In the following pages, the case study of Mr. N. with a diagnosis of pneumonia will be presented. Pneumonia is a lower respiratory tract infection. It can be caused by viral, bacterial, fungal, protozoan or parasitic infections (Brashers, 2006). Pneumonia can be acquired in the community, known as community-acquired (CAP). It can be acquired in a nursing home (NHAP). Pneumonia can also be contracted in hospital and this type of pneumonia is known as a nosocomial infection. Mr. N was diagnosed with right upper lobe pneumonia at initial diagnosis. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essayMr. N is a young Caucasian, Christian, upper-middle class man, aged 36. The patient is a non-smoker. He is married with 2 children and is expecting a third child. He presented to the hospital complaining of acute onset of fever, chills, chills, pleuritic chest pain, cough, and excessive vomiting. This man was writhing in pain, gagging, and vomiting excessively. Our main goal was to make him comfortable to help take care of him after receiving him from the emergency room to the MICU. He had been at a doctor's appointment before admission and had been referred to his endocrinologist. Laboratory tests ordered for CMP, CBC, blood cultures X 2; and a urinalysis were obtained and sent to the laboratory for processing. A chest x-ray was obtained by the emergency room radiologist. Mr. N was placed on a dilaudid pain pump for excessive pain complaints and history of chronic pain. The patient was administered oxygen at 2 liters per nasal cannula. Respiratory treatments were started every 4 hours. Mr. N was encouraged to use his incentive spirometer 10 times every 2 hours. He was encouraged to wear his SCD for circulation and to turn over, cough, and breathe deeply frequently. The patient was placed on NPO status due to excessive vomiting. His previous order of TPN was resumed along with a normal saline drip at 100 cc/hour. The patient was told to hold the bead head at 30 degrees or more. She has a history of lupus, Sjogren's disorder, diabetes, malnutrition, gastroparesis with chronic vomiting, recurrent infections, primarily pneumonia. The patient had been admitted to hospital with aspiration pneumonia three weeks prior to admission. This young man has had multiple hospitalizations and treatments. He had spent 164 days in hospital a few years prior to this hospitalization. Most hospitalizations consisted of acute and chronic pancreatitis problems that were thought to be secondary to Lupus. He had been to Mexico and Russia for stem cell treatments to help with chronic inflammation secondary to Lupus and Sjogren's Disease under the encouragement of Dr. Bayer who is a big supporter of Stemedica. Stemedica Cell technologies, inc., is believed to be transforming regenerative medicine through the development and manufacturing of biologics and ischemic-tolerant adult stem cells (Stemedica Cell Technologies, 2007-2014, p. 1). N had undergone pancreatic biopsies in Illinois in an effort to find the cause of all his illnesses. This biopsy led to his first episode of acute pancreatitis and his health was never the same again. Before hospitalization he had undergone two abdominal surgeries. The first was a duodenojejunostomy in an attempt to tube feed him due to significant weight loss due to gastroparesis. At the time of surgery, the patient was diagnosed with SMA syndrome. SMA syndrome is also knownas superior mesenteric artery syndrome. SMA is a rare acquired disease in which acute angulations of the SMA cause compression of the third part of the duodenum between the SMA and the aorta, leading to obstruction (Archana, Gisel, & Bouras, 2005, p. 1). His gastroparesis was also thought to have resulted from lupus and diabetes. His second surgery was performed by Dr. Langley the previous winter. The patient stated that the surgeon did not have a name for this surgery. It was also an attempt to relieve vomiting and promote gastric motility from the stomach to the intestine in a different way. After the surgery, the patient's mother had died unexpectedly and her vomiting had not been relieved by the surgery. In fact, it was getting worse. He had a right subclavian central line port in place because he had received total parenteral nutrition at home. His medications include; prednisone 5 mg by mouth once daily, zofran 4 mg by mouth every 6 to 8 hours for nausea; Plaquinil 400 mg once orally twice daily; Hydrocodone 5-10 mg every 4-6 hours for pain; Salogen 5 mg orally four times a day; Lyrica 600 mg orally two-three times a day; Creon 500 lipase units/kg by mouth with meals/snacks, Humalog insulin pump, Dexilant 60 mg once daily, and Topamax 200 mg by mouth twice daily. Mr. N's vital signs were taken. He had a blood pressure of 200/90, a heart rate of 148 beats per minute; a respiratory rate of 32 breaths per minute and pulse oximetry on room air was 88%. His temperature is 102 degrees Fahrenheit.Mr. N was awake, alert, and oriented to person, place, and time. His pupils were equal to 3 mm, accommodated and reactive to light. The S1 and S2 heart sounds were audible without a murmur or extra heart sounds were noted. The patient's lungs were constricted in all lung fields with scattered rales. Greater decrease in the right upper lobe of the lung was noted. Bowel sounds were hypoactive in all four quadrants. The abdomen was soft, nondistended, and tender to palpation. All peripheral pulses were palpable at 2+. Generalized edema is noted. The right subclavian midline site dressing was clean, dry, and intact. The insertion site had slight redness but no heat was noted. The patient was unable to ambulate at that time due to pain, vomiting and malaise. Laboratory results revealed a