What major outcomes do you expect to achieve for this patient?
In the case of Mr. Z, the major outcomes expected are improved ventilation and oxygenation of tissues, normal ABGs, optimal gas exchange, absence of respiratory distress, and prevention of severe complications. (Eshwara et al., 2020)
What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
Due to increased respiratory rate of 40 breaths per minute, multilobar infiltrates, and COPD, severe community-acquired pneumonia (SCAP) and systemic infection would be imminent if left untreated. Antibiotic therapy specific to addressing streptococcus pneumoniae must be initiated immediately as well as oxygen therapy appropriate for comorbidity of chronic obstructive pulmonary disease (COPD). Fluid resuscitation should be used if systolic pressure is less than 90 mmHg or diastolic below 60 mmHg. Frequent reassessment should be done to evaluate present treatment modalities and to detect changes in current condition. (Eshwara et al., 2020; Metlay et al., 2019)
What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?
Until symptoms of respiratory distress subside, patient should be on continuous monitoring of vital signs and oxygen therapy. Additionally, fall precautions should be implemented and bed rest encouraged (Pneumonia in Adults, 2019). Nicotine replacement therapy and in-patient counseling should be considered as symptoms of severe tobacco withdrawal may become evident during hospitalization (Wolfenden et al., 2003).
What possible learning needs do you anticipate for this patient?
The patient should be educated on how COPD and smoking can contribute and exacerbate community-acquired pneumonia. The typical course of expected improvement once discharged should also be discussed so that the patient understands that it may be several months until pneumonia symptoms resolve. Once eligible, the patient should be educated on the benefits of the pneumococcal vaccine. (Norris, 2018; Pneumonia in Adults, 2019)
What cultural and age-related factors may have a bearing on the patient’s plan of care?
According to Cunha, risk factors for severe pneumonia increase with age due to pathologic changes in the immune system and lungs. Elderly patients have decreased mucociliary function and impaired B-lymphocyte function which leave them more susceptible to infections with encapsulated pathogens like streptococcus pneumoniae (2001). It is also important to assess Mr. Z’s attitude and belief system as it relates to implementing lifestyle changes like smoking cessation (Narayan, 2003).
2. What major outcomes do you expect to achieve for this patient?
Mr.Z clinical presentation indicates a systemic inflammatory response. The major outcomes that would be expected would be a return to stable vital signs, absence of fever and normalization of the arterial blood gas. The work of breathing will return to normal which should help the anxiety and agitation. The patient would return to baseline function and be able to perform activities of daily living without complications. Once respiratory status improves Mr.Z will be able tolerate food intake without any gastrointestinal complications.
What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
