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Having presented an initial case report on a patient, this essay is looking to analyse the patient’s medical condition with reference to pharmacology, pathophysiology, anatomy and physiology. The goal is to provide an accurate evaluation and appreciation of the patient’s nursing and medical management plan as relevant to their identified condition. The patient is an 86-year-old widow who lives alone, with only her cat for company. She is a retired teacher with no history of drugs or substance abuse except 3 to 4 glasses of alcohol per week. It can be appreciated that the patient has always been very active and continues to read books regularly. In the case report, it was stated that the patient would require vaccinations against pneumonia and viracella. In addition, hygienic education was noted to be a good approach for ensuring that the patient significantly reduces her risk of getting viral and bacterial infections at her age. This assignment details the contents of a Clinical Case Conference (CCC) involving the history of the patient described above.
Upon admission, the patient was found to be suffering from pneumonia. Pneumonia can be identified as a primary disease or a fatal complication in an individual who is suffering from other debilitating ailments. By definition, pneumonia is a pathogenic infection of the lungs commonly characterized by persistent cough that is productive of sputum (Apiwattanakul, Thomas, Kuhn, Herbert, & McCullers 2014). The pathophysiology of pneumonia often depends on the specific pathogen responsible for the infection. The patient in this case was found with streptococcus pneumonia. Bacterial pneumonia can be traced back to a number of extrinsic or intrinsic factors depending on the specific circumstances of the patient. The extrinsic factors include a pulmonary irritant, causative agent or an injury to the pulmonary system. The intrinsic factor on the other hand is simply the patient, who, in this case, is considered the host (Hervás, Henales, Yeste, Figuerola, & Hervás 2011). When bacterial pathogens originally located in the upper airways of the patient get to the lung parenchyma, they are likely to culminate in a pneumonia infection although this also often depends on the immunity and health status of the patient. Additionally, it can be noted that patients with chronic periodontitis or a generally poor dentition are at a higher risk of infection. The bacterial virulence is also another independent determinant since some pathogens are resistant to antibiotics and more intelligent in terms of resisting natural removal from the lungs (Montgomery & Daum 2009). The greatest challenge for this patient would be the state of her health concerning access to enough clean air considering she was almost always in bed within a closed environment at home.
The clinical assessment for this patient involved a chest x-ray, a sputum test and some blood screening. The symptoms as gathered earlier were already indicative of pneumonia as a major possibility and thus these three tests were simply confirmatory. The chest x-ray was intended to identify the position of the infection and the findings showed a right lobe pneumonic infection. The sputum test then revealed the presence of gram-positive streptococcus bacteria. The blood screening was to investigate the WBC activity as a way of identifying whether the patient’s body was fighting an infection (Moskowitz & Wiener-Kronish 2010). The findings indicated the presence of lymphocytosis based on a high white blood cell count.
In terms of how nursing management relates to medical management in this context, it is significant for the patient to be aware of the reasons why they are taken through the various tests and physical examination. According to this, the role of the nurse is to explain the situation to the patient, with clear emphasis on the points of concern that could be important to the patient. For example, requesting a chest x-ray cannot be taken lightly and the patient should understand why it is necessary. Effective communication is one of the basic roles of a nurse during a clinical assessment.
The medical management team must thus work with the other involved professionals effectively if they are to get the right diagnosis for the patient. The nurse is responsible for giving primary care and collecting patients’ information. Similarly, the laboratory technicians should know what they are testing for in order to look in the right places. An interdisciplinary collaboration in this case is the only way to ensure that the patient gets effective, timely and accurate medical attention within the health care facility.
As for the primary health care strategies, one of the main concerns is quality. The patients are in the facility because they need medical attention for their current condition and they expect to be treated effectively to restore their health. The role of the nurse in such a situation is to make sure that the patient is catered for beyond their medical needs. The nurse handles the overall health of the patient and this goes beyond offering prescribed medication. Health promotion must also be practiced, with the patient in this case, especially needing information of how to ensure that they take care of their health at home.
The patient was admitted on the 15th of September at 1440 hours. She reported chest pain on inspiration, general body weakness, fever, severe sputum cough and pyrexia. She had been experiencing these symptoms for about a week prior to seeking medical help. The preliminary diagnostics showed that the patient had pneumonia, after which she had to be admitted given the severity of the infection and her overall health status. It also had to be considered that she was a geriatric patient who lived alone. As recommended, the pharmacological treatment involved a prescription of Ceftrazan IV 1g daily, Maxolan Oral 10mg TDS, Colan 2 tab. TDS and Movulon 2 tab TDS (Torres & Cillóniz 2011).
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The non-pharmacological treatments on the other hand mostly involved educating the patient on what she should be doing in order to be healthy. Based on the patient’s health status and living conditions, it was decided that she needed to spend more time outside the apartment in order to get enough fresh air. She was also advised to eat more healthy meals and limit her exposure to stressful environment as much as possible. In addition, the patient’s pain management was preferred as herbal since antibiotics were likely to complicate her situation taking into account her health and the general status of her aging body. Thus instead of the conventional analgesics and antibiotics, she was advised to use mint, melissa, lemon, ginger and honey in her herbal tea.
The main diagnostic tests were as discussed above under the patient’s clinical assessment. The chest x-ray enabled to understand of the extent of this patient’s infection and it was determined that the right lobe of the lung was completely infected. The blood tests also indicated that the patient had an increased number of white blood cells thus indicating lymphocytosis, which further confirmed that her body was attempting to fight an infection but her immun system was rather weak (Montgomery & Daum 2009). As for the sputum test, it helped to identify the causative agent in the patient’s condition, with streptococcus being the present bacteria.
