Ventilator-Associated Pneumonia
Question
Exam Content
Case Study
Read the following case study:
You are a staff nurse working in an intensive care unit and assigned to care for a 75-year-old African American man who had coronary artery bypass graft surgery four days ago. The patient has a history of chronic obstructive pulmonary disease exacerbated by heavy smoking. His postoperative course has been difficult, and he has suffered a number of setbacks. Staff members, despite their diligent efforts, have not been able to wean him off the ventilator since the surgery. He has required frequent suctioning throughout the shift, and he is being evaluated for the development of ventilator-associated pneumonia.
Today, when returning from lunch, you observed that an experienced nurse was suctioning your patient. His secretions were thick, and you observed that the nurse was instilling saline into the patient's endotracheal tube as she was suctioning him. The patient turned red and began coughing, and it was obvious he was in distress.
Assignment
Identify the theory-practice gap in the case study above and describe how this potential gap can impact nursing practice and patient care.
Create a concept map that depicts your assumptions and findings of the theory-practice gap. Show alignment of nursing theory and its relation to the nursing process (including alignment with critical thinking and clinical decision-making) for an improved nursing care plan.
Write an 875- to 1,050-word summary explaining how the concepts in nursing theory align to the nursing process, including alignment with critical thinking and clinical decision-making for an improved nursing care plan.
Include the following in the summary:
The theory-practice gap that you identified in the case study and how this potential gap can impact nursing practice and patient care
A plan to close the gaps in this scenario which will consist of how theory, research, and practice interact to create positive patient outcomes
Use visual presentation software from the College of Education Technology Resource Library to create your concept map. To review your options, do the following:
Select Web Tools in the Table of Contents.
Select Collaboration & Productivity from the list of tools.
Include at least 2 scholarly resources from the University Library to support you work.
Cite and format your sources according to APA guidelines.
Submit your concept map and summary.
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1. Create a concept map that depicts your assumptions and findings of the theory-practice gap.
undefined% of total grade
2. In the concept map, show alignment of nursing theory and its relation to the nursing process (including alignment with critical thinking and clinical decision-making) for an improved nursing care plan.
undefined% of total grade
3. Write a summary explaining the concept map and how the concepts in nursing theory align to the nursing process, including alignment with critical thinking and clinical decision-making for an improved nursing care plan.
undefined% of total grade
4. Include in the summary the theory-practice gap that you identified in the case study.
undefined% of total grade
5. Include in the summary how the potential gap can impact nursing practice and patient care.
undefined% of total grade
6. Include in the summary a plan to close the gaps in this scenario, which will consist of how theory, research, and practice interact to create positive patient outcomes.
undefined% of total grade
7. Include at least 2 scholarly resources from the University Library to support you work.
undefined% of total grade
8. APA Guidelines
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Solution
Ventilator-Associated Pneumonia
Conceptual map
Nurses diagnosed the patient with ventilator-associated pneumonia. The desired goal is to collect sputum cultures while Hydration and a thorough respiratory assessment are the interventions. It is best to refrain from smoking. There is sufficient oxygen to prevent it.
Care Plan
In this instance, the patient was diagnosed with pneumonia, required mechanical breathing, and had many secretions. Ventilator-associated pneumonia (VAP) manifests itself at least 48 hours after endotracheal intubation. Antibiotic-resistant microorganisms are a significant concern. In ventilated patients, pneumonia often occurs with fever, a rise in white blood cells, reduced oxygenation, and oozing pus tracheal secretions (Kumar, 2021). They might well employ a positive blood culture for the same organism detected in respiratory secretions, or a bronchoscopic specimen of the lower respiratory tract with Gram stain and culture, to confirm the diagnosis. The infection is treated with antibiotics. Chronic conditions play a role in the overall poor prognosis. In addition to the other symptoms.
It is evident that the patient is coughing or has phlegm. The patient is currently making a recovery following surgery, which has made his ventilator-acquired pneumonia significantly worse. If the patient is not given the appropriate therapy, there is a good chance that their health may deteriorate. Therefore, sputum cultures will be acquired at the initial stage of the treatment to establish a baseline for the course of treatment and to determine whether the patient would benefit from interventions (Kumar, 2021). It will also be necessary to do a thorough assessment of the patient's respiratory system to determine whether there have been any further shifts in the patient's health, it will also be necessary to do a thorough assessment of the patient's respiratory system.
