Question:

Edward Hunter is a 89-year-old widower who was admitted to your hospital 5 days ago. He has hypoxaemia (oxygen saturations 82% by ambulance) as well a bacterial chest infection.

He has been receiving intensive home nursing support for more than six months. This includes home oxygen treatment.

He had an episode of unstable angina, and a myocardial ischemia one month prior.

In 2007, he was fitted with a coronary catheter.

His condition is continuing to deteriorate.

He is currently receiving 15 litres oxygen through the nonrebreather Mask.

A severe form of dyspnoea has rendered him immobile and unable eat.

He is a bit sluggish, and has very little appetite.

His cough, breathlessness, pain and discomfort at night make him restless and disturbed.

His symptoms were aggravated by inspiration and he had been experiencing pleuritic pain.

The palliative team reviewed Mr. Hunter 4 days ago because he was experiencing more pleuritic pain during inspiration.

1.Discuss common fears, myths, and barriers to health-care professionals offering pain management services to patients

2. Discuss the importance of recognizing an opiate-naive patients.

Discuss how the nurse can reduce the chance of adverse effects due to the administration of opiate drugs in an opiate-naive person experiencing acute pain.

3.The fundamental principles of social Justice in a Health Care context include self-determination. Equity,access and rights. Participation.

Discuss how you interpret Mr. Hunter’s actions in withholding the prescribed pain medication (nocte) by the nurse. What are the implications for social justice principles?

Answer to Question: NUR231 Evidence Based Nursing Research

Streptococcal pneumonia is the main cause of pneumonia in elderly people.

The RN should pay special attention to the patient’s acute care and, after the significant improvement, patient teaching.

Mr. Hunter needs a Registered Nurse (RN). The RN should focus on the following: improving the airway integrity, providing rest to preserve energy, maintaining proper nutrition, fluid balance, and helping to prevent any further complications.

A Registered Nurse (RN) would place importance on the maintenance and improvement in the respiratory function. He would also support the recuperative process and examine for signs such as pleuritic and breathing problems, cough, tachypnoea, and breathlessness.

Tacthypnoea is a condition that causes a patient to have difficulty breathing. Nursing considerations include improving the patient’s ability to breathe.

He is also suffering from pleuritic pain due to inspiration.

A patient suffering from pneumococcal bronchitis may have sputum with rust color. This is an indication of the condition.

The patient’s nutrition and risk of infection should be considered. This will help reduce the likelihood of infection and further complications.

It is also important to consider the respiratory status after every four hour to avoid any hypoxemia or change in breathing (Tabloski, 2013).

Patients with pneumococcal lung disease will have altered ventilation and diffused symptoms.

The patient has altered ventilation if there is obstruction of airflow into and out of their lungs.

This is due to two main mechanisms.

There is a compression or narrowing of the airways, and also disruption of the neuronal transmittings required to stimulate airways mechanics.

The alveoli in the lower part of the respiratory system are responsible for gaseous exchange.

This happens because of bacteria that has been accumulated around the endotracheal tube or tracheostomy. It causes ineffective breathing and a blockage in the airway.

There is a blockage of the mechanical airflow from the lungs to the outside and inside of the membrane. This causes impairment in the diffusion and movement of the gases through the membrane each minute.

Reduced efficiency in gas exchange occurs when there is compression or narrowing the airways. This results in shortness and decreased lung expansion (Masoumi-et al. 2016).

The diffusion process involves oxygen and carbon dioxide being exchanged at the alveolar junctions. These junctions are dependent on the partial tensions of the carbon dioxide and oxygen.

The oxygenation status can be determined by the movement between gases in plasma, alveoli, and red blood cell depending on the partial pressures.

Because Mr. Hunter has pneumonia, this means that there is less space for oxygen exchange at the alveolar-capillary junction.

Because of pneumonia, oxygen cannot get into the cells and carbon dioxide can’t get out through the body’s lungs. This is where the exchange happens at the Alveolar Capillary Junction.