potassium of 3.2. The white blood cell count was 19.0. A leftward shift of leukocytes was noted. Hemoglobin was 7.8 and hematocrit was 28.7. Urinalysis was normal. Chest x-ray revealed patchy infiltrates throughout with increased consolidation noted in the right upper lobe. The next morning blood cultures were positive for yeast. Host defenses against lung infections are influenced by inherited genetic components of inflammation, our body's ability to fight disease, and precise lung defense processes (Brashers, 2006). In acquiring bacterial pneumonia, the organism is often aspirated, inhaled, or spread into the bloodstream from other sites of infection. The upper airways are essential for resisting infection. The ability of saliva, cough, gag reflex and IgA antibodies in the mucosa can be repressed by disease, smoking, poor immunity and endotracheal intubation. The lower airways have cilia in the mucous membranes that attempt to force contaminants out of the lungs. Surfactants coat the alveoli and reduce tension; preventing the collapse of the alveoli. This allows oxygen to penetrate the lung lining and move into the blood. Macrophages are cellsimmune system proteins that are created in response to an infection or by accumulating damaged or dead cells. Phagocytosis of macrophages and leukocytes is another response of the lower respiratory tract to fight infections. Macrophages and leukocytes phagocytose the opposing pathogen. Cell-mediated immunity is the activation of lymphocytes and destruction of intracellular microbes (Kumar, Abbas, Fausto, & Aster, 2010). Humoral immunity consists of the activation of B cell lymphocytes and eliminates extracellular germs (Kumar et al., 2010). Cellular and humoral immunity are both defended against offending agents of the lower respiratory tract. Some of these defense mechanisms may be altered by decreased consciousness, smoking, cystic fibrosis, chronic bronchitis, immunocompromise, intubation, or long bed rest (Brashers, 2006). Dust cells or monocytes in the lungs live on the surfaces of the lungs and clean to remove particles such as dust or microorganisms. They constitute a primary defense system against invasion of the lower respiratory tract. Every day, dust cells clear the airways of harmful organisms without creating a large inflammatory response. If the bacteria are too numerous and capable of causing disease by breaking down the host's protective mechanisms, macrophages recruit leukocytes and trigger the inflammatory response by releasing cytokines. Cytokines are proteins released by immune cells and act on other cells to coordinate appropriate immune responses. This response leads to inflammation. Inflammation causes ventilation-perfusion mismatch and causes hypoxemia. Apoptosis of lung cells occurs with hypoxemia. Apoptosis is the process of programmed cell death in the body. This action helps in destroying any harmful agent like bacteria, tuberculosis, influenza, fungal infections in the lungs. The action of apoptosis is beneficial in fighting infections, but also plays a role in lung damage. The infection may remain in the lungs or may cause septicemia, meningitis, endocarditis, and/or systemic inflammatory response syndrome (SIRS) (Brashers, 2006). Lupus is an autoimmune disease. This means that the body's natural defense system, the immune system, attacks healthy tissue instead of just attacking bacteria and viruses. This causes inflammation. Lupus affects the lungs, muscles, brain, heart and kidneys. Sjogren's syndrome is an autoimmune disease in which the glands that produce tears and saliva are destroyed. The condition can affect other parts of the body, including the kidneys, lungs, and pancreas. Insulin-dependent diabetes mellitus, now known as type 1 diabetes mellitus, is a known autoimmune disease that causes the destruction of insulin-producing cells. This young man's overactive immune system attacked his pancreas, causing diabetes. Chronic inflammation causes infections. His body is chronically inflamed by his overreactive immune system. He has a damaged immune response. Since Sjogren's syndrome can indeed affect his lungs; the surfactants in your lungs may be lower; thus decreasing oxygenation. High glucose levels are caused by hormones produced to fight disease. Stress and illness cause high blood sugar levels. Mr. N's body is chronically stressed and managing his blood sugar has been difficult. After receiving a positive yeast culture; the central line was disrupted and sent for culture. The patient continued to experience low oxygen levels and began to have an altered level of consciousness. He was sent for a CT scan of the lungs which revealed lobe pneumoniaright upper lobe and embolic pneumonia of the left upper and lower lobes. The central line was positive for yeast. A picc line was placed for intravenous access. Antifungals have been added to current broad-spectrum intravenous antibiotics to fight bacterial and fungal infections. Reduced mortality is seen with rapid initiation of antibiotic treatment. Corticosteroid therapy was started through the IV to combat the inflammatory response. Steroid therapy and antibiotic therapy improve gas exchange and patient outcomes. An insulin drip was started with hourly blood sugar checks to regulate blood sugar. This would facilitate healing and fighting infections. A potassium bolus was started and given every six hours for a potassium level of 3.2 to prevent arrhythmias. Once the vomiting decreased, the patient was able to follow a clear, liquid diet. Lovenox injections were started for the prevention of DVT. Patient respiratory treatments, incentive spirometry, and turning, coughing, and deep breathing techniques were strongly