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Unit V Promoting Health in Patients With Oxygenation Disorders
• Vibration/percussion • Early mobility
l Encourage “at-risk” patients to get a pneumonia vaccine.
Pulmonary hygiene is done in an effort to mobilize res- piratory secretions and allow expectoration. This reduces the incidence of atelectasis and worsening pneumonia in hospitalized patients. l Patient positioning Elevating the head of the bed to 30 degrees prevents aspi- ration of colonized nasopharyngeal secretions and gastric contents and facilitates lung expansion. Side-to-side turning assists with alveolar recruitment strategies to ensure maxi- mum ventilation–perfusion. For infiltrates of only one lung, when turning, preferentially position patient with the good lung down to maximize perfusion to the functional alveolar units. l Monitor intake and output. Optimal fluid balance assists with thinning respiratory secre- tions for ease of expectoration and maintains adequate tissue perfusion/oxygenation. l Ensure adequate nutritional support. Adequate caloric intake is necessary for cellular recovery. Small, frequent meals that are high in protein and vitamins are recommended. Assess cough, gag, and swallow reflexes prior to offering food and drink. If reflexes are impaired, maintaining NPO status or initiating enteral feedings via feeding tube may be required until a formal swallow evalu- ation can be obtained and the degree of aspiration risk can be determined. l Activity grouping Approach activities of care with intervals of rest. Fatigue and decreased tissue oxygen delivery limit activity tolerance. ■ Teaching l Hand hygiene and respiratory etiquette Frequent and effective hand washing is the most effective method for minimizing the spread of infectious organisms. Proper use and disposal of tissues for sneezing and coughing are also important. l Encourage adequate rest. Introduce strategies to combat fatigue and conserve energy. l Take antibiotics as prescribed; stress the importance of finishing all medication even if patients begin to feel better. Antibiotics offer a “cure” for bacterial infections. Incomplete treatment can lead to a recurrence of symptoms and the emergence of drug-resistant organisms. l Encourage proper nutrition and fluid intake. Adequate nutrition is essential for healing and recovery from respiratory infections. Sufficient fluid intake can thin secretions for easy expectoration. l Understanding of signs and symptoms indicating wors- ening respiratory status; how and where to seek medical attention Patients and families should be able to verbalize a clear understanding of which signs and symptoms indicate the need to seek medical attention.
Vaccination affords the best protection against future illness from pneumonia. As part of the national hospital perfor- mance measures, the CMS and TJC require all inpatients to be screened for the pneumonia vaccine and offered the vaccine
before discharge if appropriate. Evaluating Care Outcomes
Patients with mild cases of bacterial pneumonia are success- fully managed as outpatients on oral antibiotic regimens. Most patients with pneumonia requiring hospitalization fully recover from their illness and are discharged without complications. A well-managed patient recovering from bacterial pneumonia will demonstrate stable vital signs, absence of fever for 24 hours after completion of antibi- otic therapy, unlabored breathing, oxygen saturation above 92% (or return to patient’s baseline) without the use of oxygen therapy, absence of cough/sputum production, and clear chest x-ray with increased energy levels and activity tolerance. CASE STUDY: EPISODE 2 Mr. Markham’s chest x-ray shows suspicious cavitating lesions. He is admitted to the medical unit with suspicion of TB. He is imme- diately put in isolation on airborne precautions. His temperature, heart rate, and respiratory rate remain elevated at 38°C (100.5°F), 100 bpm, and 24, respectively. His oxygen saturation decreases to 90%. He is started on oxygen via a face mask. An IV line is inserted, and IV fluids are started. Sputum and blood cultures are sent to the laboratory…
TUBERCULOSIS Epidemiology
Tuberculosis (TB) is a significant and potentially life- threatening respiratory infection caused by the organism Mycobacterium tuberculosis , an aerobic acid-fast bacillus (AFB). Tuberculosis infects one-third of the world’s pop- ulation. The CDC monitors the prevalence of TB in the United States and reported 9,093 new cases of TB (2.8/100,000 persons) in the United States in 2017, which represents a 1.8% decline from 2016, the smallest decline in 10 years. The majority of these new cases occurring in the United States were caused by reactivated latent tuber- culosis infection (LTBI). Populations living outside of the United States, low socioeconomic groups that have obsta- cles in accessing healthcare, and racial and ethnic minori- ties have the highest incidence. In the United States, tuberculosis disproportionately affects populations of African, Hispanic, and Asian descent. Tuberculosis is also a persistent problem in the homeless and incarcerated pop- ulations. Persons infected with HIV or who have AIDS are
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