I Abstract: The purpose of this research is to compares hospital at home and patient in hospital care for neuromuscular disease (NMD) patients with respiratory tract infections. The main outcome measures were need for hospitalization, treatment failure, time to recovery, death during the first 3months following exacerbation, and cost of patient care. The diagnoses of NMD were based on the standard clinical, DNA, and biopsy data. The diagnosis of a respiratory tract infection was based on the presence of fever, throat irritation or sore throat. Fifty nine patients with NMD were identified as suffering from a respiratory tract infection and therefore considered for the study but some patients were excluded because some required critical …show more content…
Oronasal mask was used with all subjects to start NIV. Manually and/or Mechanically Assisted Cough - manually assisted cough was employed to provide optimal insufflations. Portable ventilator was used to deliver deep insufflations. Both assisted coughs were administered for the first 3 days of the home care practical by a respiratory care therapist, who visited the patients every morning. They trained them for 3 days how to use NIV. The pulmonology also visited the subjects for the first three days. The nurses visited the patients mornings and afternoons until recover them not to getting worst. Out of the 53 subjects, twenty six patients were recruited to the hospital at home care and twenty seven were hospitalized. The two groups were similar in demographic, clinical, and pulmonary function characteristics, however pneumonia as a cause of acute decompensation was most frequent in the hospitalized group versus the hospital at home group. In the hospital at home group 18 subjects or 69.2% responded well and eight required hospitalization. These eight subjects were all older and suffered from ALS which is an advance form of NMD and also had a history of more hospitalization during the last three years. Three out of those eight subjects required intubation due to mucus encumbrance and severe hypoxemia and eventually needed a tracheotomy. Three other subjects required full time ventilatory dependence and a 24 hour surveillance in respiratory ICU.
Patient outcome consisted of performing 10 deep breaths per hour. We have reviewed details that were difficult for the patient to remember, such as breathing out before placing the lips on the mouthpiece, and holding breath for 3 to 5 seconds at the top of each inhalation. With empathy, I provided understanding that being hospitalized is never easy due to sensory overload, pain and lack of privacy. Additionally, we have discussed the basic pathophysiology of lung inflammation and what it can do to a person. So overall, the outcome included enhanced disease knowledge with effective use of incentive spirometer.
This case study incorporates a common presentation seen by the nurse in clinical practice: community acquired pneumonia with a history of COPD causing an acute exacerbation. Principles of spiritual care are also naturally situated in
This is a 50 years old male with no significant past medical history presented initially with shortness of breath and hypoxia and was transferred to the ICU. He was treated for bilateral pneumonia that required prolonged mechanical ventilation via a tracheostomy. He has necrotizing pneumonia and he has been in the hospital for 6 weeks due to the development of multi-organ failure. He was weaned from mechanical ventilation to the point he was tolerating a CPAP/PS mode. Later on, it was noticed that he
B.T. has a nursing diagnosis of ineffective airway clearance that requires nurse management with prescribed beta 2 adrenergic agonists, and teaching effective coughing and breathing techniques. The respiratory therapist will assist by performing nebulizer treatment and teaching the patient about home nebulizer. The nurse will emphasize on the importance of adhering to medication regimen and taking the right medication at the right time.
I selected this article, because it is relevant in my life. My sister, passed in August. She had suffered from lung disease for over 10 years, even though she was totally dependent on the ventilator, she was conscious and alert. She was weak but, could still walk across the room unaided. And if it meant that she could go shopping, she would have you pack up the whole house; 3 tanks of oxygen, portable ventilator, suction machine, and wheelchair.
This essay provides a written account of the holistic assessment used when admitting a patient onto a respiratory ward. A brief outline is also included of the processes involved together with the resources used for collating information. Using the Roper, Logan and Tierney activities of daily living (ADL’s), eating and drinking, has been identified as one goal of nursing care. A short reflection has also been included based on experiences gained on a first clinical placement on the ward. For the benefit of this essay the selected patient will be referred to as Mrs P in order to maintain confidentiality.
