Elisabeth Fandrich

10/13/08

511, C, K

Pneumonia

Pneumonia is inflammation of the lower airways. It can be caused by a variety of organisms (e.g., bacteria, viruses, parasites, irritating agents, aspirated food/fluids). The inflammation results in increased mucus production and thickening alveolar fluid.

Prognosis is highly dependent on patient’s age, preexisting lung disease, infecting organism and response to antibiotics. 511, C, K is a 60 year old patient whose admitting diagnosis was pneumonia but who had a large array of coexisting disease processes. The prognosis of this patient is more difficult to estimate as there are so many factors involved. The patient has a history of Addison’s disease, CAD, CHF, A-Fib, pacemaker, MI, HTN, DM, hyperlipidemia, stroke, bipolar disorder, seizure disorder, COPD, dilated cardiomyopathy, cholecystitis with recent cholecystectomy, chronic constipation, delirium, GERD, hypothyroidism, recurrent pneumonias, pulmonary HTN, edema, peripheral neuropathy, chronic anticoagulation, and Barrett esophagitis.

Symptoms of pneumonia can include shortness of breath, dyspnea, fever, chills, cough, crackles, rhonchi, discolored (possible bloody) sputum, tachycardia, tachypnea, pain with respiration, headache, muscle aches, joint pains and nausea. 511, C, K presented to the ED with weakness, confusion and nausea which started several days previous to presenting at the ED. The patient also stated that she had not produced a BM in 10 days. The patient’s abdomen was distended and firm indicating possible obstruction. When I assessed the patient, I noted coarse crackles bilaterally, a grossly distended abdomen which was firm. The patient displayed generalized weakness, tremors in both hands, expressive aphasia, confusion, pallor and cool extremities.

A chest x-ray showed general appearance of congestive failure or pulmonary edema with a possible bibasilar pneumonia and cardiomegaly with a pacemaker. The patient has a slightly elevated WBC on admission (10.51) and even more so with the most recent lab (11.64) indicating an infective process. The patient is also taking many medications that influence nearly every lab test performed.

Common treatments for pneumonia include the use of supplemental oxygen (to help meet the body’s needs), antibiotics, bronchodilators, fluid intake increase (contraindicated for this patient due to CHF), and encouraging the patient to perform coughing and deep breathing exercises as well as incentive spirometry.

Pneumonia Elisabeth Fandrich 1

Treatments for this patient seemed unfocused and broad. Many medications prescribed have serious interactions with each other (see drug cards). The patient was weak and confused but compliant with requests. Her speech was clear, but expressive aphasia was apparent.

The patient was receiving bronchodilator treatments, but not specifically for pneumonia (history of COPD), the patient was also receiving a broad spectrum anti-biotic, but no sputum had been cultured.

The most concerning signs for me with this patient were the apparent breathing difficulties (airway clearance, gas exchange), the inadequate perfusion related to CHF and the likely (but undiagnosed) bowel obstruction.

References:

Medical-Surgical nursing DeMystified

Mary DiGiulio, RN, MSN, APRN, BC

Donna Jackson, RN, MSN, APRN, BC

Jim Keogh

Introduction to Medical-Surgical Nursing

Linton

Pneumonia Elisabeth Fandrich 2