Pneumonia case study interventions

[*M_o_n_i_c_a*]

Hi everyone here is my case study

Derek Smith, a 75-year-old male, has been admitted to the medical ward with pneumonia. He has been feeling generally unwell and coughing for the past two weeks. When you come in to see him, he is sitting up in bed. Mr Smith has an audible inspiratory wheeze. Other clinical data include: Temperature: 38.5 0C, Respiration rate: 24 breaths/min, Oxygen saturation: 95% on Oxygen mask 5L/min, skin colour: pink.

Now based on the ABC care cycle i picked my two priority problems as Ineffective airway clearance and Impaired gas exchange. Now i have to find an intervention for each problem. I am having problems finding research to back up my interventions. So i was wondering if you could help me by sharing ones that you think might be appropriate. Thank you very much for your help and guidance :)

[Christina0985]

Hi,

Looks like we are both doing Health Alt 1 at QUT. I went for Ineffective Airway Clearance and Risk for fluid volume deficit related to dyspnoea and fever. Ive had trouble finding evidence based literature too. And ive found nothing at all to support my interventions (esp patient specific data). Medline seems to be the best database. And any High Acuity nursing text might help as it has some case studies that help you determine your interventions. I dont know what intervention to go for with ineffective airway clearance yet but ive gone with monitoring fluid input and output for the volume deficit one as hydration will help replace fluids lost via kidneys, skin, increased resp rate and fever (which derek has)...and it also helps decrease viscosity of mucus therefore aiding in breathing and expectoration of mucus. But anyway, let me know what intervention you go with for airway clearance. I was thinking cough enhancement but I would have gone with pain relief but the case study is very vague. I dunno....good luck and hope this helps a tiny bit.

[Christina0985]

Further to my previous post, for the ineffective airway clearance im going to go with administering humidified O2 as this will help liquify his secretions making them easier to expectorate. The study says he already has a cough so cough enhancement isnt neccessary - the cough he has atm obviously isnt productive and the humidified O2 will help make it productive. Success of this is pretty obvious, vitals will return to normal, less audibkle inspiratory wheeze if any and sputum production.

As with the second problem I chose, im now thinking i should have gone with impaired gas exchange which is annoying as ive already done my fluid vol deficit.

Again....good luck. Hope u get to see these posts before the assign is due.

[*M_o_n_i_c_a*]

Hey thanks

Yeah i am at qut in health alt 1. Its good to know im not the only one having issues with the subject. I ended up going with Airway clearance. The intervention i used was chest physiotherapy which covers cough enhancement and positioning and all that kind of stuff. I found some articles on this at JBI connect. I had to change impaired gas exchange to activity intolerance because impaired gas exchange was too similar to airway clearance. For this i am just doing a structured excercise program tailored to his needs. I hope you get yours finished on time as well. Thanks for your help

[Christina0985]

I pondered chest physiotherapy but thought that was something to be referred to the specialist and ended up on the humidified oxygen to liquify his mucociliary secretions. Hopefully, with enough support via references I can pull this off. Theres no right answer which makes it difficult. Good luck.

[NRSKarenRN, BSN, RN]

What do your nuring textbook say about these health issues...often at end of chapter is evidenced based article lists.