Question

Pneumonia Case Study Mary O'Neal is a 35-year-old executive assistant and a part time college student. On returning home from class one evening, she begins to chill. She alternates between chills and sweats all night. Staying home from work, she remains in bed most of the next day. Her fever continues and she develops cough and chest pain. She describes her chest pain as a dull ache that was initially substernal but now is localized in her lower right lateral chest. The pain increases with deep breathing, coughing, and moving. When the cough becomes productive of rusty colored sputum the following day, she seeks medical treatment from her family doctor. Mrs. O'Neal denies any previous history of respiratory diseases other than frequent usual colds, denies history of smoking or medication allergies. Vs: BP-116/74, P- 104 and regular, RR-26, T-101.8. Stat CBC shows WBC of 18, 900 with increased numbers of neutrophils and bands. Chest X-ray was done and a diagnosis of bacterial pneumonia established. Oral penicillin V 500 mg every 6 hours for 10 days Do any of the factors identified in the case study increase Ms. O'Neal's risk for acute bacterial pneumonia? What is bacterial pneumonia? How does it differ in presentation to viral pneumonia]? What test are utilized to diagnosis pneumonia Develop a plan of care 5 aspects Develop a teaching plan for. Ms. O'Neal. 5 aspects

Answer 1

Bacterial pneumonia is an inflammation of the lungs due to bacterial infection. Different types of bacteria can cause pneumonia. This type of pneumonia can occur in both lungs, one lung, or one section of a lung. Pneumococcal disease, which Streptococcus pneumoniae causes, is a major cause of bacterial pneumonia.

The two most common causes of pneumonia are bacteria and viruses. ... In bacterial pneumonia, there will likely be a much more visible presence of fluid in the lungs than viral pneumonia. Bacterial pneumonia is also more likely to enter the blood stream and infect other parts of the body.

Blood tests. Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection. However, precise identification isn't always possible.

Chest X-ray. This helps your doctor diagnose pneumonia and determine the extent and location of the infection. However, it can't tell your doctor what kind of germ is causing the pneumonia.

Pulse oximetry. This measures the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream.

Sputum test. A sample of fluid from your lungs (sputum) is taken after a deep cough and analyzed to help pinpoint the cause of the infection.

Your doctor might order additional tests if you're older than age 65, are in the hospital, or have serious symptoms or health conditions. These may include:

CT scan. If your pneumonia isn't clearing as quickly as expected, your doctor may recommend a chest CT scan to obtain a more detailed image of your lungs.

Pleural fluid culture. A fluid sample is taken by putting a needle between your ribs from the pleural area and analyzed to help determine the type of infection.

Antibiotics improve outcomes in those with bacterial pneumonia. First dose of antibiotics should be given as soon as possible. Increased use of antibiotics, however, may lead to the development of antimicrobial resistant strains of bacteria. Antibiotic choice depends initially on the characteristics of the person affected, such as age, underlying health, and the location the infection was acquired. Antibiotic use is also associated with side effects such as nausea, diarrhea, dizziness, taste distortion, or headaches. In the UK, treatment before culture results with amoxicillin is recommended as the first line for community-acquired pneumonia, with doxycycline or clarithromycin as alternatives. In North America, where the "atypical" forms of community-acquired pneumonia are more common, macrolides (such as azithromycin or erythromycin), and doxycycline have displaced amoxicillin as first-line outpatient treatment in adults.In children with mild or moderate symptoms, amoxicillin taken by mouth remains the first line. The use of fluoroquinolones in uncomplicated cases is discouraged due to concerns about side-effects and generating resistance in light of there being no greater clinical benefit.

For those who require hospitalization and caught their pneumonia in the community the use of a β-lactam such as cephazolin plus macrolide such as azithromycin or a fluoroquinolones is recommended. Antibiotics by mouth and by injection appear to be similarly effective in children with severe pneumonia.

The duration of treatment has traditionally been seven to ten days, but increasing evidence suggests that shorter courses (3–5 days) may be effective for certain types of pneumonia and may reduce the risk of antibiotic resistance.For pneumonia that is associated with a ventilator caused by non-fermenting Gram-negative bacilli (NF-GNB), a shorter course of antibiotics increases the risk of that pneumonia will return. Recommendations for hospital-acquired pneumonia include third- and fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, and vancomycin.These antibiotics are often given intravenously and used in combination. In those treated in hospital, more than 90% improve with the initial antibiotics.For people with ventilator-acquired pneumonia, the choice of antibiotic therapy will depend on the person's risk of being infected with a strain of bacteria that is multi-drug resistant.Once clinically stable, intravenous antibiotics should be switched to oral antibiotics.For those with Methicillin resistant Staphylococcus aureus (MRSA) or Legionella infections, prolonged antibiotics may be beneficial.

The addition of corticosteroids to standard antibiotic treatment appears to improve outcomes, reducing death and morbidity for adults with severe community acquired pneumonia, and reducing death for adults and children with non-severe community acquired pneumonia. Side effects associated with the use of corticosteroids include high blood sugar. A 2017 review therefore recommended them in adults with severe community acquired pneumonia. A 2019 guideline however recommended against there general use. There is some evidence that adding corticosteroids to the standard PCP pneumonia treatment may be beneficial for people who are infected with HIV.

The use of granulocyte colony stimulating factor along with antibiotics does not appear to reduce mortality and routine use for treating pneumonia is not supported by evidence.