inflammation in the lung and pleura

Fever due to the presence of the infection and infection

Intercostals retraction due to impaired ventilation

Haemoptysis due to rapture of blood vessels

Nausea and vomiting due to gastrointestinal tract involvement and disturbance

Headache due to cerebral hypoxia resulting from inadequate air intake

General body malaise due to tissue hypoxia

Anorexia due to the inflammatory process general effects of the infection process

Joint or muscle pains due to tissue hypoxia

b) Mention five (5) causes of pneumonia

Chronic bronchitis

Viral infections such as measles which affects the respiratory tract and also reduces the immunity

Inhalation of foreign material into the respiratory tract which later descends into the lower respiratory tract causing pneumonia

Obstruction of the respiratory tract by growths e.g. cancer which leads to retention of fluids and secretions in the lung tissue this fluid eventually becomes infected

Prolonged to cold which irritate the respiratory tract and reduces the ability of cilia to expel the foreign bodies including micro organisms. This raises the risk of micro organisms invading the respiratory tract

Describe the management of Mr. Jere while in hospital till discharge. (50%)

Aims;

To relieve dyspnoea

To promote quick recovery

To prevent septicemia

INVESTIGATIONS at least 5 for 5%

History from the patient may reveal stabbing chest pain made worse by deep breathing or cough

On auscultation there will be reduced air entry and crackling sound (rales) in the affected lung.

On percussion there will be dullness on the affected side due to consolidation of the underlying lung

Sputum for microscopy culture and sensitivity will demonstrate the causative agent and the specific drug to be used.

White blood cell count will show elevated leukocyte count.

Blood culture can show the causative agent if bactraemia is present

Computerized tomography will show pneumonia even where chest X ray can not

Chest X ray will show areas of opacity( seen as white patches)

TREATMENT 10% for route, dose, frequency, s/e, nursing/implications

Bacterial infection give antibiotics e.g. Crystalline penicillin

Analgesics and antipyretics like panadol

Oxygen therapy to counteract hypoxia

If the infection was fungal anti fungal have to be used e.g. Fluconazole 100mg bd 7-14 days

Broncho dilators e.g. ventolin 2-4mg tid

NURSING CARE

Environment

Patient will be nursed in a well ventilated room to prevent other respiratory tract infection

Patient will be nursed in a well lit room for easy observation and for orientation to time and place

Patient will be nursed in a general ward but reverse barrier nursing will be used to prevent acquisition of nosocomial infections

Will include the oxygen giving apparatus for use because patient is dyspnic

I will include the drip stand in the room for IVI when need arises

Position

Patient will be nursed in fowlers position to promote lung expansion and relieve dyspnea

I will change the patient’s position two hourly to prevent development of pressure sores

As the condition improves I will let the patient adopt any position of comfort to promote rest

Rest

I will nurse the patient in a quiet room to promote rest

I will play the radio at low volume to promote rest

I will answer all phone calls promptly to prevent disturbing the patient there by promote rest

I will do related procedures in blocks to promote rest

I will administer prescribed analgesics in order to promote rest

I will ensure that squeaking trolleys a oiled to prevent noise and there by promote rest

Observations

I will do vital sign and BP to act as the base line data in order to know if the condition is improving or deteriorating

I will observe for cyanosis if improving or getting worse and give oxygen therapy when necessary

I will observe for dyspnoea if present will prop up the patient to promote lung expansion and there by relieve dyspnoea

I will observe the pressure area to detect on set of pressure sore development

I will observe the sputum for colour amount and consistency to detect Haemoptysis and report the physician

I will observe the patient’s facial expressions to detect pain and administer prescribed analgesics like paracetamol and observe the action and side effects

I will observe the feeding pattern of my patient and take measures like giving small frequent meals to promote appetite

I will observe the respirations to detect tachycardia and report accordingly

Psychological care

I will explain the disease process in order to raise the knowledge levels and thereby alley anxiety

I will encourage the patient to ask question and I will answer accordingly those I cannot answer I will refer to the physician

I will explain all procedures to my patient in order to allay anxiety

I will involve a successfully managed case to come and talk to my patient in order to allow the patient ask pressing question and get answer this will improve the patients outlook on his condition

I will involve the loved ones in his care in order for him not to feel neglected.

I will provide diversional therapy in order to shift the patient’s mind from the hospital routine and his condition

I will involve him in planning his own care in order for him not to feel left out

I will explain to him that as the health care team we are doing everything possible to ensure that he get better in order to promote co-operation.

Hygiene

I will encourage the patient to take plunge baths in order to remove dead epithelium and promote comfort

I will do hair care to promote self esteem and also prevent pediculosis

I will do nail care to prevent auto infection

I will do mouth care to prevent halitosis

Any soiled linen and clothes will be changed to promote comfort

Elimination

I will provide a lot of fluids and roughage to prevent constipation

I will prove copious fluids in order to promote renal wash out and there by prevent renal problems

I will offer a bed pan if he is confined to bed to ensure bowel movement

Nutrition

I will provide energy giving foods like nshima to provide the energy needed for the metabolic processes

I will provide protein foods like fish and beans to promote replacement of worn out tissues

Vegetables and fruits will be provided to raise the immunity and promote skin and mucous membrane integrity

I will provide a lot of oral fluids to prevent dehydration due to excessive sweating and promote bringing up of phlegm

I will serve small frequent meals to promote appetite

I will allow visitors to bring food preferred by the patient in order to promote appetite

I will do regular mouth washes in order to promote appetite

Exercises

If my patient is confined to bed i will do passive exercises like limb movement and massage in order to prevent muscle atrophy and promote blood circulation

I will encourage the patient to do deep breathing exercises in order to promote lung expansion

I will encourage early ambulation as soon as the condition permits in order to prevent deep vein thrombosis and other complications of immobility

Medication

I will administer prescribed analgesic like paracetamol at the right time to promote rest

I will give prescribed antibiotics like X-pen to promote quick recovery

I will ensure that the drugs are swallowed in my presence to promote recovery.

I.EC.

I will educate the patient about his condition in order to create awareness and prevent recurrence of the condition

I will explain the need for taking the medication in order to promote compliance

I will educate the patient about the sign and symptoms of the condition for early diagnosis and treatment thereby preventing complications

I will talk to the patient about the need to take a balanced diet using locally available foods in order to boost the immunity

I will educate the patient about the need to keep the review dates so that his progress is monitored to ensure full recovery

I will advise the patient to avoid smocking to prevent continued irritation of the air way thereby preventing recurrence of the condition.

I will advise my patient to keep warm in order to prevent asthmatic attacks

d)Explain five (5) complications of pneumonia

Bronchiectasis

Empyema

Septicaemia

Empyema

Pleural effusion