Management of Acute Bronchopneumonia in the First 24 Hours
Harry Ware, 45 years old man visits the hospital with chest pain, cough complains. The doctor admits him to the ward immediately, where he is diagnosed with acute bronchopneumonia. The essay is about the medical and nursing management of Maria’s condition in the next 24hours. The nurse will reassure Harry and gain his consent to do history taking. The nurse will choose her words carefully to ensure that the patient’s dignity is maintained during all nursing process phases. The patient will be put in a comfortable and private environment to ensure privacy. The nurse then will reassure Harry and gain informed consent to perform a physical examination on him. The nurse will inform him about the outcome, then position him and thank him.
Bronchopneumonia is a pneumonia subtype. It is an acute inflammation of the bronchi, followed by swollen patches in the lungs. It is frequently compared with lobar pneumonia; Bronchopneumonia (lobular) often contributes to lobar pneumonia as the infection progresses. (Mattila et al., 2014, p. 2) Pneumonia is a lung infection that is caused by a microbial organism. ‘Pneumonitis’ is of a more general term. It defines an inflammatory process in the lung tissue that may predispose a patient to, or put a patient at risk of microbial invasion. Pneumonia is one of the common causes of death in the United States. It is the seventh leading cause of death in the United States in all ages and both sexes, resulting in nearly 70,000 deaths each year. (Cheever and Hinkle, 2014, pg. 531)
The process assessment of pneumonia should be accurate, as there are many respiratory problems with similar manifestations. (Belleza, 2018, p. 3)
- History taking should be made mainly on a recent infection of the respiratory tract.
- Physical exam: respiration per minute, and the sound of the breath is measured during the physical exam.
- Chest with x-rays should be done to identify structural distribution abnormalities. Chest x-rays can be clear in mycoplasma pneumonia.
- Fibreoptic bronchoscopy. Can both be diagnosed (qualitative culture)
- Pulse oximetry; to identify abnormalities depending on the extent of lung involvement and underlying lung disease.
- Sputum and blood cultures may be done to identify the causative organism. (Belleza, R.N., 2018, p. 5)
The medical management will be secondary prevention. It includes:
- Hydration is essential in the protocol because fever can lead to an insensible loss of fluid.
- Administration of antipyretics to reduce fever and headache.
- The nurse may administer antitussives to prevent related coughs.
- Total bed rest is recommended until there is less evidence of infection.
- Administration oxygen in case hypoxemia occurs.
- Pulse oxymetry to assess oxygen levels and measure the efficacy of the treatment. (Mattila et al., 2014, p. 4)
- Aggressive respiratory intervention. Other steps include the use of high doses of oxygen and mechanical ventilation.
Nursing assessment is key to the diagnosis of pneumonia. The nurse should be tracking the following:
- Temperature and pulse shifts
- The color, amount, and smell of the secretions
- Frequency of cough
- Degree of shortness of breath
- Changes in findings of physical assessment (primarily assessed inspecting and auscultating the chest)
- Changes in the x-ray findings (Mattila et al., 2014, p. 3)
Also, it is vital to assess the elderly for;
Unusual behavior, altered mental state, dehydration, excessive tiredness, fatigue, and cardiac failure.
Depending on the assessment outcome, the nursing diagnosis of Mr. Ware can include:
- Inadequate clearance of airways due to secretions in the lungs.
- Intolerance of activity related to impaired lung function.
- Risk of low fluid volume associated with fever and dyspnea.
- Inadequate nutrition for the body requirements of the body.
- Inadequate understanding of care protocol and preventive health requirements (Belleza, R.N., 2018, p. 5).
Nursing interventions include:
- Semi-Fowler’s position. Mr. Ware should be placed in a relaxed position to facilitate rest and breathing and regularly shift positions to increase secretion clearance and pulmonary ventilation and perfusion.
- Improving airway patency by removing the secretions is necessary because the secretions interfere with gas exchange and can slow recovery. The nurse supports hydration (1.5 to 3 L / day) because adequate hydration loosens the lung’s secretions. Secretions should be eliminated because they interfere with the respiration and can delay recovery. Humidification can also loosen up the secretions.
- Physiotherapy of the chest is critical as it mobilizes secretions.
- The nurse will administer electrolyte fluids and nutrients to maintain the nutrition of the patient.
- Patients and families are advised on the cause of pneumonia, the treatment of pneumonia symptoms, and the need for follow-up. (Cheever and Hinkle, 2014, p. 533)
The predicted outcomes of Harry Ware after the nursing management include the following:
- Demonstrates improved airway capacity.
- Maintains enough hydration.
- Consume adequate food intake.
- State reasons for management methods.
- Shows no complications (Belleza, R.N., 2018, p. 5).
- Complies with medication protocols and prevention methods.
- When the patient’s condition improves, administer oral antibiotics as directed by the physician, and teach the proper patient administration and possible side effects. Encourage the patient to do breathing exercises to help in secretion clearance. Smoking cessation is encouraged because it irritates the mucous membrane. On discharge, the patient should be informed that strict compliance with follow-up tests is necessary to verify the most recent chest x-ray or physical examination findings.