NURSING CARE PLAN Pneumonia- COPD

NURSING CARE PLAN Pneumonia- COPD Patient: Joan Walker, 84 years old History of Present Problem: Joan Walker is an 84-year-old female who has had a productive cough of green phlegm that started four days ago that persists. She was started three days ago on prednisone 40 mg PO daily and azithromycin (Zithromax) 250 mg PO x5 days by her clinic physician. Though she has had intermittent chills, she had a fever last night of 102.0 F/38.9 C. She has had more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement so she called 9-1-1 and was brought to the emergency department (ED) where you are the nurse who will be responsible for her care. Personal/Social History: Joan was widowed six months ago after 64 years of marriage and resides in assisted living. She is a retired elementary school teacher. She called her pastor before coming to the ED and he has now arrived and came back with the patient. The nurse walked in the room when the pastor asked Joan if she would like to pray. The patient said to her pastor, “Yes please, I feel that this may the beginning of the end for me!” T: 103.2 F/39.6 C (oral) P: 110 (regular) R: 30 (labored) BP: 178/96 O2 sat: 86% 6 liters n/c NANDA-I Dx Goal Expected Outcome Nsg Intervention Rationale Evaluation P: Impaired gas exchange E: decreased functional lung tissue Patient will maintain optimal gas exchange, as evidenced by ABGs within the patient’s usual range, oxygen saturation of 90% or greater, alert 1.The nurse will assess patient for altered breathing patterns in the beginning of the shift and every 1-2 hrs. 1.Assess for altered breathing patterns: -Auscultate breath sounds every 1 to 4 hours -Increased work of breathing -Monitor respiratory pattern - abnormal rate, rhythm, and depth of 1.The patient with COPD has hyperinflation of the alveoli. This change leads to an increased anteroposterior chest diameter (barrel chest) and 1.Patient has improved breathing patterns in response to therapy in 3 days. This study source was downloaded by from CourseH on :43:03 GMT -06:00 S: (AEB) Productive cough of green phlegm, fever, difficulty breathing. responsive mentation or no further reduction in level of consciousness, relaxed breathing, and baseline HR for the patient. 2. The vital signs will be checked in the beginning of each shift and then every 2 hours. 3. The nurse will administer medication per MD order and respiration - Monitor blood gas values and pulse oxygen saturation levels -Monitor for patient’s use of accessory muscles -Assess for abnormal chest excursions 2. Check vital signs in the beginning of each shift and then every 2 hours. 3.Administer bronchodilators, expectorants, antiinflammatory agents (steroids), and flattering of the diaphragm. As a result the patient may have decreased chest excursion and increased accessory muscle use. Both rapid, shallow breathing patterns and hypoventilation affect gas exchange. Hypoxia is associated with increased breathing efforts. 2.Hypoxia or hypercarbia may cause initial hypertension, tachycardia, and increased respiratory rate. 3. These medications reduce airway resistance, treat 2.Vital signs checked every 2 hours. 3. Partially met. Patient received antibiotics for 7 days. Continues This study source was downloaded by from CourseH on :43:03 GMT -06:00 according to prescribed schedule. 4. Will have activities scheduled 30 minutes after medication administration. Patient will have frequent rest periods scheduled or per patient’s request. 5. Patient will have continuous low oxygen therapy 2L/min via nasal cannula. ( Gulanic, M. & Myers, J.L., 2017) antibiotics, as ordered. Encourage fluid intake for up to 2500 ml/day within cardiac or renal reserve. 4.Plan activity with interspersed rest periods and after bronchodilator treatments. Work with the respiratory therapist for the best sequence of pulmonary treatment. 5.Administer low oxygen therapy as indicated (2L/min by nasal cannula). If insufficient, switch to high-flow oxygen apparatus (eg.Venturi mask) for more accurate oxygen delivery. ( Gulanic, M. & Myers, J.L., 2017) (Ackley, B.J. & Ladwig, G.B. ,2020) infection, and facilitate secretion removal. Fluids help minimize mucosal drying and maximize ciliary action to move secretions. 4. Activities with increase oxygen consumption and should be planned so that the patient does not become hypoxic. Pacing activities will help the patient conserve energy. 5. COPD patients who chronically retain carbon dioxide depend on “hypoxic drive” as their stimulus to breathe. When applying oxygen, close monitoring is imperative to prevent unsafe increases in the patient’s Pao2, taking bronchodilators and expectorants as ordered. 4. Patient had frequent rest periods between treatments, able to tolerate procedures. 5. Partially met, patient is not maintaining O2 Sat above 90% on 2 L/min Oxygen therapy via nasal cannula. Using Venturi mask 4L to keep O2 Sat over 90%. This study source was downloaded by from CourseH on :43:03 GMT -06:00 which could result in apnea. ( Gulanic, M. & Myers, J.L., 2017) PATHOPHYSIOLOGY OF PNEUMONIA