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Pneumonia: Manual Of Infection Prevention And Control

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Pneumonia: Manual Of Infection Prevention And Control

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Pneumonia: Manual Of Infection Prevention And Control

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Question:
Discuss about the Pneumonia for Manual of Infection Prevention and Control.
 
Answer:
Introduction

Joice is a 76-year-old lady presenting with pneumonia. She has a previous medical history of osteoporosis and a surgical history of hysterectomy. She is allergic to sulphur, and she is currently she is on Atonel and ostelin vitamin D & calcium medication. She has started manifesting signs of having a productive cough, expectorating yellow sputum, being febrile (39.2oC), feeling of coldness, and shortness of breath. These are typical symptoms of pneumonia which affect gaseous exchange in the lungs. The elevated temperature can be linked to an infection in the lungs due to a certain pathogen while the shortness of breath is due to hypoventilation in the lungs due to consolidation (White, Duncan & Baumle, 2012). A productive cough is a sign of a bacterial infection which causes irritation of the mucosa within the tract hence production of secretions by the goblet cells. Nosocomial pneumonia is an infection that usually affects the lower respiratory tract. It occurs when the system is not incubated during the period of patient admission and typically manifests itself few days after hospitalization. Investigations should be done to rule out other diseases such as metastatic lung cancers and pneumonia of radiation origin. Sputum evaluation, complete cell count and bronchoscopy are the major tests done accurately to diagnose the condition Patients under ventilator machines are at risk of contracting the disease (Lippincott, 2012). The occurrence of the condition in the old lady can be linked to her advanced age because her immunity is compromised. Other risk factors for the condition are alcoholism habits, HIV infection, diabetes disease and heart failures.
Anatomy and Physiology
Exchange of gases in the body takes place in the lungs. The upper respiratory tract delivers air into the lungs during inhalation. Lungs are covered by a serous layer referred to as pleura which contains pleural fluid that aids in the smooth motion of the lungs during the process of breathing. Each lung is divided into lobes with several alveoli in them (Marieb, E. N., Hoehn & Hutchinson, 2014)). The alveoli are arranged in clusters facilitating sufficient gaseous exchange. Several factors determine the movement of air in and out of the lungs which include resistance to air flow and compliance of the lungs. The alveoli are highly vascularized to ensure maximum diffusion of the respiratory gases. The alveolar-capillary membrane is very effective in a healthy individual during this process due to its large surface area and its thinness. In a healthy adult, the gases diffuse with no complication due to the concentration gradient created in the capillaries and alveoli. Blood flow through the capillaries is referred to as pulmonary perfusion (Marieb, Hoehn & Hutchinson, 2014). Any deviation from the norm in the process is due to a respiratory disease or anomaly.
 
Microbiology
The laboratory results show an elevated number of white blood cells mainly neutrophils (8×109/L) which should ideally be 2.0×109/L. This is typical of pneumonia infection. The arterial pH (7.0u/l) is lower than the norm (7.35u/l-7.45u/l). This can be attributed to building up of high levels of carbon dioxide as a result of ineffective ventilation (Williams & Hopper, 2012). The levels of calcium are compromised from the usual of 10.0mmol/L.This is due to the advanced age of the patient which causes a decrease in oestrogen levels in the body. Oestrogen is a crucial hormone in calcium synthesis in the body (Fox, 2014)). There is an elevated level of aspartate aminotransferase hormone (39u/l) which is more than the usual value of between 12u/l and 20u/l. This is due to the increase of liver function of detoxification of impurities that build up in the body. The common microorganisms for hospital-acquired pneumonia are s.aureus, p.aeruginosa and enterobacter (Imran, Amjad & Haidri, 2016). It is often associated positive blood cultures. Certain strains of the pathogens are resistant to antimicrobial drugs except for vancomycin (Lippincott, 2012). This can be linked to overuse or misuse of certain antimicrobial agents. A new pulmonary infiltrate on chest x-ray is common. A purulent sputum and bacteraemia are common in affected patients
Pathophysiology
Following exposure of the lungs to a pathogen during the process of inhalation, metastasis of infected haematogenous agents or aspiration, the lower respiratory system gets compromised. The process is aggravated by impaired host defences or the presence of a pre-existing highly virulent organism (Hart, Loeffler & Kent, 2012). Some diseases such as lifestyle illnesses, comorbid conditions, metabolic syndrome and malnutrition put the patient at a greater risk of acquiring the condition. The patient presents with advanced fevers,tachycardia, and pleural effusions. The state alters natural ventilation and diffusion of gases within the lungs. A reaction which brings about inflammation takes place in the lungs resulting in the production of exudates which consequently impairs the normal exchange of gases (White, Duncan & Baumle, 2012). Leucocytes then shift into the alveoli and occupy the air spaces. The ventilation is inhibited due to the increased secretions and oedema from the mucosa which causes occlusion within the bronchi. Patients with a pre-existing airway disease may suffer from bronchospasm due to hypoventilation, poor perfusion results. Blood traversing the pulmonary circulation end up not being oxygenated adequately (Hart, Loeffler & Kent, 2012). This brings about the deficiency of arterial oxygen hence the reduced oxygen saturation in the body of the affected patient.
 
