NURBN2023: Written Analysis of Case-based Scenario Assessment Answer

Introduction

The patient in the given clinical scenario is a 36-year-old female who has been admitted to the emergency unit, following an episodic event of respiratory distress. She has been struggling with increased shortness of breath, productive cough and fever. On examination, the patient is observed to have decreased air entry and coarse crackles in the middle left thorax. She has been confirmed diagnosed with community-acquired pneumonia. This has been confirmed with her sputum culture. The patient has a past significant history of mild childhood asthma. She has been vaccinated against pertussis and Covid-19 and not against influenza. Her current vitals indicate high-grade fever and reduced urine output, which is an issue of serious concern. Her physical appearance is also indicative of signs of distress and exhaustion. The current clinical case analysis will focus on collecting the important cues and information, establishing goals and seeking respective actions for enhancing positive clinical outcomes.

Collect Cues

The patient's core body temperature has been noted as 39.2 which is comparatively higher than the normal body temperature. The patient is struggling with community-acquired pneumonia. This indicates that she is struggling with active infection and thus, having an increased body temperature (Yoo et al., 2020). The patient has also been having a productive cough for the past three days. This also indicates a strong progression of the disease manifestation which is surmounting to enhanced bacterial invasion (Forstner et al., 2020). Therefore, there is a constant rise in the body temperature of the patient. The chest X-ray is also indicative of the presence of coarse crackles and decreased air entry (Hirai et al., 2020). During the condition of pneumonia, the alveoli of one or both lungs tend to fill with pus and fluid exudate. This pilling up can interfere with the gaseous exchange and can compromise the normal ventilatory pattern. Thereby, hindering normal ventilation and perfusion in the lung spaces and compromising the vitals. It will help the nurses to take the collection of the necessary details that are needed for the care of the patient. The information will further decide what treatment needs to be delivered.

Process

Two of the key factors which are acting as a major contributory factor to the clinically deteriorating health status of the patient in the given case study include her childhood history of asthma and nil vaccination status for influenza. History of childhood asthma plays a major part in patients developing underlying pneumonia. This is mainly due to progressive lung damage caused due to asthma for the patients. During the early onset of the disease condition, the patients might not have strong immunity to fight against the infection (Albuhairi et al., 2021). This can also enhance their vulnerability to disease progression and potential damage to the air spaces. Thereby, compromising the efficacy of lungs in enabling a robust status of effective ventilation and perfusion for sustainable gaseous exchange. Due to progressive damage, the lung tissues and alveolar spaces might also get weakened and thereby, enhancing the chances of development of increased vulnerability to developing an infection (Wang et al., 2019). Their vaccination status of Sarah is also indicative of no history of vaccination against pneumonia. Having a positive vaccination status can safeguard the patient from the increased risk of the vulnerability of catching the infection (Lin et al., 2020). This can also be the contributory cause to the progression of the disease condition for Sarah, who has a significant medical history of a respiratory condition. The vitals noted for the patient are also indicative of the clinical deterioration of the patient, leading to negative clinical outcomes. The patient has a past significant history of mild childhood asthma. She has been vaccinated against pertussis and Covid-19 and not against influenza. It needs multiple aspects to being covered at a time by which the desired care will be delivered. The process will be the designing of treatment plans that address the needs of patients.

Justification of problem

The cause of ineffective oxygenation noted for the patient is directly related to the clinical manifestation of the condition of community-acquired pneumonia. Due to this condition, there is a potential infection caused to the lung spaces of the patients. The lung spaces and alveoli tend to become inflated with the active presence of infection. These spaces tend to fill up with pus or fluid (Legg et al., 2023). This can also result in impacted ventilation and can make it difficult for the patient to easily breathe. It can also impact the delivery of oxygenated blood to various organs and thus, a compensatory impact of poor oxygenation throughout the body.

