Case study of pneumonia pdf

Covid pneumonia is defined by a positive result for SARS-CoV-2 on a reverse-transcriptase—polymerase-chain-reaction RT-PCR assay of a specimen collected from the upper or lower respiratory tract together with radiological features of pneumonia and clinical features of hypoxaemia and dyspnoea. We describe a case of a patient with Covid infection, progressive pneumonia, development of a hyperinflammatory state and cytokine release syndrome CRS who was successfully treated with steroids and tocilizumab.

In January , a year-old gentleman with a background of asthma on long-term low dose inhaled corticosteroid inhaler had an acute exacerbation of his asthma in February triggered by a viral upper respiratory tract infection and acute sinusitis and was managed with bronchodilator nebulization and a 7-day course of oral prednisone 30 mg daily.

He made an uneventful recovery and proceeded to travel to Austria on 29 February During his stay in Austria, he had contact with a Covid positive individual and started developing upper respiratory symptoms on 7 March. On his return to South Africa on 8 March he had a fever, sore throat, dry cough, severe wheezing and worsening dyspnoea.

He was advised to self-isolate at home and was managed telephonically with bronchodilator nebulization, oral prednisone 30 mg daily for 5 days and paracetamol. By 11 March he was not feeling any better and had ongoing fever and cough.

The Covid PCR test had become available at that stage and his initial test with a private pathology laboratory was negative. Over the next 3 days his symptoms worsened, and on 16 March he was admitted to hospital to an isolation ward where blood tests showed a lymphopaenia and a rising CRP Table 1. A high-resolution CT scan of his chest showed bilateral asymmetrical peripheral ground glass infiltrates in a subsegmental distribution, particularly in the lower zones.

A repeat Covid PCR swab on this occasion was positive and he was diagnosed with Covid pneumonia. In keeping with national and international guidelines recommending against the use of systemic corticosteroids, prednisone was discontinued. Over the next 5 days his clinical condition worsened despite antiviral therapy. His hypoxaemia worsened and he had increased bilateral chest infiltrates on follow-up radiology Figure 1.

His PaO2:FiO2 ratio decreased to After a discussion with the team he was treated with tocilizumab mg IV, given as two doses of mg 24 h apart on 23 and 24 March, as well as methylprednisolone 40 mg IV daily for 5 days.

Portable chest radiographs on 17 and 20 March showing progressive bilateral pulmonary infiltrates. Within 24 h following the tocilizumab infusion, there was an improvement in his fever, biomarkers Table 1 and hypoxaemia.

Mechanical ventilation was avoided and he was monitored for another 6 day in the isolation unit. He was discharged home on 27 March, where he continued to make an uneventful recovery.

Follow-up blood tests as an outpatient showed normalization of his lymphocyte count and CRP Table 1. A repeat nasopharyngeal and throat swab test for Covid on 31 March was negative. It has been postulated that there are three distinct but overlapping phases and pathological subsets of Covid infection and subsequent Covid disease in humans, the first two triggered by the virus itself and the third, by the host response. Patients progressing to this last severe phase of Covid have clinical and laboratory evidence of an exaggerated inflammatory response, similar to the CRS, with persistent fever, worsening ARDS, elevated inflammatory markers and proinflammatory cytokines and MODS.

The Covid virus binds to alveolar epithelial cells, activating the innate and adaptive immune systems resulting in the release of pro-inflammatory cytokines. Although corticosteroids are not routinely recommended for the treatment of Covidassociated lung injury, CRS immunosuppression with corticosteroids and other therapies is likely to be beneficial. The common organisms responsible for HAP include the pathogens Enterobacter sp.

Influenzae, Klebsiella species, proteus, Serratia marcescens, P. Pneumonia in the immunocompromised host occurs with the use of corticosteroids or other immunosuppressive agents , chemotherapy, nutritional depletion, use of broad spectrum antimicrobial agents, Acquired Immuno Deficiency Syndrome, genetic immune disorders, and long term advanced life support technology mechanical ventilation.

PCP has a subtle onset, with progressive dyspnea, fever, and a non-productive cough. Aspiration Pneumonia : Aspiration Pneumonia refers to the pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway. The most common form of aspiration pneumonia is bacterial infection from aspiration of bacteria that normally reside in thr upper airways.

Aspiration pneumonia may occur in the community or hospital setting. Common pathogens are S. They are : 1. Bronchopneumonia 2. Lobar pneumonia 1. Bronchopneumonia : The term bronchopneumonia is used to describe pneumonia that is distributed in a patchy fashion, having originated in one or more localized areas within the bronchi and extending to the adjacent surrounding lung parenchyma.

