Monday- Medication
Your patient is admitted with PNA and the Physician has changed the antibiotic from Cephtriaxone IV to amoxicillin PO. Your patient asks why the physician change their antibiotic?
Your symptoms have improved from the use of wide spectrum IV antibiotics and it is time to deescalate from IV to PO antibiotics. Preparing for discharge.
COPD often presents with overlapping signs and symptoms of ____ & _____?
Chronic Bronchitis & Emphysema
Name 3 resource that can be used to educate your patient at discharge.
Stoplight tool, Exit Care, Micromedix, Expert Drug Advice
Both COPD and PNA patients should be avoiding this trigger and receive a cessation education packet.
Smoking
Give an example of a complex carbs vs simple carbs
Simple carbs: digest quickly and send immediate bursts of glucose (energy) into the blood stream. Candy, white rice, white pasta, soda, honey
Complex carbs: digest more slowly and supply a slower release of glucose into the blood stream. Fruits, legumes, starchy vegetables, whole grain products
A 70 year old woman who lives in an ALF is concerned about contracting PNA. What prophylactic intervention can your patient be administered outpatient to decrease the risk of PNA.
PNA Vaccine
What is a nursing consideration for a patient admitted with PNA who is unable to ambulate d/t weakness and SOB.
Turn and reposition Q2
How are you going to educate your patient on antibiotic administration at home?
-Take at the same time each day, DO NOT stop even if you feel better, take medication until complete
-Take medication with food
-Take a probiotic
How often should you instruct your patient to cough and deep breath after discharge.
2-3 times an hour
Why is it so important that your patient who was admitted with PNA makes a follow-up appointment within 2 weeks of discharge.
After the antibiotic course has been completed PNA patients are at risk for decompensation. That is why the readmission rate for PNA is high.
What are the 4 types of PNA?
CAP, HCAP, HAP, VAP
Your patient has just been discharged from the hospital with a diagnosis of PNA. What diet related education are you going to provide?
Encourage fluid intake and a balanced diet- complex carbs, protein, fruits/ vegetables, with limited sodium and simple cabs. A balanced diet helps to increase energy and supports the immune system.
Your patient is admitted with LLE cellulitis and has PEG tube in place. What daily nursing intervention should be done to decrease the risk of developing PNA while in the hospital?
oral care, instruct to cough and deep breathe, IS, activity as tolerated
Your patient is being discharged with PNA. What are some good exercise to recommend to your patient at discharge.
Light weight lifting, arm raises, leg extensions, ankle pumps, walking (all within patient means).
DD Your COPD patient has been prescribed Albuterol PRN and Advair BID. How should the patient be directed to use them in their daily life.
Maintenance inhalers work to reduce inflammation and provide ongoing disease management. Unlike rescue inhalers that should only be used in an emergency situation, maintenance inhalers are used routinely, often once or twice daily — even when the patient isn’t experiencing any symptoms.
Your patient who is admitted with PNA is currently on 3L NC. At baseline your patient does not require O2. What tests can I anticipate prior to discharge?
ODS/ WDS
How many stages of COPD are there and how are patient’s diagnosed.
4; PFTs, health hx, & clinical presentation
How do you know if your patient's PNA is hospital acquired vs community?
If diagnosed after 48 hrs of admission it is HAP.
Why is it important to encourage fluid intake in patient with COPD/ PNA?
Encouraging oral fluids will mobilize respiratory secretions
What lifestyle modifications should your COPD patient implement to prevent infections?
Wash hands, cough into elbow, proper nutrition, avoid large crowds, vaccinations
Your COPD patient asks you why it is so important to exercise. What is your response?
Exercising regularly is an important part of a healthy lifestyle. Exercise and physical activity improve your shortness of breath by increasing blood flow (circulation). This causes your heart to pump more oxygen through your body. Exercise also improves energy levels, heart health, sleep, and strengthens breathing muscles.
Name one common side effect of: Bronchodilators, Corticosteroids, & Antibiotics
Bronchodilators: nervousness/ shakiness, palpitations/ tachycardia, dry mouth
Corticosteroids: hyperglycemia, increased appetite/ weight gain, body fluid retention, mood changes, oral thrush- inhaled
Antibiotics: rash, diarrhea/C diff, anaphylaxis
DD A COPD patient who is a known CO2 retainer is in severe repertory distress and unable to form complete sentences. RT is on the way. What would you instruct the patient to do in the meantime and what respiratory intervention would you expect.
Tripoding, pursed lip breathing, and BiPAP
Your pt who has just been discharged from the hospital with a COPD exacerbation calls concerned about new onset purulent sputum. How should the patient be directed.
Call PCP
Formation of mucous plugs leads to decreased oxygen into lungs and decreased carbon dioxide expired from lungs (air trapping) leading to _____ & _____?
hypoxemia and hypercapnia
DD Name 3 types of food that patients should avoid due to the increase mucus production.
Dairy, artificial sweeteners, alcohol, processed meats
Smoking in COPD patients can irritate the airways resulting in inflammation and hypersecretion of mucous. Name 4 other irritants that patient’s should be educated to avoid?
Pollen, dust, mold, pet dander, chemical fumes, aerosols
What is tripoding and when would you instruct your patient to use it.
Tripoding (bracing of arms on both legs) leaning forward in the tripod position takes some of the pressure of breathing off your lungs. The effort of the diaphragm — the main muscle used to inhale — is increased in this position, and gravity helps the muscle to move down and increase the space in your thoracic cavity. The thoracic cavity houses your lungs, and the extra space around the lungs from this position helps them expand more, releasing carbon dioxide and increasing oxygen intake. It is used during times of respiratory distress.
72 year old male is admitted with SOB/COPD exacerbation. Your patient has a hx of DM and takes metformin at home. While in the hospital the patient was ordered IV solumedrol Q6 and sliding scale insulin. Why is your patient on sliding scale insulin while in the hospital and how are you going to educate your patient about discharging with Prednisone PO.
To maintain tighter glucose control levels while taking a corticosteroid. Continue to monitor blood sugars closely at home. May need to discharge with sliding scale insulin and monitor blood sugar levels as prednisone is tapered/ completed.
Your patient is admitted with PNA and is currently on 2L NC. The following are her most recent set of vitals: HR 123, O2 sat 85%, BP 87/52, RR 26, and Temp 101.9. Your pt is A&O at baseline but is now confused and having a difficult time breathing. What does your patient's clinical presentation suggest?
Sepsis
Name the two types of immune cells that go into the alveoli during bacterial PNA?
Neutrophils and macrophages
H. influenzae frequently affects the elderly and those with comorbidities. What are the 3 common comorbidities that that are at a higher risk for developing PNA.
COPD, DM, & Alcoholics
Your end stage COPD patient is having trouble eating due to feeling short of breath. What eating modifications might you recommend to your patient?
Smaller/ more frequent meals vs large meals to allow the diaphragm to move more easily and breathe better.
DD What is the purpose of an incentive spirometer and how would you instruct a patient on how to properly use it after discharge.
An IS is a tool that measures how well you are filling your lungs with each breath. Learning to take long deep breaths using this tool can help you keep your lungs clear and active. IS should be done 10 times every 1-2 hours while awake.
What are some ways to educate the patient on how to conserve energy at home?
Planning rest times/space out activities such as bathing or therapy to limit oxygen consumption, using assistive devices, tripoding