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Patient X2, a 70-year-old has recently been diagnosed with “bilateral lower lobe pneumonia”. He has a history of chesty cough and visited a General physician as he has been suffering from a mild fever for the last 4 days. The doctor referred him to the hospital for further care and monitoring for the management of IV antibiotics. The patient had an oxygen saturation level of 92% on 2 litres which was 24% and with a body temperature of 38°C. In addition, the patient had 120/60 mm HG blood pressure with a pulse of 108 beats/minute. Moreover, the rate of respiration was 30 breaths/minute with a productive cough, general pain in the ribs while coughing and whole breathing deeply, along with weakness and dehydration signs has been seen. In this essay, an analytical approach will be taken to demonstrate the pathophysiology of the patient’s condition and A to E assessment reflection on pathophysiology. In addition, a critical discussion will be done on necessary nursing skills as well as the code of practice in nursing. Working in the healthcare industry, it is the responsibility of all healthcare professionals to maintain the privacy and confidentiality of the patients. In the UK, the code of ethics or the professional standards are made by NMC or the “Nursing Midwifery Council” (Nmc, 2018). In the end, a discussion will be done on Nursing and Pharmacological intervention underpinning theories.
The patient has been diagnosed with mild fever, cough, and breathing difficulties, along with low blood pressure. The normal oxygen saturation level or SpO2 is 95% or higher and the patient has an oxygen saturation level of 92%. Lower oxygen saturation or hypoxia or hypoxemia results in where the organs and body tissues do not get enough oxygen (Gokhale et al. 2020). This indicates that the patient has been suffering from any heart disease or lung disorders such as asthma, bronchitis or emphysema which is creating barriers to reaching oxygen to other body parts. The normal blood pressure is 120/80mm Hg Systolic pressure (SP)/Diastolic Pressure (DP); therefore the patient has low blood pressure as well. Hormonal misbalance or lower heart rate or bradycardia may cause lower blood pressure. However, the patient is having 108 beats/minute; whereas the normal pulse rate in human beings is 70 to 100 beats/minute (Sanyal and Nundy, 2018). This indicates due to major stress on the heart or some other problems, the heart needs to beat frequently in order to pump a sufficient amount of blood to maintain the body's functions. On the other hand, the normal respiratory rate in adults is 12-16 breaths/minutes and the old gentleman has a respiratory rate of 30 breaths/minutes. Increased respiratory rate is a common symptom of asthma as in this condition resistance to the airflow gets restricted as the airways get narrowed down. That significantly reduces the delivery of oxygen to the alveoli of the lungs. During acute worsening of this resistance or at the time of asthma attack, the respiratory rate of the patient increased significantly.
The patient had all the symptoms that indicate asthma and following diagnosis, the patient was found to have “bilateral lower lobe pneumonia”. It is considered to be a serious illness caused by a serious infection in the lung causing inflammation and scar. This type of pneumonia affects both the lung and the lower respiratory tract mainly. “Pneumococcus”, “Haemophilus influenzae”, “Group A Streptococcus'', and “Moraxella catarrhalis” are some of the bacteria that cause this pneumonia and also “SARS-COV-2” virus that commonly cause Covid, has been also found to cause Pneumonia as well. It has been found that various viral species colonise the nasopharynx (Garg et al. 2019). Patients who are resistant to these microorganisms due to reduced immunity and inflammation reaction occur in alveoli that produce “exudates”. This interferes with the oxygen diffusion with the C02 band in this condition the WBC relocates into the alveoli in order to fill the vacant spaces. Mucosal oedema is caused and in the lungs there remain some areas which are not ventilated enough to cause partial occlusion of “Bronchus” or the “Alveoli” (Santos et al. 2020). This condition is followed by Hypoventilation and results in the entry of deoxygenated blood to reenter pulmonary circulation via these “under-ventilated areas' ' as well as travel to the left side of the heart without carrying any oxygen or carrying significantly less oxygen. In the end, the oxygenated blood and deoxygenated blood get mixed and result in hypoxia.
In healthcare interventions, the A to E approach is taken in medical emergencies as well as for treating any patient. In this regard, A stands for “The AIrway”, B stands for “Breathing”, C stands for “Circulation”, D stands for “Disability” and E stands for “Exposure”. In an emergency, this approach is widely accepted as it significantly improves the outcome of the patients. This approach can be implemented with or without the use of any equipment. This is the major reason it can be used even at home and in emergency rooms, even in general wards or intensive care units. Other than saving in a life-threatening situation, it also acts as an as well as treatment algorithm. Therefore, in the care and treatment intervention of asthma, various stages are involved and these are clinical assessment, investigation as well as intervention where the problems of the patients are assessed regularly by the nurse or doctors and also the condition is monitored to see the response of the patient to the treatment. According to the findings of (), before proceeding to the ABCDE approach, it is very crucial to note the condition of the patient, particularly the signs and symptoms of airway concession.
