What cultural and age-related factors may have a bearing on the patient’s plan of care?

4 discussion responses

Respond to these discussion posts, in 125 words and at least one reference.

1. What major outcomes do you expect to achieve for this patient?
In the case of Mr. Z, the major outcomes expected are improved ventilation and oxygenation of tissues, normal ABGs, optimal gas exchange, absence of respiratory distress, and prevention of severe complications. (Eshwara et al., 2020)

What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
Due to increased respiratory rate of 40 breaths per minute, multilobar infiltrates, and COPD, severe community-acquired pneumonia (SCAP) and systemic infection would be imminent if left untreated. Antibiotic therapy specific to addressing streptococcus pneumoniae must be initiated immediately as well as oxygen therapy appropriate for comorbidity of chronic obstructive pulmonary disease (COPD). Fluid resuscitation should be used if systolic pressure is less than 90 mmHg or diastolic below 60 mmHg. Frequent reassessment should be done to evaluate present treatment modalities and to detect changes in current condition. (Eshwara et al., 2020; Metlay et al., 2019)

What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?
Until symptoms of respiratory distress subside, patient should be on continuous monitoring of vital signs and oxygen therapy. Additionally, fall precautions should be implemented and bed rest encouraged (Pneumonia in Adults, 2019). Nicotine replacement therapy and in-patient counseling should be considered as symptoms of severe tobacco withdrawal may become evident during hospitalization (Wolfenden et al., 2003).

What possible learning needs do you anticipate for this patient?
The patient should be educated on how COPD and smoking can contribute and exacerbate community-acquired pneumonia. The typical course of expected improvement once discharged should also be discussed so that the patient understands that it may be several months until pneumonia symptoms resolve. Once eligible, the patient should be educated on the benefits of the pneumococcal vaccine. (Norris, 2018; Pneumonia in Adults, 2019)

What cultural and age-related factors may have a bearing on the patient’s plan of care?
According to Cunha, risk factors for severe pneumonia increase with age due to pathologic changes in the immune system and lungs. Elderly patients have decreased mucociliary function and impaired B-lymphocyte function which leave them more susceptible to infections with encapsulated pathogens like streptococcus pneumoniae (2001). It is also important to assess Mr. Z’s attitude and belief system as it relates to implementing lifestyle changes like smoking cessation (Narayan, 2003).

2. What major outcomes do you expect to achieve for this patient?
Mr.Z clinical presentation indicates a systemic inflammatory response. The major outcomes that would be expected would be a return to stable vital signs, absence of fever and normalization of the arterial blood gas. The work of breathing will return to normal which should help the anxiety and agitation. The patient would return to baseline function and be able to perform activities of daily living without complications. Once respiratory status improves Mr.Z will be able tolerate food intake without any gastrointestinal complications.
What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
The patients’ respiratory status must be addressed, the arterial blood gas indicates respiratory alkalosis from hyperventilation, but the PO2 is not critically low, concern would be due the increased work of breathing endotracheal intubation may be indicated although with the patients’ history of COPD being able to wean off the ventilator may be difficult as that 61% of those with COPD fail weaning from the ventilator (Kuo et al., 2016).Bipap may be used before proceeding with intubation, a small dose of sedation could also be tried to manage the patients anxiety and compliance with Bipap. Fever management is also indicated to reduce the metabolic demand on the body to help improve oxygenation (Norris, 2019). Treatment for pneumococcal pneumonia is assumed to have been started that include antibiotics along with fluids as the indicated treatment for sepsis. The patients vital signs must be continuously monitored, would need to be transferred to the intensive care unit for continuous monitoring, vasopressors may be required if the patient mean arterial pressure drops below 65mmHg. Lastly due to the history of smoking a nicotine patch may also help some of the patients anxiety to prevent nicotine withdrawal.

What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?

Mr.Z is at risk for decline due to his mentation. A patient sitter may be indicated to keep him from removing his bipap mask. If a sitter is not effective, mittens may be used and escalate to wrist restraints if needed. Oral care must be completed, breaks from the bipap could be done for food and drink if tolerated, if not tolerated then Mr. Z could be assessed for total parental nutrition. Toileting should be frequently monitored, a urinary catheter may be inserted if the Mr. Z is unable to use a urinal as a result of the shortness of breath.

What possible learning needs do you anticipate for this patient?

Smoking cessation will be required to address once Mr. Z mentation improves and is indicates willingness to learn. Smoking alters the normal flora within the tracheobronchial tree which places an individual at higher risk for infection (Norris, 2019). The vaccination status of Mr. Z would need to be assessed and education on the importance of receiving the pneumococcal pneumonia vaccination due to the patient’s risk factors which include COPD and smoking.

What cultural and age-related factors may have a bearing on the patient’s plan of care?
Being a white male from the scenario, there might be some resistance with of lifestyle due to the era from which he grew up in. Age related factors included difficulty understanding how to administer medication especially inhalers properly (Sam, 2016). It is unknown if Mr.Z has family support which would be helpful for smoking cessation; could give him more motivation to make the lifestyle changes needed. Smoking was seen as a status for males and was prevalent in the higher socioeconomical groups which could hinder the desire for Mr. Z to quit (Di Novi & Marenzi, 2018).