Through the convenience sampling, 90 clients were recruited as research participants were in the waiting room of the respiratory clinic. 60 subjects agreed to attend a support group for socialization with each other. 30 of 60 clients were assigned to participate in the presentation and therapeutic exercises by the instructor. The instructor group divided into halves: 15 clients received instructions with family caregiver and the other clients without a caregiver. The second 30 clients received written materials and allowed to access the website for video presentation and exercises. Half of website group assigned to the family caregiver and the other half without a caregiver. The last 30 subjects were assigned as a control group, and half of these clients received usual care with family caregiver and other 15 clients without a family caregiver. The data was collected by the pulmonary functional status survey, 30 items, five points, Likert-type scale.
This essay will now analyze the nursing intervention that requires for the acutely ill patient to prevent an exacerbation of chronic obstructive pulmonary disease. The nurse carried out an initial assessment of a full history, taking in consideration that the patient was over 35 years of age who has been, or still is, a cigarette smoker, with vascular related diseases and had symptoms of breathlessness on exertion, chest tightness, wheezing, coughing, sputum production especially in the morning and chest infection (Currie 2009). A physical examination was done to check the patient respiration rate, depth and rhythm, blood pressure, pulse, temperature and oxygen saturation (Lynes 2007). The acutely ill patient’s respiration was between 30-34 breaths per minute, blood pressure 580/98, pulse 110 beat per minute and saturation levels 80-82%. Increase respiration indicates that the patient was in fear, pain and anxious. Anxiety causes stimulation of sympathetic nervous activation which forces bronchioles
ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).
Management of the acutely ill adult is a complex and perplexed procedure. It requires underpinning knowledge of the pathophysiology of the disease currently affecting the patient, as well as ensuring that professionals are equipped to deal with the development of a rapid deterioration. The National Institute for Clinical Excellence (2007) explain that patients are sometimes inadequately treated due to staff not acting in a sufficient time manner, and so a systematic assessment of the patient recommended by the Resuscitation Council (2006) should initially be followed (Jevon, 2009).
The purpose of this paper is to assess the effects of oral care on ventilator-associated pneumonia for inpatient
Home health care has become an increasingly acceptable and popular form of health care provided to patients for acute, chronic, and terminal illnesses. Home health continues to rise in demand for a variety of reasons. Home health is a cost effective method of providing patients with the care that they require (Phipps, Monahan, Sands, Marek, & Neighbors, 2003, p.154). Patients can receive needed care without the added cost of a hospital stay or an extended hospital stay. This helps to lower the cost for hospitals, insurance companies, public assistance, and the patient. Other added benefits to patients receiving home health care are a decrease in nosocomial (hospital acquired) infections, improved nutritional status, personalization of
is Pneumonia. This is based on the patient’s subjective and objective data. The collaborative diagnosis to address this problem is Pneumonia r/t immobilization; r/t pleural effusion, and r/t debilitation (Carpenito, 2013, p. 859-860). The nursing goal for this patient on the day of care is to control and reduce the complication of pneumonia (Carpenito, 2012, p. 860). The nurse will monitor the patient’s respiratory status while assessing for sign and symptoms of infection, and inflammation (Carpenito, 2012, p.
Nurses are a vital component in patient care. The importance of conducting efficient nursing assessments is critical in order to provide both patient-centered care and safe, effective patient healing. Nurses are often responsible for taking care of patients with very complex disease processes. They frequently provide care to patients with illnesses such as Chronic Obstructive Pulmonary Disease (COPD). According to the Centers for Disease Control and Prevention, in 2014, approximately 6.8 million adults were diagnosed with COPD within the Unites States. The completion of proper assessments and initiation of interventions for these patients are crucial in order to prevent further complications of the illness.
The patient's overall symptoms and lab work suggest that she is suffering from hospital acquired pneumonia. Currently the patient is presenting a moist chesty cough. Additionally, her heart rate is elevated, her oxygenation is low, and her RR is high. She has a raised white blood cell count, which indicates infection. Finally, the patient is acting confused and disoriented, which can be the direct result of a lack of oxygenation to the brain. All of these symptoms point to pneumonia (Torres, 1999).