Category: Pneumonia

Hospital-acquired complications (HAC) put a significant burden on the Australian healthcare system. Different sources suggest that the number of hospital-acquired complication cases occurring each year may be anywhere between 80,000 and 165,000 (Mitchell et al., 2017). However, as Mitchell et al. (2017) report based on the results of their meta-analysis, the scale of the problem might be even more serious as there is a lack of surveillance of HAC. HAC cases often result in the need for acute care, which is associated with significant challenges for healthcare workers. It is not a rarity to witness an emergency department struggling financially and not being able to cover all its needs regarding the key resources used in acute care intervention. Aside from that, health reform implementation often faces hurdles in the form of the lack of standardisation across the board and the discrepancy between guidelines and actual capacity of hospitals. This essay presents a case study that describes a patient suffering from hospital-acquired pneumonia and provides recommendations for current preventive care. It also draws a comparison between work practices in New South Wales and the Australian national standards and guidelines.

Overview of Hospital-Acquired Pneumonia

Pneumonia is caused by an infection that leads to the inflammation of air sacs in one or both lungs. The germs that spread pneumonia, be they viral or bacterial, are contagious. Pneumonia is the second most common HAC in Australia that is associated with a high mortality rate (the all-cause rate of 25-50%) (Australian Commission of Safety and Quality in Health Care, 2018; Hupp & Ferneini, 2015). According to the Australian Commission of Safety and Quality in Health Care (2018), each year Australian hospitals see as many as 17,584 cases of hospital-acquired pneumonia. The rate for this type of HAC is currently at 46.6 per 10,000 hospitalisations.

The condition causes considerable distress in patients as it is associated with a buildup of mucus (sometimes streaked with blood), difficulties breathing, chest pain, low energy and other symptoms. Aside from that, pneumonia prolongs the length of stay and increases costs of admission. Pneumonia is especially dangerous for elderly patients: the disease develops extremely fast and the overall prognosis is poor (Mitchell et al., 2017). For these reasons, it is critical to prevent hospital-acquired pneumonia in the first place and in the event of a patient developing the condition, prescribe adequate treatment.

Presented Case

For the sake of anonymity and confidentiality, from here on, the patient presented will be referred to as A. A. is a 67-year-old Caucasian man who was brought to the emergency unit by his family a few hours after a rapid onset of left-sided weakness and aphasia. The patient’s primary diagnosis was stroke; he was recommended urgent hospitalisation until significant improvements. The emergency department logged A.’s vital signs: blood pressure of 150/ 90 Hg in both arms, body temperature of 37.2C, respiratory rate of 16 breaths per minute and a heartbeat rate of 95 beats per min. A.’s teeth and gingiva showed no signs of disease; no gag reflex was detected. The medical staff noticed that the patient’s laryngeal cough reflex was weakened. On the Glasgow Coma Scale, A. scored four for eye movement (opens eyes spontaneously), four for verbal performance (confused, disoriented), and four for movement (withdrawal to painful stimuli). After the patient showed first signs of improvement, the medical staff encouraged him to walk with their support.

A.’s past medical history revealed some of the risk factors for pneumonia: he suffered from chronic obstructive pulmonary disease with chronic bronchitis. Besides, A. had been a lifelong smoker and suffered from diabetes. The hospital staff applied some preventive strategies such as hand hygiene to avert cross-contamination and appropriate disinfection or sterilisation of respiratory-therapy devices. However, two days after admission, A. started displaying concerning symptoms: the patient was sweating profusely and complained about the shortness of breath and the feeling of tightness in his chest. A. was coughing quite a lot, producing greenish mucus. After blood tests and chest X-ray, A. was diagnosed with hospital-acquired bacterial pneumonia and administered acute care. The patient was given antibiotics and nonsteroidal anti-inflammatory drugs (ibuprofen).

Core Acute Care Nursing Concepts

Hospital-acquired pneumonia treatment and prevention strategies are primarily based on the Adult Pneumonia Guideline (Community and Hospital-acquired) and Hospital-acquired Pneumonia & Ventilator-associated Pneumonia (Adults) Clinical Guideline provided by the Australian Commission of Safety and Quality in Health Care. When it comes to the nursing management of patients such as A., two core acute care concepts are applied – treatment and prevention. Treatment of hospital-acquired pneumonia typically takes seven days and requires the administration of antibiotics and ongoing monitoring of the patient. The length of treatment can be modified based on the dynamics of the progress. Mendoza and Patel (2016) highlight the importance of initiating antimicrobial treatment soon after the onset of hospital-acquired pneumonia. A delay in drug administration is associated with higher rates of mortality (Mendoza and Patel, 2016).

The second core concept used in the management of patients such as A. is prevention. In medicine, prevention encompasses strategies undertaken to decrease the chances of a patient getting a disease or condition. When it comes to hospital-acquired pneumonia, preventive care can make a significant difference in the quality of patient outcomes. Rothberg et al. (2014) conclude that hospital-associated pneumonia is more lethal than the community-acquired type, which is why it is imperative to avert such cases rather than handling the consequences of neglect and poor treatment.

Strengths and Weakness of the Nursing Management Provided

The first notable element of preventive care administered by the hospital staff is the patient’s assessment for risk factors. The Australian Commission of Safety and Quality in Health Care (2018) discusses in detail which host factors put patients at a greater risk of developing hospital-acquired pneumonia. A.’s medical history was thoroughly investigated, and the medical staff was able to discover that the patient had had a long story of living with chronic obstructive pulmonary disease (COPD) and chronic bronchitis. A.’s nurses pointed out the fact that the patient’s increasing age might be making him especially fragile, and his diabetes must have contributed to his overall poor condition. Besides, from the conversation with A.’s family and A. himself, the medical team learned about his smoking habit that must have also made him more prone to developing lung infections.

Apart from the initial assessment and identification of A. as a vulnerable patient, the medical staff administered two important interventions: hand hygiene to avert cross-contamination and appropriate disinfection or sterilisation of respiratory-therapy devices. Passaro, Harbarth and Landelle (2016) have found that hand hygiene was an effective measure against hospital-acquired complications of all kinds, especially pneumonia. The access to bedside antiseptic hand rubs and increased pneumonia awareness among medical staff resulted in a reduction in the nosocomial infection prevalence (from 16.9 to 9.9%). Sterilisation of respiratory-therapy devices to protect A. from contracting pneumonia was also a recognised evidence-based practice. Guzmán-Herrador et al. (2016) discovered that the use of a nasogastric tube was one of the strongest contributing factors to hospital-acquired pneumonia. In summation, the medical staff showed awareness of the threat and took some reasonable measures to decrease the chances of the patient suffering from a HAC.