encouraged. There are several nursing diagnoses that must be addressed with a diagnosis of pneumonia; including knowledge of the patient's deficit, risk of dehydration, unbalanced nutrition, acute pain, activity intolerance, risk of infection, impaired gas exchange and, last but not least, ineffective airway clearance. Airway management should always be addressed initially. Ineffective clearance of the airway is the first nursing diagnosis that should have been addressed during Mr. N's hospitalization. The airway, when pneumonia is present, could be compromised due to the presence of secretions. The breathing pattern would be affected. The alteration of the patient's oxygen-carbon dioxide ratio due to decreased oxygen and poor gas exchange due to exudates on the alveoli causes an increase in respiratory rate. Hyperventilation begins to cause an increase in the tidal volume of air to facilitate the absorption of more oxygen. Bronchospasms occur and may cause dyspnea, immobile discharge, and infection. There are several attempts by the nurse to create effective breathing. Mr. N and his family were taught the importance of wearing oxygen and cooperating with prescribed breathing treatments. This would increase its oxygen uptake and enhance healing efforts. Upon admission, the patient was encouraged to CDB with frequent position changes, maintain the head of the bed at 30 degrees or more, and use the incentive spirometer every two hours as prescribed. The patient was instructed to comply with respiratory therapy. The patient has a history of aspiration and has continued to experience vomiting, placing him at increased risk of aspiration again. All these interventions will help exchange the airways. The family and patient were taught the importance of all these techniques to promote the patient's well-being. If antibiotics are started within the first four hours of hospitalization, the chances of death are significantly reduced. Laboratory tests of this patient show a significant decrease in hemoglobin and a significant left shift of leukocytes increases the possibility for bacteria to invade and camp in a specific part of the body. In this case, the patient's initial infection was right upper lobe pneumonia. Embolic pneumonia was the second diagnosis. The central line was removed because the cultured tip revealed the growthof the yeast. Yeast from the catheter spilled infected emboli into the lungs. In this case the infection is a top priority. IV antifungal therapy increased his chances of survival along with the administration of antibiotics. Good universal precautions are in order with this patient. His immune system is constantly compromised and good hand washing with him, staff and family would support his overall health. A dietician was consulted to increase nutrition due to vomiting and history of malnutrition. Correct administration of TPN and nutritional intake play a fundamental role in controlling infections. Control of pain and nausea would be significant to maintain effective breathing, adequate gas exchange, and resolution of the infection. The patient's attending physician continued home therapy upon admission. Dilaudid was ordered for adequate pain control. PO Zofran was changed to IV route. The nursing staff told the medical team that Zofran was not relieving his nausea. IV phenergan has been tried to no avail. IV Compazine was ordered and nausea control was achieved. Pain and nausea contributed to inadequate breathing and gas exchange. The risk of aspiration due to vomiting increases the risk of infection. Mr. N's medical team, nursing staff, dietician, and family worked assertively to resolve his pain and nausea by communicating appropriately with each other. The expected results for Mr N and maintenance of his airway were achieved upon doctor's orders, nursing and respiratory staff initiated, administered and followed up on prescribed medications and treatments. Continuous teaching of the patient, family and each other created a very positive outcome for Mr. N. The difficulty breathing was relieved and the airway was maintained throughout his hospitalization. The patient was able to verbalize understanding and demonstrate deep breathing techniques. This intervention, encouraged by all the staff involved, contributed to achieving correct oxygenation and alleviating hyperventilation. The patient remained free of cyanosis and was able to establish a normal breathing pattern. With all medications, interventions and the patient's ability to remain cooperative, ease of breathing was achieved. All patients prescribed painkillers, nausea, and respiratory medications and treatments performed were successful in maintaining adequate airways; good gas exchange and effective breathing. Mr. N's wife was able to intervene by noticing a decline in the patient's level of consciousness and he was ordered to have a bi-pap for one day of his hospitalization. This helped the patient when he was compromised and facilitated adequate gas exchange. The next day he was able to return to the nasal cannula and had the necessary airway maintained. The patient's wife was able to encourage the patient to use proper hand washing and disinfection and assist him with general cleanliness to prevent the spread of the infection. She, the patient, and the staff also strongly encouraged visitors to adhere to precautions. Adherence and timely administration of prescribed antibiotics and antifungals were necessary and were achieved by the nursing staff during Mr. N's hospitalization. Housekeeping did an excellent job of maintaining a clean environment. Proper disinfectants used during cleaning also facilitated the spread of the infection. The multidisciplinary treatment plan was.