I. Background/Rationale Pneumonia is a respiratory disease that causes an inflammation of the lung parenchyma commonly caused by microbial agents such as Streptococcus pneumoniae and Haemophilus influenzae. The disease is acquired through inhalation of the microorganism in respiratory droplets, as well as aspiration of secretions in the upper gastrointestinal tract that contains bacteria capable of causing pneumonia. It can be categorized into community-acquired pneumonia and hospital-acquired pneumonia.
The main difference between the two is the length of time it took for the patient to exhibit signs and symptoms of pneumonia. If the patient shows signs of pneumonia within 72 hours of admission into the hospital, then the patient is classified in the community-acquired pneumonia category. The 72 hours period represents the incubation period that it takes for the bacteria to cause the signs and symptoms that the patient experiences. Pneumonia is a very common respiratory disease in the Philippines. Therefore, it will not be uncommon for a medical-surgical ward to have patients with this condition.
As a student nurse, I am interested in the management of patients with pneumonia, especially in those patients with community-acquired type as well as the prevention of the hospital-acquired pneumonia. II. Problem Statement ?What is the difference in the focus of management between patients who have community-acquired pneumonia and hospital-acquired pneumonia? ?How does the nurse manage patients with community-acquired pneumonia? oWhat are some of the skills in which a nurse has to be very proficient in order to provide quality nursing care for these patients? ?How does the nurse manage patients with hospital-acquired pneumonia?
oWhat are some of the skills in which a nurse has to be very proficient in order to provide quality nursing care for these patients? III. Summary The first article, “Early Intervention for the Pneumonia Patient: An Emergency Department Triage Protocol” is an article that studied a specific intervention that can be used to improve patient outcomes in those with community-acquired pneumonia. As the disease is one of the leading causes of death in the United States, research has been done to identify an early intervention for the improvement in the outcomes of patients with community-acquired pneumonia.
This certain intervention was that every hospital should ensure that at least 75% of patients with pneumonia receive antibiotics within 4 hours after the patient’s arrival in the hospital. Since statistics showed that there was a hospital that failed to meet this requirement, this study was done to determine factors that hindered the hospital to meet the requirements set by the Centers for Medicare and Medicaid Services and to formulate a plan to improve the compliance of rate of the hospital.
The researchers provided a case review in order to identify the factors that contributed to the decrease of the hospitals compliance rate. Then, they developed a triage protocol wherein the Emergency Department (ED) nurse initiates diagnostic studies and promotes early treatment of patients presenting with a high suspicion of pneumonia. The ED nurse, working with the ED physician, radiology staff and pharmacology staff formulated a plan of action that they followed in order to provide early treatment for patients who may have pneumonia.
The second article, “Preventing Nosocomial Pneumonia” in turn, deals with hospital-acquired pneumonia. This article highlights the importance of the nurse’s role in preventing patients who have a high risk of acquiring pneumonia by decreasing the risk of aspiration and preventing colonization of the respiratory tract as these are the most common causes of hospital-acquired pneumonia. The study demonstrated the importance of making oral care a priority prophylactic measure. They had found out that oral care is given low priority by nurses in all settings as was the result in another study.
The researchers then hypothesized that consistent oral care would definitely decrease the incidence of hospital-acquired pneumonia and added the fact that it might also improve the patient’s nutritional intake. They then implemented an oral care protocol that is to be delivered at certain times to the intervention group. The groups were not only divided into control and intervention groups but were also classified under 3 categories: ventilated patients and those with an artificial airway, high-risk patients and low-risk patients.
The oral care protocol was initiated upon admission and continued until discharge and data was collected by means of retrospective chart reviews following discharge. IV. Findings The difference between community-acquired and hospital-acquired pneumonia is that most of the time hospital-acquired pneumonia occurs due to lack of competent nursing care. Community-acquired pneumonia may only be prevented with health education about the prevention of acquiring pneumonia while the hospital-acquired type is prevented with appropriate and prompt nursing interventions.