However, the medical staff failed to provide the patient with a wider range of preventive interventions that could have increased his chances to avoid HACs. Firstly, A. could have benefitted from allied health interventions such as chest physiotherapy. Besides, A. was not monitored for issues that could enable early identification of pneumonia. Namely, the Australian Commission of Safety and Quality in Health Care (2018) recommends paying attention to vulnerable patients’ respiratory rate and monitor them for signs of sepsis. The latter may include but are not limited to high temperature, increased heart rate and elevated blood pressure. Other symptoms that might be indicative of bacterial pneumonia in its early stages are white cell count, C reactive protein and arterial blood gases (Australian Commission of Safety and Quality in Health Care, 2018). All in all, pneumonia prevention with regard to A.’s case left a lot to be desired.

It should be noted that even the current treatment strategy might be suboptimal under certain circumstances. Mendoza and Patel (2016) write that on the one hand, antimicrobial treatment of pneumonia of both kinds (community- and hospital-acquired) is the standard. On the other hand, these days, patients often have histories of excessive use or even abuse of antibiotics, which results in antibiotic resistance. This risk should be taken into account when treating A.

Best Practice Guidelines

Because pneumonia poses a significant risk not only to patients’ quality of life but also to their general survivability, several different governing bodies have published their recommendations regarding treatment and prevention of this condition. The Clinical Excellence Commission (CEC) (n.d.) addresses hospital-acquired infections on the whole. The commission pays special attention to the surveillance of the disease at various levels, which should result in precise and reliable statistics regarding disease prevalence and management. This idea is not found in the Adult Pneumonia Guideline (Community and Hospital-acquired) published by the governing body of New South Wales (NSW Health, 2012).

Nor is this recommendation echoed in the Hospital-Acquired Complications Information kit by the Australian Commission of Safety and Quality in Health Care (2018) or the document by the Government of South Australia (2018). This implies that while the CEC fulfills its function as a surveillance body, lower-level facilities are not encouraged to gather data, which could be helpful in understanding trends in their own limited context. The workplace does not have strict procedures regarding data collection, which is consistent with the latter two documents.

The US Centers for Disease Control and Prevention (CDC) (2003) provide recommendations similar to those found in the Australian documents mentioned above. However, the CDC puts forward a suggestion regarding the replacement of nasogastric tubes with oro-tracheal tubes to prevent pneumonia. The Australian guidelines as well as the guidelines published by the Clinical Excellence Commission contain this idea. The workplace does not use oro-tracheal tubes in lieu of nasogastric tubes, instead, it sterilises the latter – a practice that is promoted by all the mentioned governing bodies.

Both New South Wales and the Australian Commission of Safety and Quality in Health Care prioritise risk assessment for further preventive measures. However, the Australian Commission of Safety and Quality in Health Care (2018) pays more attention to listing all possible risk factors and grouping them into various categories such as host and environmental factors. Besides, the Australian Commission of Safety and Quality in Health Care (2018) is more elaborate in its classification of risks into modifiable and non-modifiable, which can be easily translated into prevention strategies. As seen from the present case, the workplace puts an emphasis on risk assessment. However, in A.’s case, the medical staff focused on host factors (smoking, diabetes, age and others) rather than environmental factors (A.’s potential exposure to other patients).

All the guidelines analyzed in this section contain similar recommendations regarding patient treatment. They adhere to antimicrobial treatment as a standard for addressing hospital-acquired pneumonia. The length of treatment cited as the ideal is the same in both New South Wales and statewide documents: from five to seven days. However, the statewide guidelines make it a point to advise treatment length reduction where possible. The rationale behind reduction is the need to decrease patients’ chances of developing antimicrobial reduction. This is consistent with the research by Mendoza and Patel (2016) that provides a caution regarding the use of antimicrobial medication for hospital-acquired pneumonia treatment. The workplace shows commitment to both the regional and statewide guidelines by prescribing A. a seven-day antimicrobial treatment. However, the workplace does not pay regard to reducing the exposure to antibiotics.

Areas for Improvement

The analysis of the case of A. and various recommendations regarding hospital-acquired pneumonia treatment has shown that the workplace needs to concentrate on several growth areas for further HAC rate reduction. The barriers to the administration of evidence-based prevention and treatment strategies fall into three categories: nurses’ limited knowledge and expertise, unfavorable work conditions and incompetent human resource management (Atashi et al., 2018). The first category encompasses a range of smaller issues: professional attitude, lack of specialised knowledge and the lack of motivation, engagement and accountability. As the analysis of relevant guidelines has shown, they do not contain any discrepancies that could appear confusing to medical staff. Hence, the primary cause might lie in healthcare workers’ lack of personal initiative in studying legal texts and seeking ways to implement them. They might not be aware of the wide range of practices targeted at hospital-acquired pneumonia prevention, which is why they have only implemented a few of them.

The second category of barriers is the inadequate hospital environment. While the workplace has shown a high standard for hand hygiene and sterilisation of medical equipment, it was not able to provide A. with chest physiotherapy. Besides, vaccinations have not been widely available or even considered for patients such as A. These two facts imply that as it is right now, the workplace might not be conducive to effective strategy implementation. Lastly, some of the issues might stem from poor human resource management. The workplace is typically overwhelmed with patients, many of which suffer from severe conditions. Heavy workload and staff shortage mean the practical impossibility of paying attention to every single patient. Besides, human resource management at the workplace appears not to prioritise staff training that could propel the implementation of statewide guidelines.

Recommended Changes and Their Implementation

Inadequate hospital environment and poor human resources management would require a profound restructuring of the facility. Since hospital-acquired complications stem from a multitude of factors, addressing them might take recruiting a multidisciplinary team (MDT). The primary advantage of having an MDT at a facility is the complementary nature of each person’s expertise. Due to a variety of skills and knowledge, every member can provide a fresh perspective on a patient’s course of treatment. For instance, in the case of A., the medical staff did dismiss some of the critical factors. Had it been an MDT collaborating on A.’s case, there might have been better suggestions regarding pneumonia prevention. The effectiveness of having an MDT is grounded in hard evidence. For instance, Aoki et al. (2016) show that the presence of a multidisciplinary swallowing team decreases pneumonia onset in acute stroke patients. Such a team can identify the symptoms of dysphagia early on and take measures to protect a patient.

Another meaningful response to the problem described in the previous section is patient and caregiver education, which will address the deficient knowledge of both parties. For nurses, it can take the form of formal (organised sessions) and informal training (workplace mentorship). The focus should be on improving healthcare workers’ accountability and motivation to be proactive as opposed to being reactive and handling consequences. As for patients, they should be educated on host factors for developing hospital-acquired complications. For instance, A. could work on smoking cessation that would, in turn, serve as a relief for his COPD and bronchitis and make him less vulnerable to pneumonia. Hospital-acquired complications require a group effort of all stakeholders and scientific evidence to serve as a basis for bedside interventions.