Patients with pneumonia are at risk of hypoxemia (Sachdeva, 2016).

Hospital-acquired pneumonia (HAP), also known by nosocomial, is caused when any patient is admitted to a hospital and is exposed to pneumonia (only bacteria).

It can be spread by the patient or staff who are unable to understand the source of the infection.

This is unlike community-acquired or untreated pneumonia, in which the patient is isolated from the healthcare system.

HAP patients either stay in long-term facilities or make frequent hospital visits. Common bacteria that cause HAP are Staphylococcus aureus, P. aeruginosa, including the methicillin-resistant S aureus (MRSA), methicillin-susceptible S aureus (MSSA) and Klebsiella pneumonia.

It is caused by bacteria, not viruses (Lin. 2015).

CAP is the most widespread type of pneumonia that can be caused by bacteria, viruses, or parasites.

CAP can be caused by Haemophilus Influenza, Streptococcus Pneumonia, atypical bacteria like Mycoplasma pneumonia and Chlamydia pneumonia as well as Legionella sp.

HAP and Cap differ in that they are caused by bacteria and viruses, according to Behnia et.al. 2014).

Aspiration pneumonia happens when an individual inhales food or saliva into the lungs.

When there is a weakness in defense or if the aspiration contents contain bacteria that can cause pneumonia, it is called aspiration pneumonia.

Impairment in coughing can cause the inability to cough out foreign matter. This causes the lungs to retain the foreign material.

It is generally caused by bacteria that usually reside in the nasal pharynx and oral pharynx.

Haemophilus flu, Streptococcus asthma, and Staphylococcus aureus, are gram-negative bacteria that can cause pneumonia.

This inoculum usually represents aspiration pneumonia. 2016).

Mr. Hunter has pneumonia. A nursing plan is in place to help him with his hypoxemia and impaired ventilation.Nursing care for

ArgumentsIneffective airway clearance

It’s used to remove any secretions in the respiratory tract that could be causing pleuritic symptoms.

It will also aid in the expansion of the lungs and improve your breathing.

It would be beneficial in reducing secretions and promoting aeration.Impaired gaseous exchange

It is performed to replenish the excess or deficit of carbon dioxide or oxygenation removal that occurs at alveolar capillary membrane when the patient suffers from dyspnoea and hypoxia (Butcher et. al. 2013).Adequate nutrition

To increase metabolism.

This can help maintain the body’s weight while increasing appetite.

It will also replenish any nutrients lost by the patient to compensate for hypermetabolic condition.

Drinking insufficient fluid

This would allow you to maintain good skin turgor as well as stable vital signs, capillary recharge, and moist mucous Membrane.

Fluid loss can occur due to hyperventilation and mouth breathing.

Warm fluids could also be beneficial in mobilizing the secretions and expectoration.

Acute pain

Persistent coughing, as well as potential tissue damage, can lead to pleuritic discomfort.

A pain management program would be able to control and relieve the pain by increasing activity tolerance, relaxing and getting proper sleep (Torres, et al. 2015).

Activity intolerance

The inability to use the physiological energy necessary for a desired activity because of the imbalance between demand and supply of oxygen.

The purpose of this exercise is to increase the patient’s tolerance to the activity.Risk for infection

It is used to treat the infection and eliminate secondary complications.

It would also improve the primary defenses and increase the ciliary actions and respiratory secretions.

It also boosts secondary defenses to decrease immunosuppression and fight existing infections (Sopena et. al. 2014).

Ineffective breathing technique

Reduced gaseous exchange, hyperventilation and ventilation can improve ventilation.

It’s used for dyspnea relief, to improve oxygenation and shortness-of-breath, and to restore normal breathing.

It is also beneficial in healthy gaseous interchange and increased absorption for the patient (Lewis and al. 2014).

It is imperative to monitor Mr. Hunter’s heart rate, oxygen saturation and temperature as he has pneumococcal fever.

Low oxygen levels cause pneumonia and increase heart rate, causing abnormal rhythms and tachycardia.