The pathophysiology of Pneumonia needs to be considered in this regard such as if there is any blood in the airway due to epistaxis, trauma as well as hematemesis. The intervention is done if there is any soft tissue swelling or Laryngospasm. The nurse or the doctor performs “basic airways manoeuvres” that help to maintain whilst. “Head-tilt chin-lift manoeuvre” is one of the effective strategies in “the Airway” approach that helps in opening the airway of the patient. In addition, “Jaw thrust” can be performed if the patient is presumed to suffer from trauma. “Nasopharyngeal airway (NPA)”, “CPR” etc. are performed (Nice, 2019). Moreover, the nurses check the breathing levels in the patient to check the respiratory rate, and oxygen saturation and also sometimes “Percuss” to check for any association with “pleural effusion” or “lobar collapse” (Eekholm et al. 2020) Chest X-ray is also performed in this stage. According to the case study, the patient was advised 2 litres of oxygen and “Co-amoxiclav” which contains “amoxicillin”. This medicine is a combination of antibiotics and it is used for lung or respiratory tract infections such as pneumonia (Haghdoost, 2019). The medication comes under the intervention of “Breathing” of the A to E approach. Other intervention strategies like a diagnosis of heart rate and blood pressure and blood sugar levels are also checked in the patients (Carter et al. 2020). The nurses check the level of disability such as whether the patient is conscious or not and responding to the treatment. In this way, nursing intervention is performed using the ABCDE approach for treating, caring and supporting patients with pneumonia.
In order to treat any patient who suffers from any respiratory distress due to lung infection such as pneumonia, the nursing priorities include maintaining or improving the respiratory function of the patient as in this case as well, the RR is very high. Improvement in the airway potency, preventing the complications and supporting the patient with adequate nutrition, rest, and medication can help to cure this disease (Grief and Loza, 2018). Therefore the nursing skills that are crucial for improving the potency of the airway include helping the patient in performing the coughing exercises and performing chest physiotherapy in order to loosen the secretion that can interfere with gas exchange (Chaves et al. 2019). Moreover, as the mentioned patient has signs of dehydration, as part of nursing intervention, continuous monitoring is crucial to ensure the patient at least consumes 2 litres of water (Chou et al. 2019). An adequate supply of electrolytes along with nutrient-rich beverages needs to be supplied either by feeding orally or by enteral feeding through Ryle’s tube. Therefore, the nurse needs to have knowledge of putting this tube correctly so that it does not enter the larynx. As part of the code of ethics, the nurses need to fulfil the social, psychological as well as physicals of the patient (Nmc, 2018). In addition, respecting the privacy of the patient is also very crucial and so the nurse can only share the information about the patient with their family members and concerned health care professionals. Patients with pneumonia are quite vulnerable and so it is the duty of the nurse to raise concern if risk gets detected. Moreover, the nurse must not prescribe any medicine to the patient without asking the doctor and if this happens it is considered an unethical practice.
In order to care for this patient, it is very crucial to take the “PCC” approach or “Patient-centred care” approach. Four principles are followed in this approach where the patients are treated with dignity, respect as well as empathy. Another very important aspect is providing coordinated support, care and treatment to the patients (Balfour, 2020). Coordination care significantly enhances the recovery chances and this is particularly important for this patient as he is 70 years old and needs special attention for treating this life-threatening pneumonia. Moreover, personalised care or support is another principle of PCC. The patient needs to manage his heart rate, respiratory rate and hypotension most importantly he has signs of dehydration and all of these together are certainly life-threatening. In this regard, the physiotherapist can perform chest physiotherapy to clear the airway secretion and the dietician and guide on the duet that can ensure speedy recovery of the patient. The role of the doctor here is to prescribe the medication. However, in the PCC the role of the nurse is most significant as she has to continuously monitor the patient, and provide him timely medicines and life-support such as CPR if the situation deteriorates. PCC involves the decision of patients and their family members that assist them to develop their own capacities. In this regard, the role of the nurse is to make the patient understand the rationale of this treatment. As per Torres et al. (2020), “Co-amoxiclav” has been found to be beneficial as it helps to kill the pneumonia-causing bacteria. This is the reason the patient has been prescribed this medication for the treatment of pneumonia.