Reference List

Aoki, S et al. 2016, ‘The multidisciplinary swallowing team approach decreases pneumonia onset in acute stroke patients’, PloS one, vol. 11, no. 5, e0154608.

Atashi, V, Yousefi, H, Mahjobipoor, H & Yazdannik, A 2018, The barriers to the prevention of ventilator‐associated pneumonia from the perspective of critical care nurses: a qualitative descriptive study, Journal of Clinical Nursing, vol. 27, no. 5-6, pp. e1161-e1170.

Australian Commission of Safety and Quality in Health Care 2018, Hospital-acquired complications information kit.

Centers for Disease Control and Prevention 2003, Guidelines for prevention of nosocomial pneumonia.

Guzmán-Herrador, B, Molina, CD, Allam, MF & Navajas, RFC 2016, Independent risk factors associated with hospital-acquired pneumonia in an adult ICU: 4-year prospective cohort study in a university reference hospital, Journal of Public Health, vol. 38, no. 2, pp. 378-383.

Hupp, JR & Ferneini, EM 2015, Head, neck, and orofacial infections: an interdisciplinary approach, Elsevier Health Sciences, Amsterdam.

Mendoza, C & Patel, S 2016, ‘Antimicrobial therapy for hospital-acquired pneumonia’, US PHARMACIST, vol. 41, no. 7, pp. HS11-HS15.

Mitchell, BG, Shaban, RZ, MacBeth, D, Wood, CJ & Russo, PL 2017, ‘The burden of healthcare-associated infection in Australian hospitals: a systematic review of the literature’, Infection, Disease & Health, vol. 22, no. 3, pp. 117-128.

NSW Health (2012) Adult pneumonia guideline (community and hospital-acquired).

Pássaro, L, Harbarth, S & Landelle, C 2016, ‘Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review’, Antimicrobial Resistance & Infection Control, vol. 5, no. 1, p. 43.

Rothberg, MB et al. 2014, ‘Outcomes of patients with healthcare-associated pneumonia: worse disease or sicker patients?’, Infection Control & Hospital Epidemiology, vol. 35, no. S3, pp. S107-S115.

The Clinical Excellence Commission n.d., Hospital acquired complications.

The Government of South Australia 2018, Hospital-acquired pneumonia & ventilator-associated pneumonia (adults) clinical guideline.

Hospital-acquired pneumonia is a severe disease and the reason for the deaths of many people. It is also known as the nosocomial one and is usually caused not by a virus but a bacterial infection. This disease refers to any pneumonia that a patient contracts in a hospital during at least 48–72 hours after being admitted (Meehan and McKenna, 2020). Since it is a serious problem that threatens people and hospitals, some solutions have to be created in order to eliminate this issue. The purpose of this paper is to suggest a way of decreasing the number of patients with hospital-acquired pneumonia and support this idea with several articles.

It is of vital importance to reduce the risks of hospital-acquired pneumonia appearing at hospitals as there are severe consequences of this disease. They include discharge to a long-term care facility, expensive medical treatments, and prolonged lengths of stay in the hospital (Hess et al., 2011). Avoiding the aftermaths depends not only on nursing care but also on the awareness of patients of common measures of preventing the disease. The key idea for reducing the number of people with hospital-acquired pneumonia is that patients should be educated about the host and environmental factors of its development. According to Adamuz et al. (2015), implementing individualized educational programs for patients with hospital-acquired pneumonia is rather effective and helps to reduce rehospitalizations and subsequent healthcare visits. If people know the factors of the development of this disease, they are more protected from catching it.

Some of the patients are at the highest risk of catching hospital-acquired pneumonia. The risk factors include previous antibiotic treatment; a coexisting illness such as kidney, liver, lung, and heart dysfunction; age older than 70; and recent abdominal or chest surgery (Sethi, 2019). Moreover, the use of proton pump inhibitors like esomeprazole or pantoprazole for gastroesophageal reflux disease treatment may also be the risk factor.

Reference List

Adamuz, J. et al. (2015) ‘Impact of an educational program to reduce healthcare resources in community-acquired pneumonia: the EDUCAP randomized controlled trial’, PLoS One, (10)10.

Meehan, C. D. and McKenna, C. (2020) ‘Preventing hospital-acquired pneumonia’, American Nurse Journal, 15(2), pp. 16-21.

Sethi, S. (2019) Hospital-acquired pneumonia.

Clinically, mucor is known as a fungal mold and a microbial genus. This mold can be found in a human’s digestive system and even in the soil or rotten plants. According to Liu (2011), mucor is normally known to grow as a white to gray mold. Biologically, mucor is a member of the zygomycetes species. Mucor is known to grow in environments with very high temperatures. Although mucor is economically significant and not necessarily harmful to humans, it can also cause infections.

A patient is likely to get an infection through mucor if they inhale the fungal spores. In addition, the inhaling of the conidia can be dangerous to a patient with a weak immune system. The possibility of such infection is high if the patient is suffering from other ailments such as cancer, diabetes, and kidney failure. Medics have also reiterated that patients receiving medication for acute iron poisoning can highly get a mucor infection (Liu, 2011).

The pathophysiological progression of the mucor infection into pneumonia is started by a causative agent. In this case, the mucor is inhaled into the human body through the respiratory tract. It has also been proven that the aspiration of oral secretions is one of the ways through which causative agents gain entry into the human body. Consequently, the causative agent enters the lungs with the aid of the circulating blood. In this context, the commonly known causative agents are mucormycosis, Histoplasma capsulatum, Cryptococcus neoformans, and coccidioides immitis. The causative agent multiplies and causes inflammation and edema of the lungs. This is because such causative agents can release toxins that damage the lungs. Pneumonia will only occur if air sacs and lungs’ airways are unable to function properly (Anatomical Chart Co, 2005). This is only possible if liquid instead of oxygen fills into the air sacs.

In the case of mucormycosis, pneumonia intervention entails surgery (Shields, 2005). This intervention should be conducted during the early disease detection stage. Surgical intervention entails removing the already infected tissues or dead tissues. This can also be supplemented with intravenous antifungal therapy. The use of antifungal drugs can also be prescribed for the patient. Such drugs include antibiotics or echinocandins.

Abnormal lab values are considered as results, not within the range of results that can be termed as normal. In this case, there is always a need to redo the lab test on the patient. In this case, the abnormal results should be compared with what is considered normal. From the laboratory tests, the abnormal values are that the patient is not having enough oxygen, is unable to exhale enough carbon dioxide and the patient is having a kidney malfunction.