The heart’s ability to send electrical signals is made possible by the high pressure in its blood vessels.

A lung infection can increase the heart rate.

The ineffective breathing pattern leads to low oxygen levels which can cause rapid heart beta.

Pneumonia may cause atrial fibrillation. In this case, there is irregular heart rhythms.

Monitoring the heart rate is essential to restore a regular rhythm in pneumonia (Ooi/Wu 2014).

Pneumonia is known for its characteristic symptoms, such as fever or elevated body temperature.

It is vital to monitor the body temperature of a pneumonia patient.

There is a bacterial and viral infection. Fever is an adaptive reaction to infection.

The development of pathogens within the respiratory system is evident by an increase in body temperature and the inability to neutralize them.

The body attempts to kill the infection by increasing the body temperature. This causes pneumonia symptoms such as fever and elevation.

The body’s attempts to fight fever infection is reflected in inflammation in the lungs or in the alveoli (McCaughey 2014).

The oxygen saturation levels should be monitored as pneumonia can cause a decrease in the blood’s availability of oxygen. Therefore, timely monitoring is essential.

Also, there is a decline in breathing ability. It is therefore important to keep oxygen saturation levels above 92% so that external oxygen supplementation is not required.

The oxygen saturation level should be monitored as low oxygen levels can indicate that there are low oxygen levels in blood.

Inflammation can cause the air sacs in the lungs to become more elastic, which causes them to not be able absorb oxygen into their bloodstream.

As a result, pneumonia is most commonly characterized by shortness and difficulty breathing.

It is vital to ensure that oxygen saturation levels are at least 92% for patients suffering from pneumonia. Lower oxygen saturation is linked to mortality and morbidity (Ochoa Gondar et.al. 2014).

If a patient refuses nursing care, it’s important that nurses provide the necessary information so that the patient can accept the procedure.

It is possible to convince Mr. Hunter to continue using oxygen supplements by giving him information about pneumonia and supporting the importance to maintain normal oxygen levels.

It is important that the nurse communicate well with Mr. Hunter so that he can understand the consequences of stopping using the oxygen supplements.

After a while the nurse should be able to help the patient understand why he is refusing the oxygen supplement and what the consequences would be.

Patient teaching is the best strategy to get him to accept the life-threatening treatment (Meng and al. 2015).

It is essential that nurses and patients have a good relationship. Trust in treatment can be increased by listening to the patient and communicating well.

Moorhead et.al. 2014).

To manage this situation, we should first understand Mr. Hunter’s perspective so that we can get to the bottom of what the patient thinks about the outcome of the procedure.

This would enable the nurse to determine the true motivation of the patient’s decision.

This allows the nurse to explain to the patient the reasons for refusing treatment.

This will also give the patient the opportunity to teach the patient how the procedure would benefit them.

Another way to encourage patients to voice their concerns about the procedure is to have them discussed.

Nurses can use their communication skills to make Mr. Hunter accept the treatment and understand the implications (Kuhse Schuklenk & Singer 2015).

What I have taken away from this experience is two things: how to identify specific healthcare needs, and how to manage ethical dilemmas so that patient-centered care can be developed and strategies that are tailored to the specific needs of each patient.

It taught me problem-solving skills and critical reasoning that I can use to make decisions in the clinical setting.

I learned about the importance clinical reasoning in nursing practice from this situation.

These steps include collecting cues, processing information that can be helpful in understanding the patient’s problem and planning and execution of interventions.

It could also be used to help patients evaluate their outcomes and reflect back on their learning.

It is a valuable tool in building excellence for patient-centered, patient-centered health care.

My future plan is to increase my critical thinking skills so that I can make better decisions and solve problems more effectively for safe nursing practice.

It will also improve my communication skills, which would help in handling ethical dilemmas that might arise during nursing practice.

I will also utilize the clinical reasoning cycles efficiently in my professional work. This would affect my experience and knowledge of using reflective thinking as part of learning and identifications of potential and existing issues in nursing practice.