The patient in this case is affected by a number of psychosocial, environmental and economic factors such as old age, loneliness, tension, and anxiety. Thus, it is important for the nurse to provide love, hope and care in order to improve her condition. The patient lives alone in an apartment, confined and limited in her movems due to frailty as an elderly person. Given this, economically and legally, she is still capable of self sufficient.
While the patient’s lifestyle indicates the need for improvement, she is still legally able to stay on her own as she maintains full control over her mind and body. Ethically, beneficence, non-maleficence and autonomy are the most important principles ensuring that a patient is well taken care of and is allowed to make critical choices pertaining to their treatment at the facility.
The patient needed to be educated on how to stay healthy even while being on her own at home. It was necessary to appreciate the role of physical activity and especially getting out of bed was crucial so that she could get some fresh air. Healthy eating habits were also emphasized.
The patient lives alone and thus cannot be discharged in her weak state. However, after the medications have taken effect and she is no longer sickly, the patient can be discharged with a reminder on pain management and health promotion as well as a follow up visit. There is a need to ensure that the patient’s lifestyle changes for the better if she is to remain healthy in her advanced age.
Watkins and Lemonovich (2011) discuss the diagnosis and management of community acquired pneumonia among adults. The patient in this case did not acquire pneumonia through interaction with other people but rather through her limited access to fresh air. Either way, her causative agents were in the air, which places her in the community-acquired category. This particular research focuses on the details of how the condition should be investigated and managed for positive health outcomes. In terms of relevance, the article emphasizes on the importance of understanding the specific pathogens that are responsible for an infection in order to find the best therapy for treatment. In this case, understanding that the patient had streptococcal pneumonia was the bottom line for the pharmacological and non-pharmacological treatment provided. The research findings thus offered an effective guide on how a specific type of pneumonia would have to be handled in order for the treatment to be effective.
Gonzalez-Castillo et al. (2014) also performed an impressively insightful research for the case. This research focuses on the risk factors for the clinical presentation of geriatric pneumonia. The authors cover a number of psychosocial and anatomic aspects that are likely to present a risk of the disease for an elderly patient. The clinical presentation as discussed by these authors gave an accurate guideline with which the patient’s condition could be easily identified at the stage of primary diagnostics. The fact that the patient lives alone and spent most of her time in bed meant she had limited exposure to clean air and physical exertion. This, along with her complicated medical history in which she suffered a myriad of chronic conditions made the situation much easier to understand. The research simply pointed out the issues in the patient’s condition and situation that could be considered as independent determinants for the prevalence of pneumonia amongst the elderly.
The management for this case involved an interdisciplinary approach in which the work of the nurse went beyond providing medical care and support. According to Jean Watson’s theory of caring, the role of the nurse is to work closely with the patient in order to cater as effectively to the patient’s needs as possible. In this particular case, the patient needed more love and care in order to remedy her loneliness and anxiety as an elderly person living alone and being exposed to a lot of horrific news in the present society. This means that one of the patient’s basic needs was companionship, which was provided by the nurse who interacted with the patient and tried to cheer her up on numerous occasions. The formulation of a close working relationship with the patient is in accordance to the best practice of nursing under Jean Watson’s theory of caring (Noel 2010). The nurse in this case was not just responsible for the patient’s biological health but also her psychological and social contexts.
Also, it can be widely expected that the primary care strategies were effectively adhered to in this case. In the context of best practices, the quality of care is determined by the patient’s ability to receive accurate treatment within the shortest possible time (Prince 2013). This patient’s treatment began shortly after admission considering that her condition was accurately diagnosed in the primary tests that had been conducted. The patient was immediately placed under the right pneumonia therapy based on her medical history and current condition, so that she did not have to wait for too long or risk being misdiagnosed.
Interdisciplinary collaboration was also observed in the management of the case. While the patient would mainly be attended to by the nurse, the physician and the laboratory technicians also effectively played their designated roles in providing the patient with the suitable kind of therapy given the condition. The tests conducted and the considerations made in relation to the patient’s medical history all played a vital role in ensuring that the patient was treated effectively. Without interdisciplinary collaboration it may have been difficult to have a complete therapy for the patient in such a short time (Petrosillo, Cataldo, & Pea 2015). Best practice requires interdisciplinary collaboration to make certain that the patient’s case is handled effectively and seamlessly as required.
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Considering that the patient is elderly and very weak, an ideal approach would be to have her treated in a geriatric facility that is transitional for a nursing home. At 86, the patient is legally able to live alone and generally take care of herself but her health is deteriorating significantly as she is under so many medications for various conditions that seem to be worsening with time. The patient no longer has the strength to move around comfortably or even make herself a meal. Living alone at this point of her life is not the right thing to do. On the other hand, the patient is still fully capable of making her own decisions and she is not willing to leave the comfort of her own home. Without experiencing the contexts of a nursing home and its potential benefits in her current condition, the patient may never agree to assisted living. A transitional facility should however provide an insight into the nursing home so that the patient reconsiders committing to one. Alternatively, the patient could have home nursing care to help her with the diet and physical activity. Consistent medication in relation to the pneumonia is not needed, so the nurse would not necessarily be focusing on medical management. Physical activity and exposure to fresh air as well a healthy diet would help significantly in restoring the patient’s health as she continues with her usual medications for the other conditions that she has to deal with (Vasil & Darwin 2012).
Conclusion
The patient in this case was 86 years old and , admitted with a case of pneumonia. The diagnosis and treatment of the condition were fulfilled in accordance with the best practice using some of the most recent research in the nursing field. At the end of the patient’s therapy, it was recommended that she does not go home and continue living alone. Instead, the patient should have some help with her diet and physical activity to improve her immunity and increase exposure to fresh air. The case was also effectively managed through interdisciplinary collaboration that improved the overall quality of the primary care received by the patient in question.
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