HESI Patient Review: Respiratory - Mr. Hannigan

HESI Patient Review: Respiratory - Mr. Hannigan Mr. Hannigan, a 75-year-old man is examined by his healthcare provider (HCP) in the office and he is diagnosed with right lower lobe pneumonia. He is admitted to the Medical Unit in the hospital where you work. Mr. Hannigan has community-acquired pneumonia (CAP), a bacterial pneumonia found in the lower respiratory tract of non-hospitalized persons. Risk factors for CAP include advanced age older than 65, immunocompromised host, or comorbidities such as diabetes or COPD. Mr. Hannigan has acute symptoms that increase his risks for fatal complications of pneumonia. It was decided that he should be hospitalized and receive IV antibiotics. Mr. Hannigan is accompanied by his wife and daughter, who are very upset about his hospital admission because of his confusion, increased heart rate, and shortness of breath. You review the rationale for Mr. Hannigan's nursing care. What is the underlying pathophysiology of pneumonia? - inflammation and/or infection of the lung The pathophysiology of pneumonia involves excess fluid in the lungs associated with an acute inflammatory process that is usually a result of infection. Microorganisms (bacteria, viruses, fungi, parasites) gain entry into the respiratory tract either by inhalation (from airborne transmission with talking, sneezing, coughing) or aspiration (secretions from the oropharynx or nasopharynx). The organisms are not successfully cleared, and they become established. Which considerations are critical for the nurse to make when assigning a room to a client with community acquired pneumonia (CAP)? - Mr. Hannigan's confusion Mr. Hannigan's confusion is an important consideration for room assignment. The fact that Mr. Hannigan is confused places him at risk for injury. An initial assessment found Mr. Hannigan to be disoriented to time, place, and person. Bed placement as close to the nurses' station as possible is important. Infection control Infection control is an important consideration for room assignment. Mr. Hannigan has pneumonia, although the specific organism responsible for infection is not known at this time. The means of transmission is not yet known. To decrease risk for hospital-acquired pneumonia or other nosocomial infections in other clients, Mr. Hannigan was assigned to a private room. According to Centers for Disease Control (CDC) guidelines, which isolation precautions are indicated for Mr. Hannigan at this time? - Droplet Precautions Centers for Disease Control (CDC) Guidelines for Isolation Precautions in Hospitals require that Droplet Precautions be used with persons who have suspected or known infections that are transmitted by large particle droplets, including some pneumonias. These pneumonias are contagious with coughing, sneezing, talking, and procedures requiring close contact. Usually transmission is by nasopharyngeal/respiratory secretions and/or sometimes saliva. It is possible that Mr. Hannigan has a pneumonia that will not require Droplet Precautions. However, it is prudent that Droplet Precautions be instituted to prevent transmission of infection until such time that a diagnosis suggesting otherwise is determined. Contact Precautions Centers for Disease Control (CDC) Guidelines for Isolation Precautions in Hospitals require that Contact Precautions be used with persons who have suspected or known infections that can be transmitted by direct (personal) or indirect (environmental surfaces) contact. Some pneumonias spread easily through direct contact with infected persons or indirect contact with contaminated objects or surfaces. For these pneumonias, transmission is usually by nasopharyngeal/respiratory secretions. It is possible that Mr. Hannigan has a pneumonia that will not require Contact Precautions. However, it is prudent that Contact Precautions be instituted to prevent transmission of infection until such time that a diagnosis suggesting otherwise is determined. Standard Precautions Centers for Disease Control (CDC) Guidelines for Isolation Precautions in Hospitals require that Standard Precautions be used with all hospitalized persons, regardless of diagnosis or presumed diagnosis. Standard precautions, droplet precautions, and contact precautions apply for Mr. Hannigan. Besides a private room, which of the following infection control requirements are indicated? - Wear a mask with close contact When providing close-contact (within three feet) direct care with clients on droplet precautions, the health care provider should wear a face mask. Often, this means wearing a mask when in the client's room Wear a gown when assisting Mr. Hannigan with bathing A gown should be worn when assisting Mr. Hannigan with bathing. A gown is required with substantial physical contact as part of contact precautions. Client-care activities that might involve splashes of body fluids or secretions require a gown as part of standard precautions.