Hospital Acquired Pneumonia Discussion
Admission Orders
Primary Diagnosis: (Shortness of breath and productive cough) Hospital Acquired Pneumonia
Status/Condition: Fair condition
Code Status: Full Code
Allergies: Allergic to morphine. No other known drug or food allergies
Admit to Unit: Female Medical Ward
Activity Level: Up with minimal assistance- Bed rest
Diet: Per oral. Tolerating fluids and solid foods
IV Fluids: Normal Saline 0.9% 2L in 24 hours
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- Critical Drips (None)
Respiratory: Oxygen 1L/minute (60L per hour) via nasal cannula per hour when saturation falls below 92%, four hourly suctioning (Al-Otaibi, 2019)Hospital Acquired Pneumonia Discussion
Medications:
Lisinopril 10mg PO OD
Levothyroxine 75mcg per oral
Rivaroxaban 10mg OD
Ciprofloxacin 500mg Q12 NOCTE
Nursing Orders
Monitor Vitals every 4 hours
Propp patient in bed at 45 degrees to promote breathing (Fahlberg & Laramee, 2020)
Assistance with ambulation and other activities of daily living as tolerated
Daily grooming
Daily knee assessment with weight bearing as tolerated
Provide warm drinks as needed Hospital Acquired Pneumonia Discussion
Follow-Up Lab Tests:
Arterial blood gas test
Complete blood count
Diagnostic testing: Sputum culture test, bronchoscopy, pulse oximetry, and blood culture (See & Lau, 2023)
Consults:
Consult cardiologist for cardiovascular evaluation for further assessment due to hypertension
Occupational therapist for follow-up on knee replacement therapy
Patient Education and Health Promotion :
Health education areas: patient condition
Treatment plans available
Coping skills- changes such as surgery
Fluid intake
Exercises
Diet conversant with underlying conditions
Medications used and their specifications
Discharge Planning and Required Follow-Up Care:
Discharge once patient symptoms are well-managed and the patient is stable, oxygen saturation above 94 on room air, and respiratory rate is below 20)Hospital Acquired Pneumonia Discussion.
Follow-up clinic after two weeks for general assessment.
Notify the case manager and social workers about the patient’s discharge planning (Prusaczyk et al., 2019).
Follow-up with the physiotherapist
References
Al-Otaibi, H. M. (2019). Current practice of prescription and administration of oxygen therapy: an observational study at a single teaching hospital. Journal of Taibah University Medical Sciences, 14(4), 357-362. https://doi.org/10.1016/j.jtumed.2019.05.004
Fahlberg, B. B., & Laramee, A. S. (2023). 6 Reducing Episodic Dyspnea in Heart Failure. What Do I Do Now? Palliative Care, 49. https://doi.org/10.1093/med/9780190098896.001.0001
Prusaczyk, B., Kripalani, S., & Dhand, A. (2019). Networks of hospital discharge planning teams and readmissions. Journal of Interprofessional Care, 33(1), 85-92. https://doi.org/10.1080/13561820.2018.1515193
See, K. C., & Lau, Y. H. (2023). Acute management of pneumonia in adult patients. Singapore Medical Journal, 64(3), 209. https://doi.org/10.4103/singaporemedj.SMJ-2022-050 Hospital Acquired Pneumonia Discussion
Admission Orders
Primary Diagnosis: Shortness of breath and productive cough (Possible Chronic Obstructive Pulmonary Disease)
Status/Condition: Fair condition
Code Status: Full Code
Allergies: Allergic to morphine. No other known drug or food allergies
Admit to Unit: Female Medical Ward
Activity Level: Up with minimal assistance- Bed rest
Diet: Per oral. Tolerating fluids and solid foods
IV Fluids: Normal Saline 0.9 2L in 24 hours
- Critical Drips (None)
Respiratory: Oxygen 1L/minute (0L per hour) via nasal cannula per hour when saturation falls below 92, 4 hourly suctioning (Al-Otaibi, 2019)Hospital Acquired Pneumonia Discussion
Medications:
Lisinopril 10mg PO OD
Levothyroxine 75mcg per oral
Rivaroxaban 10mg OD
Ciprofloxacin 500mg Q12
Nursing Orders
Monitor Vitals every 4 hours