Lack of enough oxygen may result from respiratory depression, which is a result of pneumonic infection. Moreover, such can also be caused by overexposure to narcotics and ailment from chronic obstructive pulmonary disease (Anatomical Chart Co, 2005). In this context, it also becomes difficult for the patient to get rid of the carbon dioxide, while having a chronic obstructive pulmonary disease or pneumonia (Anatomical Chart Co, 2005). The emotional distress that emanates from such experiences interferes with oxygen and carbon dioxide exchange. On the other hand, metabolic acidosis due to lower pH affects kidney functions.

Lack of enough oxygen requires the admission of antibiotics. This is because the patient may have other lung infections.

If the patient cannot get rid of the carbon dioxide, they can receive supplemental oxygen. This means they have to be hospitalized for a while.

Kidney malfunction can be treated by drinking plenty of fluids. This can help to ease the secretion of body toxins.

References

Anatomical Chart Co. (2005). Anatomy and pathology. Baltimore, MD: Lippincott Williams & Wilkins.

Liu, D. (2011). Molecular detection of human fungal pathogens. Boca Raton, FL: CRC Press.

Shields, W. T. (2005). General thoracic surgery, 6e. Baltimore, MD: Lippincott Williams & Wilkins.

Introduction

Pneumonia is a serious infection that affects the lungs. The disease weakens respiration by enabling fluids to seep into the alveoli (Adamec, 2011). The article below focuses on a nursing intervention of a pneumonia case study.

Nursing intervention

Ineffective breathing pattern

A nurse managing the patient illustrated in the case study should first assess the presence of impaired breathing pattern. The above involves chest physiology, suctioning when necessary and monitoring oxygen saturation. Auscultating lung fields and elevating the head of bed should also be undertaken (Fields, 2008). Uneven chest movement is expected owing to distress caused by moving chest wall. Elevating the head bead will help in lowering the diaphragm and enhancing chest expansion.

Nutrition

Imbalanced nutrition should also be assessed. Based on the case study, a nurse is expected to implement nil by mouth and intravenous plug patency (Simmons, 2010). Hydration is expected owing to nil by mouth intervention. When experienced, oral fluids should be administered.

Risk of fall

To minimize the likelihood of fall, a nurse should educate the patient on how to sit and sleep on the hospital bed. Similarly, the patient should be admitted near the nurses’ counter for easy monitoring.

Risk of infection

Nurses should be on the frontline in designing and executing policies, which enhance effective oral care supplies, accessibility to supplies, and safety measures that ensure patients are safeguarded from nosocomial infection. Intravenous plug care should also be administered (Bingham, 2010). Similarly, the patient should be encouraged to sit up in bed. Through this, pneumonia will be prevented from deteriorating.

Medication

Administer fever, vomiting, and diarrhea drugs. Similarly, antibiotics and mucolytic and analgesic drugs should be given to the patient. The drugs will help in lessening bronchospasm and deployment of secretions (Doenges, 2010). Analgesics will boost cough effort by reducing discomfort. The drug should be used vigilantly since it can reduce cough effort and lower respirations. Thereafter, a nurse should monitor the effectiveness and side effects of these medicines.

References

Adamec, C. (2011). Pneumonia. New York, NY: Chelsea House.

Bingham, M. (2010). Implementing a Unit-Level Intervention to Reduce the Probability of Ventilator-Associated Pneumonia. Nursing Research, 59(2), S40-S47.

Doenges, M. (2010). Nursing care plans. Philadelphia: F.A. Davis Co.

Fields, L. (2008). Oral Care Intervention to Reduce Incidence of Ventilator-Associated Pneumonia in the Neurologic Intensive Care Unit. Journal Of Neuroscience Nursing, 40(5), 291-298.

Simmons, S. (2010). Recognizing and preventing Mycoplasmal pneumonia. Nursing, 40(3), 53-56.

The differentiation between symptoms of acute bronchitis and pneumonia can be discussed as a challenging task because the majority of symptoms or their signs are similar, especially in middle-aged and elderly persons. However, some differences should be discussed in detail. In a 55-year-old person who suffers from bronchitis, the most typical symptom includes a dry cough that becomes productive in several days. The produced mucus is usually clear or yellow, and the fever is usually mild or not observed (Albert, 2010, p. 1346). When a 55-year-old person suffers from pneumonia, the typical symptoms also include coughing, but it is usually productive. The mucus can be of a yellow or greenish color, the fever is usually present, and it is high (Bonten, Bolkenbaas, Huijts, Webber, & Gault, 2014). Even though these symptoms are similar to the signs of acute bronchitis, it is important to focus on the fast heart rate (more than 100 beats per minute) and the increased respiratory rate (more than 25 breaths per minute) (Bonten et al., 2014). These symptoms are characteristic of pneumonia.

However, the final diagnosis can be determined only with references to the chest X-ray testing because the results are usually normal for acute bronchitis, and there are changes typical of pneumonia (Albert, 2010). In addition, it is necessary to analyze the results of the blood test (Bonten et al., 2014, p. 96). In patients older than 50 years, the symptoms of acute bronchitis and acute pneumonia can be very similar, and it is almost impossible to diagnose the problem without the X-ray testing and analysis of the heart and respiratory rates with the focus on daily changes in the body temperature.

Both acute bronchitis and pneumonia are often caused by pathogens. The usual causes of community-acquired pneumonia are S. pneumonia, H. influenza, Klebsiella pneumonia, S. aureus, M. catarrhalis, among others (Bonten et al., 2014). Acute bronchitis can be caused by a variety of pathogens that include S. pneumonia, H. influenza, and M. catarrhalis similar to pneumonia, as well as Chlamydia pneumonia and Mycoplasma pneumonia (Albert, 2010). To treat these conditions in middle-aged and elderly persons, it is important to propose an effective treatment plan based on using appropriate antibiotics to which the determined pathogens are not resistant.

In addition to the effectiveness of the proposed treatment, the management of these diseases can be influenced by certain cultural factors. Representatives of different cultures can perceive the medical treatment differently (Suarez, Bunsow, Falsey, Walsh, & Mejias, 2015). For instance, if one of the discussed patients is Hispanic, he or she can view diseases according to the ‘hot-cold’ balance. Therefore, such ‘cold’ diseases as acute bronchitis and pneumonia can be treated with the help of ‘hot’ medications, including antibiotics and vitamins. However, if the other patient is representative of the Asian culture, he or she can insist on using herbal or natural alternatives to chemicals.

In addition, the process of diagnosing can be challenging because persons can resist using X-rays to determine the final diagnosis. One more issue is the language barrier. Therefore, while planning the treatment, the healthcare provider and nurse should guarantee that the patient understands how to take certain medications and follow the treatment plan. Any cultural differences and impacts should be taken into account while managing the disease.