It will make it possible to respond more quickly and assist in deciding whether modifications to therapy are also required. For example, it may be required to provide normothermia to improve the patient's oxygen consumption. It is also essential to be aware of the possibility of an intolerance to exercise, which may necessitate using air clusters to save the patient's energy (Kumar, 2021). In this scenario, it will also be essential to stimulate airway cleansing, which involves urging the patient to cough to eliminate the phlegm build-up.
Interventions
Cough suppression should be avoided unless it is necessary for medical reasons. Regular suctioning is necessary to achieve optimal levels of gas exchange. It is of the utmost importance to ensure that the patient has no phlegm. The patient may not be eating very much orally because of their weariness. Therefore, ensuring they have enough fluid balance (Kumar, 2021). The patient needs to stay hydrated to make the quickest possible recovery. It is necessary to encourage the patient to cough and take full, deep breaths to maximize the effectiveness of the gas exchange. Patients need assistance with their food, especially if they are weak and dependent on others.
Under these conditions, there will also be the issue of determining how to provide additional oxygen. The airway of the patient must be preserved, particularly under these circumstances where large secretions are present. It is necessary to position the patient correctly to aid the patient (Kumar, 2021). Rest is also essential, particularly at times when the patient must focus their attention on breathing. It is of the utmost importance to ensure that the patient gets enough sleep and that a strict bedtime is maintained. Antibiotics must be supplied immediately while appropriate troughs are drawn.
Care considerations
Since the patient may be taking antibiotics, they must be given as quickly as possible and adequately. Any delay may hinder the patient's ability to recover from their condition (Ackey et al.,2019). It is also possible to assess the patient's trough levels to determine whether they are getting an adequate amount of antibiotic treatment. If the patient continues to show signs of improvement, despite their current state, they must get evaluated. The patient must be cared for while lying at an angle of 45 degrees, with the head of the bed elevated better to enable postural drainage (Ackey et al.,2019). After eating, the patient must sit up straight for at least an hour to reduce the likelihood of experiencing regurgitation.
The patient needs to practice good oral hygiene to reduce the number of germs present in their saliva. In this setting, avoiding intubation is the most effective technique for reducing pneumonia's adverse effects. When suctioning the patient, saline should be avoided at all costs (Ackey et al.,2019). The pressure on the endotracheal cuff must be high enough to avoid difficulties. In addition, the nasotracheal tube should be replaced with an orotracheal tube, if possible, by the attending physician. In addition, it must prevent the collection of subglottic secretions while the suction endotracheal tube is in place.
Additionally, the patient must get as little sleep as is humanly feasible (Ackey et al.,2019). The patient's breathing sounds will help determine whether any airway breathing obstructions are present, which is an essential step in the diagnostic procedure. It is of the utmost importance to refrain from making unnecessary alterations to the patient's ventilator circuit. Because of this, the patient won't have to worry about getting into touch with potentially harmful germs, which might make the patient's condition worse.
It is necessary to have a multidisciplinary task force that is conversant with ventilator-acquired pneumonia. This task force should include clinical pharmacists, respiratory therapists, and nurses (Ackey et al.,2019). In addition, it will be crucial to keep the treatment team informed and do frequent monitoring to ensure that the treatment methods used are up to the necessary standards. It is necessary to use high-quality treatment methods to enhance the patient's health; to maintain patient stability (Ackey et al.,2019). It will be essential to practice effective risk management. A vital component of this will be maintaining an in-depth understanding of the likely results of the patient's treatment. Finally, the patient's recovery needs to stay stable. It involves meeting the patient's nutritional and Hydration needs and maintaining their stability.
References
Ackley, B. J., Lad wig, G. B., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook E-book: An evidence-based guide to planning care. Elsevier Health Sciences.
Kumar, A., & Raghavendran, M. (2021). Ventilator-associated pneumonia. RGUHS Journal of Nursing Sciences, 11(2).
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