The main focus of this essay was to capture the key problems of the patient mentioned in the case study and take an analytical approach to discuss underpinned pathophysiology of the patient’s condition and pharmacological intervention. The patient has been suffering from “bilateral lower lobe pneumonia” along with some other associated complications such as hypotension, higher RR, heart rate, dehydration, and chest pain. In this regard, the ABCDE approach has been taken to treat the patient effectively and treat all the conditions. Moreover, the PCC approach has been taken as the underpinned theory for treating the patient. It has been found that patients with pneumonia are quite vulnerable and so it is the duty of the nurse to raise concern if risk gets detected. Moreover, the doctor has prescribed an antibiotic that helps in treating the disease by killing the bacteria. However, it is recommended that instead of treating this disease with antibiotics, bacteriophage therapy can be used as an alternative to this condition. Treating pneumonia with bacteriophage can significantly reduce the complications such as antibiotic resistance or diarrhoea in patients and also improve the chances of complete recovery. Bacteriophage can infect the pneumonia-causing bacteria and kill them and in this way, pneumonia can be treated effectively.
Ncbi, 2021. How are different types of pneumonia classified? Available at: https://www.ncbi.nlm.nih.gov/books/NBK525768/ [Accessed on 24 May 2020]
Nice, 2019. Pneumonia (hospital-acquired): antimicrobial prescribing. Available at: https://www.nice.org.uk/guidance/ng139/chapter/Recommendations [Accessed on 24 May 2020]
Nmc, 2018. The Code. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on 24 May 2020]
Balfour, L., 2020. Implementation and evaluation of a clinical pathway for non-invasive ventilation in critical care: a person-centred practice development approach (Doctoral dissertation, University of Pretoria).
Carter, C., Aedy, H. and Notter, J., 2020. COVID-19 disease: assessment of a critically ill patient. Clinics in Integrated Care, 1, p.100001.
Chaves, G.S., Freitas, D.A., Santino, T.A., Nogueira, P.A.M., Fregonezi, G.A. and Mendonca, K.M., 2019. Chest physiotherapy for pneumonia in children. Cochrane Database of Systematic Reviews, (1).
Chou, C.C., Shen, C.F., Chen, S.J., Chen, H.M., Wang, Y.C., Chang, W.S., Chang, Y.T., Chen, W.Y., Huang, C.Y., Kuo, C.C. and Li, M.C., 2019. Recommendations and guidelines for the treatment of pneumonia in Taiwan. Journal of Microbiology, Immunology and Infection, 52(1), pp.172-199.
Garg, M., Prabhakar, N., Gulati, A., Agarwal, R. and Dhooria, S., 2019. Spectrum of imaging findings in pulmonary infections. Part 1: Bacterial and viral. Polish journal of radiology, 84, p.e205.
Gokhale, Y., Mehta, R., Karnik, N., Kulkarni, U. and Gokhale, S., 2020. Tocilizumab improves survival in patients with persistent hypoxia in severe COVID-19 pneumonia. EClinicalMedicine, 24.
Grief, S.N. and Loza, J.K., 2018. Guidelines for the Evaluation and Treatment of Pneumonia. Primary Care: Clinics in Office Practice, 45(3), pp.485-503.
Haghdoost, M., 2019. Clinical Audit of Nurses in the Prevention of Ventilator-associated Pneumonia. Journal of Nursing Education, 7(5), pp.31-37.
Santos, C., Oliveira, R.C., Serra, P., Baptista, J.P., Sousa, E., Casanova, P., Pimentel, J. and Carvalho, L., 2019. Pathophysiology of acute fibrinous and organizing pneumonia–clinical and morphological spectra. Pathophysiology, 26(3-4), pp.213-217.
Sanyal, S. and Nundy, K.K., 2018. Algorithms for monitoring heart rate and respiratory rate from the video of a user’s face. IEEE Journal of translational engineering in health and medicine, 6, pp.1-11.
Torres, A., Bassetti, M., Welte, T., Rivolo, S., Remak, E., Peral, C., Charbonneau, C., Hammond, J., Ansari, W. and Grau, S., 2020. Economic analysis of ceftaroline fosamil for treating community-acquired pneumonia in Spain. Journal of Medical Economics, 23(2), pp.148-155.
Eekholm, S., Ahlström, G., Kristensson, J. and Lindhardt, T., 2020. Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia: a descriptive cross-sectional study. BMC infectious diseases, 20(1), pp.1-12.
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