References

Albert, R. (2010). Diagnosis and treatment of acute bronchitis. American Family Physician, 82(1), 1345-1350.

Bonten, M., Bolkenbaas, M., Huijts, S., Webber, C., & Gault, S. (2014). Community acquired pneumonia immunisation trial in adults. Pneumonia, 3(13), 95-99.

Suarez, N. M., Bunsow, E., Falsey, A. R., Walsh, E. E., & Mejias, A. (2015). Transcriptional profiling is superior to procalcitonin to discriminate bacterial vs. viral lower respiratory tract infections in hospitalized adults. Journal of Infectious Diseases, 1(2), 47-56.

Introduction

Ventilator-associated pneumonia (VAP) is a sub-category of hospital-acquired pneumonia (HAP), which occurs in patients exposed to technical airflow/ ventilation for more than 48 hours. VAP is not recognized by the causative agents; rather, as indicated through its name, the meaning of VAP is limited to patients exposed to mechanical airflow while at the medical center. A good culture following intubation is a sign of ventilator-associated pneumonia and is clinically diagnosed as such.

To be able to properly classify the causative mechanism or agent, it is usually suggested to acquire culture, before the start of technical ventilation, as a reference procedure. Many patients under mechanical ventilation are most times sedated, therefore, rarely capable of communicating. As a result, many of the characteristic symptoms of pneumonia will either be non-existent or not recordable. These include low body temperature, fever, hypoxemia, and new purulent sputum.

The condition is diagnosed and detected; in case a patient registers increasing white blood cell count during a blood test, after exposure to the ventilation process (American Thoracic Society and the Infectious Diseases Society of America, 2005, pp. 388-412).

This condition is the most prevalent nosocomial contamination among ICU patients. Systematic reviews have shown that VAP affects 10-20% of the patients exposed to mechanical ventilation for over forty-eight hours. The approximate mortality rate among patients suffering from VAP is between 24-50%, rising to 76% in cases where the infection is caused by a multi-resistant agent.

The patients who suffer from VAP are twice, as likely to die, as opposed to those not affected by it. The condition also leads to increased ICU stay and costs. Therefore, addressing the incidences of VAP will aid in improving healthcare efficiency, and the outcomes registered among patients.

This report is drawn to present an evidence-based change process, to address the problem of ventilator-associated pneumonia, through identifying the safety concerns of the patients, presenting the plan of the evidence-based change, and the setting of measurable objectives, towards the realization of the change (American Thoracic Society and the Infectious Diseases Society of America, 2005, p. 388-412).

Problem Statement

Ventilator-associated pneumonia is a prevalent problem in intensive care units (ICUs) globally, which results in increased mortality and morbidity rates, among mechanically aerated patients. It is the most prevalent infectious condition among patients at ICUs. When a patient suffers from VAP, their ICU stay is lengthened, which results to increasing hospital stays as well as the possibility of death, among critically ill ICU patients (Tablan et al., 2004; George, 1993, pp. 164-165).

Epidemiological surveys show that the condition leads to cumulative incidence levels of 10-25% approximated mortality levels among 10-40% of critically ill patients, and attributable death rates of 5-27% among ICU patients (Kollef, 1999, pp. 627-634). VAP is the principal cause of death, among the varied hospital-acquired infections (HAI), registering more than the rate of deaths resulting from central line infectivity, respiratory tract contamination among non-intubated patients, and severe sepsis. Possibly, the most concerning facet of VAP is the high level of related mortality, which goes to an approximated 46% as compared to 32% among those who do not develop the condition (Ibrahim et al., 2011).

Project statement: goal for the planned change

Although two of the bundled strategies are aimed at the reduction of VAP, the other two are aimed at preventing other likely complications, resulting from mechanical ventilation, including stress ulcers and DVTs. The intent of the planned change is the realization of a healthcare design, which can replicate the success expressed through the literature on bundled practices.

This area of planned change is based on the review of literature, sourced from evidence-based studies, applied in the practice of bundled practices. The study will focus on exposing the interventions in ventilator bundles. VAP planned change areas include identifying the strategies necessary towards the implementation of change to bundled practice and exposing the implications of the shift, which are expected to reduce the prevalence and incidences of VAP.

The goals for the planned change include the realization of an incorporated collection of interventions related to ventilator care, which presents better outcomes, as opposed to when the strategies are implemented individually. The utilization of the integrated component should result in a reduction in the prevalence of VAP (Hatler et al., 2006).

Objectives of the study and practice

The objectives of the study include taking an observational role in the administration of healthcare, where investigators do not control the intervention in a direct manner but focus on the comparison of the sequential study groups. The studies to be incorporated into the inquiry should be prospective and retrospective cohort studies, as the samples are defined before the start of the study as well as at the end of the observation duration.

The investigators should administer a follow-up study in real-time after their identification as cohorts, to evaluate the impacts of VAPBs on the declining VAP rates and the velentilatory days registered (Crunden et al., 2005). The study should also feature theory-guided project execution, encompassing prospective observation and self-reports.

There is also the objective to ensure adherence to treatment protocols, bridging the differences in staff competency and the variable nature of bundle implementation. However, due to the focus on historical controls in a non-randomized way, selection bias may become a risk, towards the internal validity of the inferences drawn from the study (Sheldon, 2001).

Agency and the identified need: practice site requiring change

St. Michaels medical Center (SMMC) has identified that there is the problem of the failure to realize patient outcomes, among patients exposed to mechanical ventilation. There is also the problem of congestion at the ICU center, mainly because the patients going in are registering long durations of stay; average count of days spent under ventilation. Lengthy durations are registered at the ICU and the prevalence of ventilator-associated pneumonias is also very high.

Due to the need for the change of ventilation exposure models and processes, aimed at the reduction of the adverse effects of these challenges, the center collaboratively operating with the OSF system-wide protocol on patient safety, set out for the implementation process. The efforts were crowned by the guidelines presented by the Institute for Healthcare Improvement (IHI) on ventilator bundles at the ICU, to increase the outcomes for patients and improve the care offered (Altman et al., 2001).

Change: the end product results

The process to be involved in affecting the change, include the review of literature for evidence-based support of the changes to be implemented, so as to determine and explore their success and their applicable nature to the case of the medical center. From the review, the major guides of the change process will have insights on the approach to use during the implementation of the changes in a successful manner, which works best for its case.

The next step is the consultation between the patient safety personnel, respiratory therapy personnel and the ICU nurses, who will deliberate upon the components of the SMMC’s bundle, which will fit into the respiratory usage and the ventilator package protocol for ICUs. The next change implementation procedure is the training of the staff from the different departments, instructing them on interventions and the protocols to be observed (Resar et al., 2005).