As inflamed, fibrous exudates accumulates and there is consolidation and frequently incomplete resolution and fibrosis.

Bronchopneumonia is more common in childrens. Lobar Pneumonia : As the name suggests, a complete lobe or even two lobes of a lung are affected, the most striking changes occurring in the alveoli, leading to production of watery inflammatory exudates in the alveoli. This accumulates and fills the lobules which overflows into and infects adjacent lobules. The disease is common in Eastern countries. It is seen typically in adult years with males predominating and is caused by Streptococcus Pneumoniae.

Occasionally Klebsiella Pneumoniae is the agent in the debilitated elderly, diabetics and alcoholics. The whole affected lobe progresses uniformly through four distinct phases illustrating the classical progression of an acute inflammation ; this has been so radically altered by antibiotic treatment.

Predisposing Factors : Chronic sick patient; debilitated, cancer patients. Patient with thoracic surgey Prolonged immobility and shallow breathing pattern. Immunosuppressed Patients and those with a low neutrophil count Neutropenic Smoking ; cigarette smoke disrupts both mucociliary and macrophage activity. Depressed cough reflex due to medications, weak repiratory muscles, e.

Aspiration of foreign materials into the lungs during a period of unconsciousness head injury, anaesthesia, depressed level of consciousness or abnormal swallowing mechanism. Nothing-by-mouth NPO status; placement of nasogastric, orogastric, or endotracheal tube. Exposure to noxious gases, exposure to cold, exposure to dirty areas and dusty area.

Advanced age, because of possible depressed cough and glottic reflexes and nutritional depletion. Transmission of organisms from health care providers. The predisposing factor of Pneumonia in my patient is Exposure to noxious gases, exposure to cold, exposure to dirty areas and dusty area and the causative organism is Streptococci Pneumococci.

Pneumonia arises from normally present flora in a patient where resistance has been altered or it results from aspiration of flora present in the oropharynx. It may also result from bloodborne organisms that enters the pulmonary circulation and are trapped in pulmonary capillary becoming a potential source of pneumonia. The pathology is described in four phases merging sequentially : all the alveoli in the lobe are uniformly affected. Stage of Congestion : This is the stage that develops due to the inflammation of lungs.

Patient develop fever, chest pain and increased sputum. Stage of Consolidation : In this stage, pus is formed which is organized by fibrosis. Initially it looks red and is known as RED Hepatisation. Stage of Resolution : Slowly the process of inflammation decreases when immunity win bacteria or when drug therapy is given. The lungs become clear but some fibrosis remains. Microscopic Appearance Clinical manifestations : S. N According to book According to Patient.

Sudden onset of chills with rapidly rising He was presented with the chief complain of fever Pleuritic chest pain aggravated by deep He complain of chest pain radiating to left breathing and coughing. Severely ill looking with marked tachypnea.

His general appearance was ill-looking with respiration rate 32bpm. Rapid and bounding pulse. His pulse rate is bpm. Purulent sputum production; sometimes Purulent sputum production. Shortness of breathe, nausea, vomiting, He has discomfort in breathing. Dyspnea, hypoxemia may be present. Not present. Poor appetite; Profuse cold perspiration. Assessment and Diagnostic findings : S. N According to book According to patient.

History Taking 2. Physical examination 3. Chest X-ray Done which shows infiltration shadows in the left lower lobe. Blood culture Done, result awaited. Sputum culture Done, result awaited. Note : Blood culture and sputum culture should be sent before the administration of antibiotics. However, an etiologic agent is not identified in half of CAP cases, and empiric therapy must be initiated. Prompt administration within hours of antibiotics in patients in whom CAP is strongly suspected or confirmed is a key treatment measure.

For outpatient who have no cardiopulmonary disease or other modifying factors, treatment should include an oral macrolide azithromycin or clarithromycin, doxycycline, or a fluroquinolone with enhanced activity against S. For those who have cardiopulmonary disease or other modifying factors, treatment should include a beta-lactam agent oral cefpodoxime, cefuroxime plus a macrolide or doxycycline. Also, a beta- lactam agent plus an antipneumococcal fluroquinolone can be used.

However, treatment regimens may be modified for individual patients. Analgesics for fever, antihistamines are usually not prescribed because it may cause excessive drying and make secretions more difficult to expectorate. Oxygen therapy, nebulisation, chest physiotherapy, intravenous fluids, if needed. Azithromycin Drug class Macrolide antibiotic Therapeutic actions Bacteriostatic or bactericidal in susceptible bacteria.

