Respiratory Case Study

Sample Solution

Why are ventilated clients at risk for pneumonia?

Ventilated clients are at increased risk for pneumonia due to several factors:

• Breached Airway Defenses: Endotracheal tubes bypass the natural upper airway defenses like the nose, throat, and epiglottis, which filter and trap inhaled particles. This allows bacteria to enter the lower respiratory tract more easily.
• Impaired Cough Reflex: The presence of an endotracheal tube can impair the cough reflex, making it difficult to clear mucus and secretions that can harbor bacteria.

Full Answer Section

• Reduced Mobility: Critically ill patients on ventilators often have reduced mobility, leading to pooling of secretions in the lungs, which creates a breeding ground for bacteria.
• Aspiration Risk: Ventilated patients may be at risk for aspiration of oropharyngeal secretions, which can introduce bacteria directly into the lungs.

2. What nursing interventions can be taken to prevent pneumonia?

Several nursing interventions can help prevent pneumonia in ventilated patients:

• Oral Care: Implementing a meticulous oral hygiene routine helps reduce bacteria in the mouth, a potential source of infection.
• Suctioning: Regularly suctioning secretions from the endotracheal tube helps clear mucus and bacteria from the airway.
• Positioning: Positioning the patient on their side or periodically changing their head position can promote drainage of secretions from the lungs.
• Pain Management: Effective pain management helps patients cough more effectively, promoting clearance of secretions.
• Peptic Ulcer Disease (PUD) Prophylaxis: Stress and medications can increase the risk of PUD, which can lead to aspiration. Prophylaxis with medications like proton pump inhibitors can help prevent this.
• Early Mobilization: As tolerated, early mobilization helps improve lung function and reduce the risk of complications like pneumonia.
• Proper Ventilator Management: Maintaining optimal ventilator settings ensures adequate oxygenation and minimizes the risk of ventilator-associated pneumonia (VAP).

3. The patient most likely had an allergic reaction to Bactrim DS that she was taking. Why did the reaction occur even though Anna has taken this medication before without any problems?

Anna's allergic reaction to Bactrim DS, despite taking it previously without issue, could be due to several reasons:

• Sensitization: Prior exposure to Bactrim may have sensitized her immune system, leading to a reaction upon subsequent exposure.
• Dose or Formulation: The current dose or formulation of Bactrim could be different from what she took previously, triggering a reaction.
• Interaction with Other Medications: Bactrim can interact with other medications, potentially increasing the risk of allergic reactions.
• Changes in Immune System: Underlying health conditions or changes in Anna's immune system could have made her more susceptible to an allergic reaction.

**4. The patient has multiple intravenous lines. One of the intravenous (IV) sites is red, swollen, and painful. **

This scenario suggests a potential complication called phlebitis, which is inflammation of the vein at the IV insertion site.

Nursing Interventions for Phlebitis:

• Assessment: The nurse should assess the redness, swelling, and pain around the IV site. They should also check for purulence (pus), a sign of infection.
• Site Change: If phlebitis is confirmed, the nurse should discontinue the IV line and insert a new one in a different location.
• Warm Compress: Applying a warm compress to the affected area can help reduce inflammation.
• Elevation: Elevating the affected extremity can promote venous drainage and reduce swelling.
• Documentation: The nurse should document the assessment findings, interventions taken, and the patient's response to treatment.

By implementing these interventions, the nurse can help prevent further complications related to phlebitis.