Mr. Hernandez is hospitalized with left lower lobe pneumonia. Arterial blood gas

Question

Mr. Hernandez is hospitalized with left lower lobe pneumonia. Arterial blood gas results are pH–7.47, pO2–60, pCO2–48, and HCO3–28. The nurse has completed a health history and a physical exam of the head, eyes, ears, nose, and throat. Now, the nurse must perform an assessment of the respiratory system. The nurse begins the physical assessment by conducting a brief history of the symptoms Mr. Hernandez has experienced related to the respiratory system. The nurse gathers the following history. He developed a productive cough with thick, yellow-green mucous, shortness of breath, and chest pain over the past week. The healthcare provider ordered a chest X-ray, which showed left lower lobe pneumonia. He was admitted for treatment of his left lower lobe pneumonia. He has a history of gastroesophageal reflux disease (GERD) and chronic obstructive pulmonary disease (COPD). His home medications are Zantac 150 mg 1 tablet by mouth twice a day, Proventil inhaler 2 puffs as needed for shortness of breath, and Advair Diskus 1 puff three times a day. He denies having a flu shot this year and has not had a pneumonia vaccine for 5 years. He has frequent sinus congestion whenever there is a change in the weather. He usually takes over-the-counter sinus medicine that will take care of the problem. He notes that he started with sinus congestion about two weeks ago, which continued to get worse and made his throat sore from the drainage and the frequent coughing. He thinks this is why he developed the pneumonia that caused him to be admitted to the hospital this time. What are Mr. Hernandez’s physical and psychosocial risk factors that may have contributed to the development of pneumonia? Based on these findings, what would you include in a teaching plan for Mr. Hernandez with the respiratory assessment findings?

Explanation / Answer

Mr. Hernandez was stressed because of sinus congestion, sore throat and frequent coughing for about two weeks. Instead of consulting a specialist, he did self medication with over-the-counter sinus medicine; this made the situation worst, and finally making him to get admitted in the hospital. As we know, the weak immune system allows the body to get pneumonia and body can’t fight off the infection. People who have chronic obstructive pulmonary disease (COPD) are at high risk of developing pneumonia and the presence of gastroesophageal reflux disease (GERD) will trigger the pulmonary disease. The excess acid produced in the stomach will regurgigate up and will damage the esophagus mucosa and GERD causes chronic cough, bronchitis and pneumonia. Mr. Hernandez did not take flu shot this year and a pneumonia vaccine for 5 years, flu shot is involved in the prevention of pneumonia and pneumococcal vaccination prevents lung infection, thus prevents the occurrence of pneumonia, because he did not take it, he got the pneumonia. Because of the nasal congestion, the tissues became inflamed and oxygen did not the reach the blood stream, which impaired the breathing. He had productive cough with thick mucus and the body became stressed because of these consequences, the infection progressed easily.

Based on the above things, we can say that, if an individual get any infection or symptoms, instead of going for a self medication, should go to a specialist for thorough check up. Specialist not only considers the present situation, he also evaluates the past history, so that they can easily figure out the causes of infection and severity. This helps them to plan for the proper treatment of the infection. A variety of factors will influence the occurrence and proliferation of infection in our body. Assessing all the parameters is must before going for the suitable treatment. Here in this case, the patient already was suffering with GERD and COPD, which exposed him to the infection and it’s spreading in the body. In addition to this he did not take flu shot and vaccine. By delaying the visit to a specialist, and going for self medication, the patient has made his condition more worst. The infection in the meanwhile has spreaded and made him to get hospitalized.

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