Food affects the absorption of this drug. Do not take with antacids. Take with food if GI upset occurs. Pantoprazole Drug classes Antisecretory agent Proton pump inhibitor Therapeutic actions Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

Caution patient to swallow tablets whole; not to cut, chew, or crush them. Symptomatic improvement does not rule out gastric cancer; gastric cancer did occur in preclinical studies. Swallow the tablets whole—do not chew, cut, or crush them. If this becomes difficult, consult with your nurse or physician. Paracetamol Drug classes Antipyretic Analgesic nonopioid Therapeutic actions Antipyretic: Reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which helps dissipate heat.

Analgesic: Site and mechanism of action unclear. Carefully check all OTC products. They may contain acetaminophen, and serious overdosage can occur.

If you need an OTC preparation, consult your health care provider. Nursing Assessment Nursing Assessment is critical in detecting pneumonia. Planning and Goals The major goals include improved airway patency, rest to conserve energy, maintenenc of proper fluid volume, maintenance of adequate nutrition, an understanding of the treatment protocol and preventive measures, and absence of complications.

Nursing Interventions Improving airway patency : - Remove the secretions because retained secretions interfere with gas exchange and may slow recovery. Promoting rest and conserving energy : - Encourage the debilitated patient to rest and avoid overexcretion and possible exacerbation of symptoms. Monitoring and managing potential complications : - Observe the patient for response to antibiotic therapy.

Address the underlying factors and ensure patient safety. Splinting reduces chest discomfort, and an upright position favors deeper, more forceful cough effort. Offer warm, rather than cold, Facilitates liquefaction and fluids. Encourage use of stress Bed rest is maintained management and during acute phase to diversional activities as decrease metabolic demands, appropriate thus conserving energy for healing. Activity restrictions thereafter are determined by c Explain importance of individual client response to rest in treatment plan activity and resolution of and necessity for respiratory insufficiency balancing activities with rest.

Client may be comfortable with head of bed elevated, sleeping in a chair, or leaning forward on overbed table with pillow support. Minimizes exhaustion and d Assist client to assume helps balance oxygen supply comfortable position for and demand.

Provide for progressive increase in activities during recovery phase. Acute a Determine pain Chest pain, usually present Pain characteristics; e.

Nonanalgesic measures administered with a gentle c Provide comfort touch can lessen discomfort and augment therapeutic measures; e. Client rubs, change of position, involvement in pain control quiet music or measures promotes conversation. Encourage independence and enhances use of sense of well-being. Risk for a Assess vital sign Elevated deficient changes; e. Provides information about adequacy of fluid volume and replacement needs. Calculate fluid balance.

Meets basic fluid needs, Be aware of insensible reducing risk of dehydration losses. Deficient a Review normal lung Promotes understanding of Knowledge function, pathology of current situation and regarding condition. During initial 6—8 weeks after discharge, client is at greatest risk for recurrence of pneumonia. My patient can perform her activities of self care. So this theory is applied.

Consists of three categories : 1 Universal- that are common to all individual like oxygen, water warmth, elimination, food intake etc. Developmental- that results from maturation according to age, my patient is young adult so this stage is related to the the development parenthood,as a result she is pregnant and waiting for the arrival of her baby normally.

So I applied this theory. My patient is focusing on eating highly nutritious diet for meeting the demands of her baby inside. She is also concern of maintaining cleanliness. It is a condition when the individual is incapable or limited to live within one's physical, biological and social environment. During the period of hospitalization my patient has some self care deficit.

Orem's has identified 3 classification of nursing system to meet the self care requisites of the patient. Unconscious patient. So I only provided assistance to the patient. In hemiplegic patient. My patient also need assistance while going toilet but she could perform other activities herself. In this system nurse attempts to promote the self care agency.

Dhruba Bhujel. He is admitted in Male Medical Ward-I. He had IV canula in situ. She couldnot come out of bed and ambulate in her 1 st post operative day. So, we helped her to perform her morning activities like facewash, etc.

She needed help while combing her hair. She has weakness and can not manage certain things by herself. As every individual has need of self care to sustain health and life. We as a nurse help an individual who is unable to maintain self care in relation to recovery from disease.

My objective is to help her to regain his health as soon as possible in order to assist my patient in performing self care and to recover soon. Hence, Orem's Theory was suitable to apply in my case study patient.

Vital signs and SPO2 monitored. Oxygen inhalation given. Nebulisation done. Admitted to Male Medical Ward —I. Blood Investigations sent. Chest X-ray done.

IV and oral medications continued as prescribed. Repeat blood investigations, urine and stool sent for routine examination.

Fever subsided. Patients general condition improving. Discharged from the hospital. Diversional therapy promotes self esteem and personal fulfillment through an emphasis on holistic care: providing physical, psychological, social, intellectual, spiritual, cultural support. Graphic essay to kill a mockingbird. Essay topics on School canteen essay in punjabi.

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