Nursing Assessment and Care of the Patient with Pneumonia

Enhancing oxygenation & oxygen transport
You are working as a student nurse in a metropolitan hospital. Steven Smith is a 32 year old man admitted to the medical ward with bacterial pneumonia. Steven appears to be asleep on his side when you enter the room and his face seems pale. You can?t see the rest of him as the bedclothes are pulled up to his neck. You can however see his chest rising and falling under the bedclothes. You check the documentation and his vital signs 2 hours ago were BP 135/80mmHg and pulse 96b/min. His respiratory rate is recorded as 28 respirations/min and the comments column on the observation chart reads: moderate recession/working hard, decreased air entry in both lung bases, scattered coarse crackles and wheezes upon auscultation and oxygen saturations 92% in room air. The sputum cup next to his bed contains yellowy-green sputum. His temperature is recorded as 38.1oC He has intravenous (IV) therapy ordered & running N/Saline 0.9% 1000ml/12 hours and is ordered IV antibiotics. Other information in the chart gives the following details: 2 week history of „flu? like illness with productive cough, presented to hospital following GP referral for chest X-ray, experiencing intermittent chest pain worsened by coughing and deep breathing, smoker 30/day, works in the building & construction industry as a labourer and divorced 5 years ago. After Steven finishes his rest, you need to perform certain nursing-based interventions to aid his recovery.

The 1800- word essay should cover the points below:
• Introduction (100 words): State an overview of the patient’s condition and identify TWO priority nursing problems. Give a brief plan for the essay topics.
• For the first problem (800 words): Briefly explain how it relates to the patient’s assessment data. Identify TWO priority nursing interventions to address the problem. Discuss briefly the nursing interventions you will implement (explain what is involved in implementing the intervention, why it is suitable, any relevant positive or negative aspects/considerations) and support/justify the use of these interventions with reference to current evidence-based literature. Outline the evaluation criteria/data that would indicate that each intervention is improving or resolving the identified problem.
• For the second problem (800 words): Briefly explain how it relates to the patient’s assessment data. Identify TWO priority nursing interventions to address the problem. Discuss briefly the nursing interventions you will implement (explain what is involved in implementing the intervention, why it is suitable, any relevant positive or negative aspects/considerations) and support/justify the use of these interventions with reference to current evidence-based literature. Outline the evaluation criteria/data that would indicate that each intervention is improving or resolving the identified problem.
• Conclusion (100 words): Briefly restate the patient’s condition and problems and how the nursing interventions can benefit the patient’s health.

Refer to current academic peer-reviewed journal articles to justify your ideas.

pick the two priority problems, (assessment data that supports the problems – a simple pathophysiology explanation and how it relates back to the problem.) (This will need to be referenced.)
Clearly state what the two interventions each for both problems. (4 in total)
Believe these to be the priority problems and interventions.
Priority problem 1- Chest pain preventing effective deep breathing, coughing and effective airway clearance.
Intervention 1 – Administer analgesia – nurse initiated analgesia (paracetamol) (referenced) ( basic, pathophysiology why it works)(referened).
Intervention 2- Nurse initiated Humidified saline nebs. (referenced) basic, pathophysiology why it works)(referenced).
Priority problem 2 – Oxygen saturations are 92% on Room air.
Intervention 1 –Apply 0² Therapy – 2 litres of oxygen via nasal prongs. (referenced) ( basic, pathophysiology why it works) (Referenced).
Intervention 2 – positional – eg semi fowler (referenced) ( basic, pathophysiology why it works) (referenced).
All related back to the scenario

Using current peered reviewed journal articles that are evidenced based and no older than 2007 to fulfil the following questions.
1. What is the current evidence saying what is the best practice in this intervention?
2. How is it intervention implemented?
3.What is the outcomes wanting to be achieved from this intervention?. ie how it address the problem/priority.
References from databases such as Cinahl, Joanna Briggs Institue, Crochrane, Nanda. Can also use. Queensland Health Hospital Policy, procedures and guidelines. Relevant to Nursing Queensland.
Keeping all resources relevant and link it to the scenario.
Matching the case scenario assessment data to priority problem. (only write about the existing data that is supplied.)

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