Therefore, the focus of care that the nurse in the hospital provides differs. Early treatment to improve patient outcomes is more appropriate for community-acquired pneumonia since the patient arrives at the hospital with the possibility of having the disease already. Prevention by proper nursing interventions is the main focus of management for patients in the hospital to preclude the incidence of hospital-acquired pneumonia. As the results of the study in the first article have shown, early identification and treatment of patients with community-acquired pneumonia is important in order to improve patient outcomes.
The article had formulated a triage protocol to aid the ED nurse in identifying patients at high risk for pneumonia or possibly exhibiting signs of it, initiating a preprinted pneumonia order set that enables the patient to undergo radiologic and laboratory studies as soon as possible and administering antibiotics as soon as results show positive for pneumonia. In the study, this plan had worked and it highlighted that it is important in nursing management of patients with community-acquired pneumonia that early identification and treatment of pneumonia patient must occur in order to improve patient outcomes.
The ED nurse must be proficient in assessment of patients in order to quickly identify those with a high possibility of having pneumonia. She should also be equipped with the knowledge of the protocol if present in the hospital when dealing with these patients. Proper and prompt administration of medications appropriate for community-acquired pneumonia must also be done by the nurse; therefore, she should have skills in these. The nurse must also explain to and support the patient in case the patient becomes anxious at the fast pace of the triage protocol.
Essential nursing interventions that decrease the risk of aspiration and prevent colonization of the respiratory tract in order to prevent the incidence of hospital-acquired pneumonia are strict adherence to hand washing routines, use of gloves, elevating the head of the bed for those at risk of aspiration and providing routine oral care to all patients. These interventions play an important role in preventing nosocomial pneumonia.
Therefore, in the management of patients with hospital-acquired pneumonia, nurses should be aware of and competent in these areas of nursing skills, most especially the provision of oral care. The nurse has to be proficient in the identification of patients at high risk of acquiring pneumonia and formulating plans of care for them. The nurse administers proper nursing interventions for each patient at risk such as elevating the head of bed, provision of frequent oral care, strict adherence to hand washing routines and others.
V. Conclusion The focus of nursing management with patients who have community-acquired pneumonia differ from those with hospital-acquired pneumonia. For community-acquired pneumonia, the focus should be on early identification of patients with pneumonia and early treatment with antibiotics. For hospital-acquired pneumonia, the focus is on prevention by prompt nursing interventions such as elevation of bed for those at risk, strict adherence to hand washing routines and most especially, provision of frequent oral care.
The nurse needs to be proficient in different skills specific to which patient she administers care. VI. Commentary These two articles have provided me with information in the management of patients with community-acquired pneumonia and hospital-acquired pneumonia. Nursing Practice Since the triage protocol formulated by the first article was proven useful in the early identification and treatment of patients with community-acquired pneumonia, the same protocol may also be used by other health institutions especially here in the Philippines.
Nurses, who are equipped with the knowledge and skills of managing patients with the community type of pneumonia, are essential to the improvement of patient outcomes in any place. The oral-care protocol in the second article was also proven to be effective in the prevention of hospital-acquired pneumonia. This is significant in nursing practice indicating the need of nurses to become more competent in providing nursing care especially those that can help prevent nosocomial pneumonia.
Simple nursing care, such as oral care, should not be neglected as it proves to very effective in decreasing the incidences of hospital-acquired pneumonia. Nursing Education Assessment skills, administration skills and especially nursing skills used in managing community-acquired and hospital-acquired pneumonia are essentials in the nurse working with these patients. Nurses should reinforce, and be more educated about techniques and other skills that can be used in managing patients with pneumonia. Nursing Research
Further research may need to be done in order to prove the effectiveness of the triage protocol and oral care protocol. This could be done in more hospitals and other health institutions to further generalize this importance of implementing these ways of managing pneumonia patients. Sources: 1Vanhoy, S and Laskowski-Jones, L. (2006) Early Intervention for the Pneumonia Patient: An Emergency Department Triage Protocol. Journal of Emergency Nursing. Vol. 32, No. 2, pg. 154-158 2Weitzel, T. , Robinson, S. and Holmes, J. (2006). Preventing Nosocomial Pneumonia. American Journal of, Vol. 106, No. 9, pg. 72A-72G.