The condition of community-acquired pneumonia can be marked by shortness of breath and cough. This can also be observed in Sarah, who is currently experiencing these symptoms. Amongst most of these cases, the patients are generally able to develop an underlying viral infection (Cuesta et al., 2019). These infections are rather difficult to be managed and controlled with antibiotics. This is also a troublesome task when the patient is having a progression of the disease condition. Along with active infection of the lung, spaces can also fill up with pus and exudate, this can also be a contributory cause for the patient to develop pyrexia (Cuesta et al., 2019). This can be noted in Sarah who is having a high-grade fever due to an underlying infection.

Establishing Goals

The primary goal for poor and ineffective oxygenation is to establish a status of proper oxygenation. This is also focused on the perspective of stabilising the vitals of the patient. It will also help in promoting the robust status of ventilation which will inadvertently assist in fighting infection.

The pyrexia for the patient can be stabilised with the help of fighting the infection. This can also be done with the help of effective medication and regular monitoring of the patient for noting any possible abnormality in vitals. This will also assist in further controlling the progression of increased core body temperature for Sarah.

Take Action

Take action will describe the actions that are taken to deal with the condition of the patient. Take action will be collected based on the information that is provided in the case study. Mitchell et al., (2019) study suggest that it is important to manage ventilator-associated pneumonia. It is important to implement strategies that are reducing the incidences of ventilator-associated pneumonia that can be improved by oral care and increased mobility and movement. It makes the displacement of the tubes that are reducing the chances of colonisation of bacteria. Patients with problems with pneumonia are required to be provided with dysphagia management. Olson et al., (2020) suggest that the patient will be community-acquired pneumonia implying both severity and pathogens. Microbiological detection methods need to be provided with that lead to the recognition of microbes in the patient. It is one of the most common infections present that is causing the hospitalisation of people in hospitals. It will make the detection of the number of microbes that are leading to the infection to take place in the patient. Cillóniz et al., (2019) check the infection for antibiotic resistance that allow the providing of the required medication dose to the patient. It should be treated with antibiotics that lead to the chances of antibiotic resistance due to which infection will not be managed. Scannapieco (2023) study suggests that poor oral health is a reason for the aetiology of pneumonia and requires prevention that is eliminating the chances of pneumonia. It will require the brushing and cleaning of the equipment which will lead to the elimination of the biofilm and reduce the chances of pneumonia. It is reported that the condition is linked to poor oral health and gum diseases that are signs of an increase in the chances of pneumonia. All these practices will eliminate the practices that hold the opportunity to contribute to incidences of pneumonia. It is also found that patients are reluctant in terms of taking the medication that will contribute to the progression of infection.

Evaluation

Effective medication management and oxygen therapy will not only help in fighting the infection. It will also assist in stabilising the vitals of the patient (Angus et al., 2020). This will also focus on constant monitoring of the patient for noting any signs of possible distress and abnormality. The clinical intervention of noting the abnormal findings for the patient with the help of screening and diagnostics will also help in close monitoring (Marchello et al., 2019). This will also assist in stabilising the patient and further preventing the clinical deterioration of the patient. Improved clinical outcomes will also help in sustaining the prevention of possible clinical complications caused due to the underlying disease condition.

Reflection

The following clinical case study reflected on the relevance of collecting cues and vital information for the patient. These details help in drafting a comprehensive care plan which revolves around an evidence-based approach. Clinical care management must be ensured with a holistic approach and after carefully examining all possible options of treatment care management. I need to develop my critical thinking skills and decision-making capacity for enabling the best possible care for the patients. This is to ensure the delivery of safe, appropriate and quality care management for the patient, leading to positive clinical outcomes.

Conclusion

The patient in the given clinical scenario was a 36-year-old female who was suffering from community-acquired pneumonia. The patient was also having a significant history of childhood asthma. The vitals of the patient were collected and analysed against the normal parameters for collecting the possible analysis of the given situation. The details were also focused on the perspective of enabling quality care for the patient along with ensuring improved clinical outcomes.