Propp patient in bed at 45 degrees to promote breathing (Fahlberg & Laramee, 2020) Hospital Acquired Pneumonia Discussion
Assistance with ambulation and other activities of daily living as tolerated
Daily grooming
Alternate day dressing on the surgical site
Provide warm drinks as needed
Follow-Up Lab Tests:
Arterial blood gas test
Complete blood count
Diagnostic testing: Pulmonary function tests, echocardiograph, and chest X-ray (Huang et al., 2020)
Consults:
Consult cardiologist for cardiovascular evaluation for possible heart failure diagnosis
Patient Education and Health Promotion (address age-appropriate patient education. if applicable):
Health education areas: patient condition, treatment plans, coping skills, fluid, diet, and medications
Discharge Planning and Required Follow-Up Care:
Discharge once patient symptoms are well-managed and the patient is stable, oxygen saturation above 94 on room air, and respiratory rate is below 20). Follow-up clinic after two weeks for general assessment. Notify the case manager and social workers about the patient’s discharge planning (Prusaczyk et al., 2019)Hospital Acquired Pneumonia Discussion.
The Rationale for Specific Decisions
Most patients are normal except for saturation and respiratory rate, which have slightly deviated. The patient cannot be admitted to critical care units because she is in a fairly stable condition and does not meet the criteria for critical care admission. The rationale for selecting a 1lt/per minute nasal cannula of oxygen is that the patient is saturating well, and minimal supplemental oxygen is required. Oxygen toxicity is undesirable, and well-saturating patients do not require much oxygen, especially if the saturation is above 92%. Other oxygen delivery methods are more efficient than the nasal cannula, and too much oxygen can lead to toxicity. In addition, oxygen supplementation should only begin when the patient’s saturation on room air falls below 92% to avoid oxygen toxicity, as Al-Otaibi (2019) supports. Hospital Acquired Pneumonia Discussion
Heart failure is often masked by respiratory symptoms such as COPD, and pulmonary function tests, chest X-ray, and an echocardiograph are required to confirm or rule out these diagnoses. Huang et al. (2020) note that symptoms are vital for patient diagnosis, but these additional tests are vital for accurate diagnosis and prompt management. Wrong diagnosis leads to mismanagement and delayed management hence poor patient outcomes. The discharge process is complex and requires several professionals, including the social worker and the advanced practice nurse/ physician, to be aware, as Prusaczyk et al. (2019) support. In addition, the discharge criteria should also be clearly outlined for a smooth discharge process. Hospital Acquired Pneumonia Discussion
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References
Al-Otaibi, H. M. (2019). Current practice of prescription and administration of oxygen therapy: an observational study at a single teaching hospital. Journal of Taibah University Medical Sciences, 14(4), 357-362. https://doi.org/10.1016/j.jtumed.2019.05.004
Prusaczyk, B., Kripalani, S., & Dhand, A. (2019). Networks of hospital discharge planning teams and readmissions. Journal of Interprofessional Care, 33(1), 85-92. https://doi.org/10.1080/13561820.2018.1515193
Huang, W. M., Feng, J. Y., Cheng, H. M., Chen, S. Z., Huang, C. J., Guo, C. Y., Yu, W. C., Chen, C. H., & Sung, S. H. (2020). The role of pulmonary function in patients with heart failure and preserved ejection fraction: looking beyond chronic obstructive pulmonary disease. PLoS One, 15(7), e0235152. https://doi.org/10.1371/journal.pone.0235152
Fahlberg, B. B., & Laramee, A. S. (2023). 6 Reducing Episodic Dyspnea in Heart Failure. What Do I Do Now? Palliative Care, 49. https://doi.org/10.1093/med/9780190098896.001.0001 Hospital Acquired Pneumonia Discussion
