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

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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

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