References

Albuhairi, S., Farhan, M. A., Alanazi, S., Althaqib, A., Albeladi, K., Alarfaj, S., ... & Alolayan, A. (2021). Antibiotic prescribing patterns for hospitalized children with community-acquired pneumonia in a secondary care center. Journal of Infection and Public Health, 14(8), 1035-1041.

Angus, D. C., Berry, S., Lewis, R. J., Al-Beidh, F., Arabi, Y., van Bentum-Puijk, W., ... & Webb, S. A. (2020). The REMAP-CAP (randomized embedded multifactorial adaptive platform for community-acquired pneumonia) study. Rationale and design. Annals of the American Thoracic Society, 17(7), 879-891.

Cillóniz, C., Dominedò, C., & Torres, A. (2019). Multidrug resistant gram-negative bacteria in community-acquired pneumonia. Annual Update in Intensive Care and Emergency Medicine 2019, 459-475.https://link.springer.com/chapter/10.1007/978-3-030-06067-1_36

Cuesta, M., Slattery, D., Goulden, E. L., Gupta, S., Tatro, E., Sherlock, M., ... & Thompson, C. J. (2019). Hyponatraemia in patients with community‐acquired pneumonia; prevalence and aetiology, and natural history of SIAD. Clinical Endocrinology, 90(5), 744-752.

Forstner, C., Patchev, V., Rohde, G., Rupp, J., Witzenrath, M., Welte, T., ... & Wallner, M. (2020). Rate and predictors of bacteremia in afebrile community-acquired pneumonia. Chest, 157(3), 529-539.

Hirai, J., Sakanashi, D., Kinjo, T., Haranaga, S., & Fujita, J. (2020). The first case of community-acquired pneumonia due to capsular genotype K2-ST86 hypervirulent Klebsiella pneumoniae in Okinawa, Japan: A case report and literature review. Infection and Drug Resistance, 2237-2243.

Legg, J., Allen, J. L., Andrew, M., Annesley, C., Chatwin, M., Crawford, H., ... & Simpson, A. J. (2023). BTS Clinical Statement on the prevention and management of community-acquired pneumonia in people with learning disability. Thorax, 78(1), 22-52.

Lin, C. J., Chang, Y. C., Tsou, M. T., Chan, H. L., Chen, Y. J., & Hwang, L. C. (2020). Factors associated with hospitalization for community-acquired pneumonia in home health care patients in Taiwan. Aging clinical and experimental research, 32, 149-155.

Marchello, C. S., Ebell, M. H., Dale, A. P., Harvill, E. T., Shen, Y., & Whalen, C. C. (2019). Signs and symptoms that rule out community-acquired pneumonia in outpatient adults: A systematic review and meta-analysis. The Journal of the American Board of Family Medicine, 32(2), 234-247.

Mitchell, B. G., Russo, P. L., Cheng, A. C., Stewardson, A. J., Rosebrock, H., Curtis, S. J., ... & Kiernan, M. (2019). Strategies to reduce non-ventilator-associated hospital-acquired pneumonia: a systematic review. Infection, disease & health, 24(4), 229-239.https://doi.org/10.1016/j.idh.2019.06.002

Olson, G., & Davis, A. M. (2020). Diagnosis and treatment of adults with community-acquired pneumonia. Jama, 323(9), 885-886.https://doi.org/10.1001/jama.2019.21118

Scannapieco, F. A. (2023). Poor oral health in the etiology and prevention of aspiration pneumonia. Clinics in Geriatric Medicine, 39(2), 257-271.https://doi.org/10.1016/j.cger.2023.01.010

Wang, B., Li, M., Ma, H., Han, F., Wang, Y., Zhao, S., ... & Peng, Y. (2019). Computed tomography-based predictive nomogram for differentiating primary progressive pulmonary tuberculosis from community-acquired pneumonia in children. BMC Medical Imaging, 19(1), 1-11.

Yoo, H., Oh, J., & Park, C. (2020). Characteristics of fever and response to antipyretic therapy in military personnel with adenovirus-positive community-acquired pneumonia. Military Medical Research, 7, 1-11.

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