The successful usage of the ICU ventilator bundles presents the need for the ownership and acceptance of the project among the respiratory therapy personnel, and the department in general, as well as the ICU personnel and the ICU department (Hampton et al., 2005).

The results anticipated by the center included the reduction of ventilator-associated pneumonia, a reduction in the average duration of stay at the ICU and the ventilator machine. At the onset, the objective of SMMC was to register 90% compliance with the instructional directives of the vital components of the ventilator management.

These included the elevation of the head section of beds at 30 degrees, dealing with peptic ulcer disease (PUD), deep venous thrombosis (DVT), oral care, hand hygiene, suctioning after every 2 hours or as the case may require, respiratory checking of the airway status on a two-hourly basis, and the assessment for readiness to exubate on a daily basis. Through the ventilator bundle implementation, SMMC realized 100% compliance from each of the intervention models (Altman et al., 2001).

The change Agents: implementation team at the agency

The implementation/ change agents team included the researchers observing the implementation of SMMC’s ventilation bundle, who took a conservative role; they were not actively involved in the implementation of the change process throughout the implementation process. The second group of agents is the ICU charge nurses and the nursing team in general, as it offered support to the implementation of the change process. The third group is respiratory therapy personnel, who play a key role in aiding the implementation areas directly linked to respiratory measures. The last agent is the patient safety officer, who is responsible for maintaining the safety of the processes for the advantage of the patients.

Theory: the planned change theory

The planned change theory will be affected on the basis of Lewin’s three-step change theory, which explains that human behavior is dynamic, reaching a balance of forces working against each other. The driving forces aid change, as they push the parties to the implementation process, towards the desired direction of change. The restraining forces impede change, as they push employees against the direction against the desired change.

According to this model, these forces should be analyzed towards manipulating the shift, towards the planned change. The first stage is unfreezing, which is the phase of getting the medical center ready for the change; making the players experience the need for the change. At this stage, the different parties will be briefed on the positive effects of the shift. An example here will be the promise of reduced work load due to the reduced ICU and ventilation durations.

The second phase is the transition phase, which covers the change process, in case of implementation and usage of the new ventilation model. This phase will require support in the form of expecting mistakes, coaching and offering training among the different implementation teams. The third phase is freezing or refreezing, which will involve imposing stability into the change process realized (Lewin, 1958).

Project approach: strategies for accomplishing the evidence-based initiative

The strategies for the realization of the evidence-based practice for preventing VAP and its effects on patient healthcare outcomes, will take place through a continuing follow-up. The care bundle model will be based on the five interventions to be implemented at the medical center, which is to be recorded for the next sixteen months.

There are 885 subjects at the start of the implementation and the number is expected to increase. Compliance at the start of the implementation is 30%, but is expected to rise to almost 100%. After starting the program, VAP incidence reduced from 15.5 to 11.7%. The reduction so far, is associated to intra-cuff pressure control, hand hygiene, sedation control and oral hygiene (Rello et al., 2012).

Barriers: barriers to the implementation of the strategies

The barriers to the implementation of the ventilator bundles include the resistance of nursing personnel, especially in the cases they felt that the planned change compromised the comfort of the patient or risks the incidence of adverse effects. There was also the barrier of non-compliance with daily goals and required standards. There were also cases of inconsistencies during the implementation of bundle interventions.

Recommendations on addressing the barrier areas

Towards addressing these barriers, the main area of concern will be realizing the full confidence of the implementing parties, as per Lewin’s three-step theory of change. The address will start with the administration of further training an education on the benefits of adopting the ventilator bundles, placing emphasis on the risk-reduction strategies and the safety of the patients administered to the model. The other focus will be associating the change to rewards like recognition of the players who successfully implement the strategies.

Conclusion

Ventilator-associated pneumonia is a sub-category of hospital-acquired pneumonia, which occurs on patients exposed to technical airflow for more than 48 hours. This condition is the most common among ICU patients, leading to mortality rates of between 24-50%. VAP is the most prevalent infection among ICU patients, leading to lengthened hospital and ICU center stays, thus increased healthcare costs.

Following the adversity of the effects of the condition, it is clear that there is need to reduce the adversities and the deaths resulting from the condition. The goal for the planned change is reducing the VAP and the conditions resulting from the condition. The objectives of the study include taking an observation role to the strategies, where the subject group will be reviewed before and after the study.

The agency in need of the change is St. Michael’s medical center, as it seeks to realize better patient outcomes and the conditions resulting from exposure to mechanical ventilation. The end results from the change implementation include the reduction of VAP incidences to 0, for the past 20 months and a decrease in average ventilation days to 2.98 from 4.76. The change agents include the researchers, the patient safety officer, ICU nurses, and respiratory therapy personnel among other aiding personnel.

The planned change theory is Lewin’s three step model, which explains change in human behavior as one that goes through unfreezing, transition phase and the refreezing phases. The project approach will be affected through a continuing follow-up. The barriers to the implementation of the strategy include the concerns of nurses over the safety of the patients, which will be addressed through re-education and further training, to affirm the effectiveness of the model and the patient’s safety.

References

Altman, D et al. (2001). The revised CONSORT statement for randomized trials: Explanation and elaboration. Annals of Internal Medicine, 134 (8), 663–694.

American Thoracic Society and the Infectious Diseases Society of America. (2005). ATS/IDSA Guidelines: Guidelines for the management of adults with HAP, VAP, and HCAP. Am J Respir Crit Care Med., 171 (4), 388–412.

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Hampton, D et al. (2005). Evidence-based clinical improvement for mechanically ventilated patients. Rehabilitation Nursing, 30 (4), 160–165.

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Ibrahim, E. H et al. (2001). The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical outcomes. Chest, 20 (2), 555-561.

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Lewin, K. (1958). Group decision and social change. New York: Holt, Rinehart and Winston.

Rello, J et al. (2012). A care bundle approach for prevention of ventilator-associated pneumonia. Clin Microbiol Infect, 10, 11-23.

Resar, R et al. (2005). Using a bundle approach to improve ventilator care processes and reduce ventilatorassociated pneumonia. Journal on Quality and Patient Safety, 31 (5), 243–248.

Sheldon, T. (2001). Biostatistics and study design for evidenced-based practice. American Association of Critical Care Nurses Clinical Issues, 12 (4), 546–559.

Tablan, O et al. (2004). CDC; Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep, 53 (RR-3), 1-36.

