CONCEPT MAP Saucier, Hali SNPLU 2/25/08

encourage pt to take deeper breaths. Do pt teaching to explain Collaborate with physician to administer antibiotics to resolve infection Medical Diagnosis Patients Story
importance of lung expansion with pneumonia. administer supplemental O2 as needed to maintain adequate oxygenation
sit pt up in bed (high fowlers) to decrease pressure on chest and allow for help the client cough and deep breath at least q2hrs to clear airways and
adequate lung expansion. expand the lungs at the bases Pathophysiology Diagnostic Workup
Obtain an incentive spirometer for the pt to encourage deep breathing. administer prescribed nebulizer breathing treatments to open airways
Pt teaching on the importance of weight loss
Clinical Manifestation Nursing Diagnosis

Etiology & Risk Factors Expected Outcome

Pt. will achieve adequate ventilation Pt will experience improved oxygenation
Secondary Diagnosis Nursing Interventions

Ineffective breathing pattern r/t obesity and
fatigue, AEB SOB, RR, depth of breathing, and pt
reports difficulty taking deep breaths (4).
My patient was a female in her 60s who
lives in an assisted living rehab facility. She
came to the hospital with chest pain, SOB,
fever, and productive cough. She also had
cellulitis in her lower extremities that was
getting worse. She was admitted for 5 days to
Incidence: Health-care Associated Pneumonia
receive IV antibiotics. I cared for her on the
5th day, so she had few s/s of pneumonia.
common nosocomial infection after UTIs (1.)
Pneumonia is an inflammation in the alveoli and the
interstitium of the lung, usually caused by an infection
(3). There are several different types, including
community acquired, hospital acquired, aspiration,
fungal, and opportunistic (1). This particular patient had
what is called health-care associated pneumonia,
because she had been living in an assisted living
facility. However, I think it could also be considered
opportunistic because of her compromised immune
status. In pneumonia, the infective agent enters the lung
(pseudomonas in this case), multiplies, and triggers
inflammation. The alveoli fill with exudative fluid
which impairs gas exchange. Exudate can consolidate
and become difficult to cough up (3). Bacterial
pneumonia is usually associated with a productive
cough, whereas viral is not (1).
Impaired gas exchange r/t ed functional lung tissue Patients Medications: (2).
(4) AEB dyspnea, tachycardia, ed RR, and O2 of less than For pneumonia:
92% on RA. - Levofloxacin (Levaquin): anti-infective
- Cefalosporin): anti-infective, 3rd
generation.
- Albuterol: adrenergic bronchodilator
- Ipratropium (Atrovent): anticholinergic
Chest X-ray shows white shadows bronchodilator
(parenchymal infiltrates (3). Other Medications:
Pneumonia Culture and sensitivity. Gram-stain of - Viramune: antiviral (plus one other
sputum to differentiate bacterial from antiviral that I forgot the name)
- Insulin coverage for diabetes
occurs in about 5-15 cases out of every 1000 viral causes and gram + vs. -.
- Nystatin (candida)
hospital admissions. HAP is the 2nd most WBC elevation (greater than 15,000/l
- Heparin sc (DVT prevention)
(3).) - Warfarin (DVT prevention
anticoagulant)
- Furosemide (Lasix): edema
- Acetaminophen (for pain)
sudden onset of fever/chills
SOB, increased RR
Productive cough (bacterial) - breast cancer Discharge Planning:
Pleuritic chest pain - communicate with LCT facility to
HIV
Confusion or stupor (due to hypoxia)
update on pt discharge status
Crackles, fremitus, bronchial breath (both of the above are 2 diagnoses that could
- ensure pt has adequate
sounds have contributed to the development of
ventilation/oxygenation before d/c.
pneumonia due to compromised immunity from
Arrange for portable O2 if needed.
HIV and from chemotherapy.)
- Pt teaching on pneumonia prevention
Diabetes
Risk factors: Lymphedema and Cellulitis in lower extremities References:
1. Lewis S.L., Heitkemper M.M., Dirkesen S.R., OBrien
chronic illness Hx of MRSA, Hep C, CHF, MI, A-fib
P.G., & Bucher L. (2007). Medical surgical
immobility
immunosuppression
nursing: Assessment and management of clinical
problems (7th ed.). St. Louis: Mosby Elsevier.
post-surgery/anesthesia 2. Deglin J.H., & Vallerand A.H. (2007). Daviss drug guide
for nurses (10th ed.). Philadelphia: F.A. Davis
Company
3. Copstead L.C., & Banasik J.L. (2005). Pathophysiology (3rd
ed.). St. Louis: Elsevier Saunders.
4. Ackley B.J. & Ladwig G.B. (2006). Nursing diagnosis
handbook: A guide to planning care (7th ed.). St.