Refer to

Behnia M. Logan S.C. Fallen L. Catalano P. Nosocomial and ventilator-associated pneumonia in a community hospital intensive care unit: a retrospective review and analysis.

BMC research Notes, 7(1) p.232.Butcher, H.K., Bulechek, G.M., Dochterman, J.M.M.

Wagner, C. Nursing interventions classification (NIC). Elsevier Health Sciences.

Kuhse H. Schuklenk U. Singer P.

Bioethics – an anthology (Vol. 40).

John Wiley & Sons.Lewis, S.S., Walker, V.J., Lee, M.S., Chen, L., Moehring, R.W., Cox, C.E., Sexton, D.J.

Anderson, D.J. Epidemiology of methicillin-resistant Staphylococcus aureus pneumonia in community hospitals. Infection Control & Hospital Epidemiology, 35(12), pp.1452-1457.Lin, Y.T., Wang, Y.P., Wang, F.D.

Fung C.P. (2015)

Klebsiella pneumoma pneumoniae communitarian-onset in Taiwan: clinical features and microbiological characteristics.

Frontiers in Microbiology, 6, 122.

Luna, C.M. Palma. I. Niederman. M.S. Membriani. E. Giovini. V. Wiemken. T.L. Wiemken. P. Ramirez. J.

The impact of ageing and comorbidities on mortality among patients admitted with community-acquired pneumonia.

Annals of the American Thoracic Society. 13, pp.1519-1526.Masoumi, M., Hanifi, N., Jamshidi, M.R.

Faghihzadeh S.

Investigating the relationship between oral lesions and early pneumonia associated with mechanical ventilation in patients undergoing mechanical ventilation in an intensive care unit.

Military Caring Sciences. 3(2). pp.107-114.McCaughey, C., 2014.

Q fever is a difficult zoonosis.

Veterinary Record, 175(1). pp.15-16.

Meng K. Li, Y. Li. S. Zhao H. and Chen L. 2015. The survey on implementation of evidence-based nursing in preventing ventilator-associated pneumonia and the effect observation.

Cell biochemistry & biophysics, 7(1), pp.375-381.Moorhead, S., Johnson, M., Maas, M.L.

Swanson, E., 2014.

Nursing Outcomes Classification – Measurement of Health Outcomes Elsevier Health Sciences.

Vila Corcoles A. Vila Ochoa Gondar O., Rodriguez Blanco T. Salsench E. Ansa X. Saun N.

Validation of CORB75, which measures oxygen saturation, respiratory rates, blood pressure and age>=75 as a more severe form of pneumonia. Infection, 42(2), pp.371-378.

Ooi H., and Wu K.

Preliminary findings on the use of heart rate variation as a tool for assessing the severity community-acquired pneumonia in hospitalized patients. Respirology, 19, p.49.Sachdeva, S., 2016.

Comparison of Klebsiella pneumonia outer Membrane lectin’s H2O diffusion with its E. coli counterpart (Doctoral dissertation. Indian Institute of Technology Hyderabad).

Sopena N. Heras E. Casas I. Bechini J. Guasch I. Pedro-Botet M.L. Roure S. Sabria M.

Study of a case-control to identify risk factors for hospital-acquired Pneumonia outside the ICU.

American journal on infection control 42(1): pp.38–42Tabloski, P.A., 2013. Gerontological nursing.

Pearson Higher Ed.

Torres A.Cilloniz C. Ferrer M.B., Gabarrus A.B.R.S., Gabarrus A.A.S., Polverino E.S., Villegas S. Marco F. Mensa J. Menendez R. Niederman M.

Prognosis and risk of community acquired pneumonia due to bacteraemia or antibiotic-resistant pathogens

European Respiratory Journal (45(5)), pp. 1353-1363.

Van Leeuwen A.M. Bladh M.L. 2017.

Davis’s comprehensive handbook for diagnostic and laboratory tests with nursing implications.

FA Davis.