Given the chest x-rays (CXR) results showing pneumonia, her elevated white blood cells (WBC) count, combined with elevated ferritin, D-dimer, and c-reactive protein (CRP), suggests that she has a systemic inflammatory response. Additionally, Beverley’s lymphocytes are elevated, which indicates a viral cause. Her physical symptoms confirm that she has low oxygenation despite oxygen use, fever, and such symptoms as lack of appetite, diarrhea, myalgia, cough, and runny nose. Despite her negative COVID-19 test last week, her symptoms point to a COVID-19 diagnosis.

Pneumonia could be the correct pathology for Beverly’s weakness because the patient exhibits coughing, fever, chest pain, difficulty breathing, headache, tiredness, and appetite loss. Moreover, the CXR results and elevated WBC count show a high likelihood of pneumonia. The correct diagnosis could be influenza because the patient shows signs of coughing, fever, diarrhea, and headache (Azer, 2020). In addition, Beverley is feeling tired almost always and has an aching body. The accurate pathology for Beverly’s weakness would be COVID-19 since the virus is a mild illness that shows cough and fever as the primary symptoms, which she has. Furthermore, the patient appears to be having symptoms of tiredness, headache, runny nose, diarrhea, body aches, and difficulty breathing. In 2020, I witnessed COVID-19 patients die upon reaching the hospital due to shortness of breath.

A cytokine storm refers to an aggressive immune response that is accompanied by interleukins, chemokines, interferons release, and other mediators (Fajgenbaum & June, 2020). The immune response is often hyperactive, which leads to a highly inflammatory reaction to the COVID-19 infection (Hu, Huang, & Yin, 2021).

An elevated CRP in the blood is an indicator of inflammation, tissue damage, and infections (Landry, Docherty, Ouellette, & Cartier, 2017). Additionally, elevated CRP levels can mean that there is inflammation in the heart’s arteries indicating a higher likelihood of heart attack (Huang et al., 2020).

Elevated ferritin levels show that a patient’s body has a condition that makes their body accumulate excessive iron (Huang, Pranata, Lim, Oehadian, & Alisjahbana, 2020). I have seen several instances where general patients with high ferritin levels showed many clinical conditions and poor outcomes.

People watch the D-dimer level to determine whether they have a blood clotting disorder such as the deep vein disorder (DVT) that impacts the lower legs (Yu et al., 2020). When the D-dimer test is positive, a patient’s body can have high fibrin products degradation (Yao et al., 2020).

After entering the body, COVID-19 viruses bind themselves to host receptors and use membrane fusion or endocytosis to enter host cells. Post-membrane fusion, the COVID-19 viruses enter the pulmonary epithelial cells and release viral contents into the cells (Velavan & Meyer, 2020). COVID-19 replicates and forms a negative RNA strand in the host cells (Azer, 2020). The first phase of the attack happens in the upper respiratory tract through conducting airways (Hu et al., 2021). Due to the upper airways’ involvement, the patient starts mild symptoms such as fever, tiredness, malaise, shortness of breath, and dry cough.

As a future advanced practice registered nurse, comprehending infectious diseases’ pathology is crucial for me. Likewise, understanding the effects of essential medical terms is critical. The information gained on the pathology and pathophysiology of influenza, COVID-19, and bacterial pneumonia will be crucial for assessing and evaluating patients with similar symptoms. For instance, a positive D-dimer test would indicate a patient has a high level of fibrin degradation, which would be easy for me to identify. Advanced practice registered nurses should understand pathology to effectively diagnose, create treatment plans, as well as assess patient outcomes.

References

Azer, S. A. (2020). COVID-19: pathophysiology, diagnosis, complications and investigational therapeutics. New Microbes and New Infections, 37, 100738. Web.

Fajgenbaum, D. C., & June, C. H. (2020). Cytokine storm. New England Journal of Medicine, 383(23), 2255-2273. Web.

Hu, B., Huang, S., & Yin, L. (2021). The cytokine storm and COVID‐19. Journal of Medical Virology, 93(1), 250-256. Web.

Huang, I., Pranata, R., Lim, M. A., Oehadian, A., & Alisjahbana, B. (2020). C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: A meta-analysis. Therapeutic Advances in Respiratory Disease, 14. Web.

Landry, A., Docherty, P., Ouellette, S., & Cartier, L. J. (2017). Causes and outcomes of markedly elevated C-reactive protein levels. Canadian Family Physician, 63(6), e316-e323. Web.

Velavan, T. P., & Meyer, C. G. (2020). The COVID‐19 epidemic. Tropical Medicine & International Health, 25(3), 278. Web.

Yao, Y., Cao, J., Wang, Q., Shi, Q., Liu, K., Luo, Z.,… & Hu, B. (2020). D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: A case-control study. Journal of Intensive Care, 8(1), 1-11. Web.

Yu, H. H., Qin, C., Chen, M., Wang, W., & Tian, D. S. (2020). The D-dimer level is associated with the severity of COVID-19. Thrombosis Research, 195, 219-225. Web.

The present article is primarily preoccupied with the examination of the COVID-19 phenomenon and its efficient treatment in the context of current medical opportunities and future interventions.

Since the virus’s emergence in China at the end of 2019, it has been associated with pneumonia as a major side effect of the infection, catalyzing a high number of deaths from pneumonia complications. The authors of the present research address the topic of diagnosing pneumonia at the early stages of the disease to prevent people from severe complications. The authors consider chest computer tomography (CT) as the most efficient means of detecting pneumonia among coronavirus patients. Thus, the broad topic area of the present research concerns the notion of pneumonia in the context of COVID-19 treatment. Moreover, the article also addressed the regularity of patients’ admission to the Intensive Care Units (ICUs) as a result of neglected CT diagnostics.

In terms of the present study, the primary objective was to define the extent to which chest CT intervention at an early admission stage could be a decisive factor in terms of preventing admission to the ICU. Although the study itself tackles many individual characteristics of a patient, including gender, health state, and exposure to the areas with high risks of coronavirus infection, the primary emphasis was placed on the patients’ exposure to timely chest CT screening.

Thus, the alternative hypothesis outlined by the researchers may be defined as follows:

H₁: The quantitative parameters originated from chest CT, along with the clinical paraments on hospital admission, may potentially affect the prediction of risk of ICU admission among the COVID-19 pneumonia patients.

The data collected for the study variables were mostly quantitative, as the researchers had to define a tangible justification of the hypothesis.

The study comprises an extensive number of independent variables that tackle both CT factors and individual factors related to one’s hospital admission. The first segment of independent variables includes:

• Age;
• Gender;
• Exposure to Wuhan for two weeks prior to the admission;
• Family clusters;
• Coexisting conditions include cardiovascular disease, COPD, chronic liver disease, diabetes, and others.

Another significant independent variable concerned whether the patient belonged to the ICU care.