Nursing Consideration for the Patient in Relation to Infection Control
Strict adherence to aseptic technique by nurses and other health care providers during any invasive and non-invasive procedure is essential in order to prevent introduction of microorganisms into the body that may possibly cause nosocomial infection (Damani & Damani, 2012). Therefore, proper sterilisation of any equipment that is to be used in any invasive procedure is crucial. Additionally, disinfection of the hospital environment using a proper disinfectant should be advocated for by the nurse to minimize the chances of microorganisms thriving within the patient’s environment (Moody, Septimus, Hickok, Huang, Platt, Gombosev, Terpstra, Perlin, 2013). Furthermore, health personnel should thoroughly sanitize their hands with an appropriate alcohol based hand rub before and after touching the patient, prior to eating, following visit to a washroom and when the hands are visibly dirty. Sneezing directly into the hands should be discourages, instead a cloth or tissue should be used (Kaye, 2016) in an effort to prevent contact transmission of microorganisms to the susceptible patient. On the other hand, administration of prophylactic antibiotics to the patient should be done to create unfavourable environment for thriving of microorganisms is recommended.
 
The Problem of Ineffective Airway Clearance Related to Productive Sputum/Tracheobronchial Secretions
Intervention and Rationale 
Getting rid of the secretion is a priority measure. This is because any secretion that is retained can consequently affect the efficiency of gaseous exchange besides slowing the recovery process. Intake of water is also necessary for thinning and loosening the secretions. This facilitates easy elimination. Alternatively, a facemask can be used to provide humidification in order to realize the same effect of thinning besides reducing tracheobronchial irritation. A reflexing technique can be employed to initiate coughing if voluntary coughing does not result in complete clearance of sputum .A simple way to of initiating a cough is by the use of an incentive spirometer (Lippincott, 2012). This is necessary for improving the patency of the airway. The patient should be positioned correctly and done unto a deep inspiratory manoeuvre and an explosive expiration.
Chest percussion and postural drainage are beneficial in physiotherapy as it mobilises sputum thus easy elimination. During this procedure, the patient should assume a convenient position and put under a mechanical precursor or manual vibrator so as to drain the secretion contents efficiently. If the patient does not have the energy to cough, nasal tracheal suctioning is advised (Perry, Potter & Ostendorf, 2016). Oxygen therapy should be administered until a satisfactory value (95percent) is achieved. This can be shown by the use of a pulse oximetry or analysis of the arterial blood gas.
 
The Problem of a Risk for Deficient Fluid Volume Related to Fever and Dyspnoea
The nurse should promote fluid intake. This is done by persuading the patient to take a lot of water. When the fluid in the body is deficient, the respiratory rate of the patient increases because of the increased workload brought about by the body’s compensatory mechanism to counter fever and laboured breathing (Williams & Hopper, 2012). A high incidence of respiration leads to an increase in fluid loss from the body during the process of exhalation. This potentially leads to dehydration. Two litres of water per day is advised unless the patient has another condition which contraindicates this measure.
Administration of antipyretics is beneficial in countering fever (Lippincott, 2012).  Non-steroidal anti-inflammatory drugs such as ibuprofen and ketoprofen are recommended. Reduced episodes of fever lessen the amount of water lost from the body through sweating. The patient should be encouraged to assume a comfortable position such as the cardiac position in order to facilitate easy breathing. Heavy exercises should be discouraged until the body’s oxygen saturation is normal. This is due to the excessive need for oxygen by the body due to building up of carbon dioxide on exercising (Montravers, Harpan & Guivarch, 2016).
In conclusion, hospital pneumonia is a lower respiratory system infection that results due to several factors which include reduced immunity, old age and increased exposure to pathogens. For this case, the patient may have been exposed to the bacterial pathogens due to reduced immunity that is associated with old age. With effective monitoring and management nosocomial pneumonia can be treated with antimicrobial therapy. Recognition of the specific pathogen causing the illness is crucial in order to identify the drugs that are active against the bacteria instead of empirical therapy that exposes one to more drug side effects. Additionally, vital signs should be monitored as well as interventions offered to normalize any deviation from the normal ranges. Noting complications and adhering to the current therapeutic regimen is crucial in facilitating early recovery. Misuse of antibiotics should be discouraged as it may result in resistance. If the patient’s condition deteriorates a change of management or referral is advised.
 
References
Damani, N, N & Damani, N, N 2012, Manual of infection prevention and control, Oxford University Press, Oxford
Fox, S, I 2014, Human physiology, McGraw-Hill, Mexico
Hart, M, N, Loeffler, A, G & Kent, T, H 2012, Introduction to human disease: Pathophysiology for health professionals, Jones & Bartlett Learning, Sudbury
Imran, M, Amjad, A. & Haidri, F, R 2016, Frequency of hospital acquired pneumonia and its microbiological etiology in medical intensive care unit, Pakistan Journal of Medical Sciences, 32, 4.
Kaye, K, S, D, S 2016, Infection Prevention and Control in Healthcare, Elsevier, Philadelphia
Lippincott, W, W 2012, Brunner and suddarth’s textbook of medical -surgical nursing, 12th ed. + handbook + prepu, Wolters Kluwer Health, New York
Marieb, E, N, Hoehn, K & Hutchinson, M 2014, Human anatomy & physiology, Pearson, Harlow, Essex
Montravers, P, Harpan, A. & Guivarch, E 2016, Current and Future Considerations for the Treatment of Hospital-Acquired Pneumonia, Advances in Therapy, 33, 2, 151-166.
Moody, J, Septimus, Hickok, J, Huang, S, S, Platt, R., Gombosev, A., Terpstra, L, Perlin, J, B 2013, Infection prevention practices in adult intensive care units in a large community hospital system after implementing strategies to reduce health care-associated, methicillin-resistant Staphylococcus aureus infections, Ajic: American Journal of Infection Control, 41, 2, 126-130.
Perry, A, G, Potter, P, A & Ostendorf, W 2016, Nursing interventions & clinical skills, Elsevier, St. Louis, Missiouri
Williams, L, S & Hopper, P, D 2012, Understanding medical surgical nursing, Davis, Philadelphia
White, L, Duncan, G & Baumle, W 2012, Medical surgical nursing: An integrated approach, Delmar Pub, New York

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