Other variables included the onset of symptoms, vital signs, and laboratory findings both inside and outside ICU care. The dependent variable, in its turn, concerns the patient’s treatment process after the timely chest CT intervention among high-risk COVID-19 patients with pneumonia.

In order to secure the study’s efficiency, the authors did not impose any limitations on the age, gender, and health conditions of the target population. Thus, the primary population of interest for the existing study addressed COVID-19 patients admitted to the hospital premises with pneumonia. Since the study is multicenter, the population encompassed various medical facilities in China. A significant criterion for eligibility was the fact of a patient undergoing chest CT that indicated such major characteristics as the lung opacity (predicted volume of abnormalities in lungs in juxtaposition with the normal lung volume).

The sample was collected from different hospital facilities in China and eventually accounted for 221 patients that were admitted to the hospital with pneumonia and COVID-19 during the period from January 17, 2020, to February 17, 2020.

The further classification of the sample may be defined as follows:

• Male patients – 125;
• Female patients – 96.
• Admitted to the ICU after pneumonia and COVID confirmation – 40;
• Pneumonia and COVID handled without ICU admission – 181;
• Deaths in the process of trial – 3 cases (all took place among the patients admitted to ICU).

The multicenter clinical trial was the primary sampling method. Thus, the researchers accounted for every registered COVID-19 case with pneumonia in the designated hospital settings. Once the patient passed the eligibility criteria, their medical history was recorded in order to create the demographic of the sample. If patients had no CT examination on admission or were sent directly to ICU without preliminary screening, they were excluded from the trial.

The data were collected with the help of the PRISMA framework, following such eligibility criteria:

1. Identification. 310 patients with confirmed COVID-10 pneumonia were selected.
2. Screening. 75 patients were excluded due to the lack of key laboratory data or direct ICU admission.
3. Eligibility. 14 patients were excluded due to the absence of CT examination on admission.
4. Included. The final sample pattern accounted for 221 participants (40 admitted to the ICU care). Excluding 3 patients that died during the hospital stay, 218 patients were discharged before March 14, 2020.

Reference

Yan, C., Chang, Y., Yu, H., Xu, J., Huang, C., Yang, M., Wang, Y., Wang, D., Yu, T., Wei, S., Li, Z., Gong, F., Kou, M., Gou, W., Zhao, Q., Sun, P., Jia, X., Fan, Z., Xu, J., Li, S., & Yang, Q. (2021). Clinical factors and quantitative CT parameters associated with ICU admission in patients of COVID-19 pneumonia: A multicenter study.Frontiers in Public Health, 9(332). Web.

Regardless of the principles of its organization and level of functioning, the main task of any health care system is to provide a guaranteed opportunity for every citizen of the country to live a long, healthy, and productive life. Medical professionals face an essential task – to provide timely assistance. The importance of making a correct diagnosis is obvious – even the most correct treatment for a false diagnosis can cause serious harm to health.

The diagnosis of a fifty-year-old man can be pneumonia. Most likely, the patient is suffering from viral pneumonia, as the man mentioned the recent illness of a neighbor. For a mild degree of this disease, a light state of intoxication, light fever with a temperature up to 38°C, normal arterial pressure, and a heartbeat less than 90 beats per minute, no difficulty in breathing, and the insignificant inflammatory phenomenon is found (Marchello et al., 2019). In most lung diseases, the bacterium Streptococcus pneumoniae, which doctors call pneumococcus, is to blame (Weiser et al., 2018). The peculiarities of the duration of pneumonia are defined by the seriousness, the features of the causative agent, and the existence of harmful consequences. Their occurrence is hazardous for elderly patients, therefore timely treatment is necessary.

The exact cause of respiratory diseases, accompanied by a cough with green sputum, is designed to establish diagnostics. Such studies as biochemical blood tests, respiratory tract examinations, and bacterioscopy sputum smears are required. Azithromycin, a macrolide group antibiotic, should be prescribed. It has a broad spectrum of antimicrobial action, and Gram-positive microorganisms are sensitive to it (Keenan et al., 2019). The patient can also be prescribed oseltamivir (Tamiflu), which inhibits neuraminidase and destroys the receptors of the infected cell for viral hemagglutinin (Shi et al., 2017). Due to the inhibition, the release of viruses from infected cells and the spread of the virus are reduced.

In conclusion, the patient can be diagnosed with a case of viral pneumonia. Pneumonia is a lung disease, an acute and severe disease of the inferior breathing organs of a contagious kind. This is indicated by the symptoms and the recent illness of a neighbor, from which the man could become infected. For treatment, the antibiotics Azithromycin and Oseltamivir (Tamiflu) can be used.

References

Keenan, J. D., Arzika, A. M., Maliki, R., Boubacar, N., Elh Adamou, S., Moussa Ali, M., Cook, C., Lebas, E., Lin, Y., Ray, K.J., O’Brien, K.S., & Doan, T. (2019). Longer-term assessment of azithromycin for reducing childhood mortality in Africa. New England Journal of Medicine, 380(23), 2207-2214.

Marchello, C. S., Ebell, M. H., Dale, A. P., Harvill, E. T., Shen, Y., & Whalen, C. C. (2019). Signs and symptoms that rule out community-acquired pneumonia in outpatient adults: A systematic review and meta-analysis. The Journal of the American Board of Family Medicine, 32(2), 234-247. Web.

Shi, Y., Zhang, B., Lu, Y., Qian, C., Feng, Y., Fang, L., Ding, Z., & Cheng, D. (2017). Antiviral activity of phenanthrenes from the medicinal plant Bletilla striata against influenza A virus. BMC Complementary and Alternative Medicine, 17(1), 1-14. Web.

Weiser, J. N., Ferreira, D. M., & Paton, J. C. (2018). Streptococcus pneumoniae: Transmission, colonization and invasion. Nature Reviews Microbiology, 16(6), 355-367. Web.

Purpose: Patient education is essential in promoting patient wellness and health. Pneumonia is a deadly disease if not treated early or prevented. This plan indicates educating the pneumonia patient on the best methods to promote his health by following the right and recommended medication and future prevention methods. The patient will also be accompanied by a family member who will also learn how to handle the patient and how to prevent the occurrence of the disease.

Goal: It is crucial to educate the patient on the importance of completing the right doses within the specified time and employing the reliable methods applicable in the prevention of the disease. In addition, this plan aims to teach the patient the causes and various ways the disease is contracted. Besides, its goal is to train the family member on the best way to handle the patient with care and love while at home.

Reference

Lewis, S., Bucher, L., Heitkemper, M., Harding, M., Barry, M., Lok, J., Tyerman, J., & Goldsworthy, S. (2019). Medical-surgical nursing in Canada (4^th ed.). Toronto, Elsevier.