HH is a 68-year-old M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV day (day 3) and azithromycin 500 mg IV day (day 3). Since admissio

Pneumonia in an Elderly Patient with COPD

Pneumonia is the second topmost cause of hospitalizations among Medicare beneficiaries and accounts for over 600,000 hospitalizations every year (Li et al., 2015). The elderly are very vulnerable to pneumonia and have a higher likelihood of mortality following infection compared to younger persons. Elderly persons who have pneumonia that requires hospitalization are likely to develop other complications, which keep them longer in hospitals (Li et al., 2015). The prognosis is poor, with the mortality rate being 20% among the elderly. According to Restrepo et al., (2018), persons who have existing COPD have a high likelihood of developing pneumonia which increases their risk of respiratory failure.  Pneumonia in a COPD patient can cause hypoxia, and this can result in other complications, including irreversible brain damage, heart attack and stroke, and kidney damage.

Patient Needs

According to Li, Wang, Han, et al. (2015), the patient will need a rehabilitation technician to decide on the right training for swallowing functioning according to the patient’s swallowing function and also to explain the relevant conditions. A dietician will also be needed for the patient’s guidance on nutrition management. The dietician will also determine the types, quantities, and properties of the food the patient will consume. The nurse will ensure that the patient’s mouth is kept clean and provide the patient with education on safe eating. The nurse will also assist the patient with food intake and give the family guidance on eating. The family members will provide the patient with mental support.

Treatment Plan

According to the Lung Association (2019), the treatment of pneumonia for patients with COPD depends on the type of pneumonia infection. For bacterial pneumonia, the patient will be prescribed antibiotics, as is the case with the patient in this case study. Bacterial pneumonia, which is very severe, might require IV-administered antibiotics. Treatment may also include frequent blood oxygen level checks, monitoring of heart and respiration rate, oxygen therapy, respiratory therapy, and other breathing treatments; and steroid prescriptions for reduction of lung inflammation. In this case study, the patient will be administered a long-acting bronchodilator, which will help in relieving his shortness of breath for long hours. This will be combined with an inhaled corticosteroid which will reduce the swelling in the airways. Thus, the patient will be prescribed 1 inhalation (fluticasone/umeclidinium/vilanterol 100 mcg-62.5 mcg-25 mcg) orally once a day.

Patient Education

According to Han (n.d), the patient will need to learn how to use the inhaler properly. Because there are different types of inhalers with slightly differing techniques for effective use, the patient will be shown how to use the prescribed inhaler. Effective use will ensure that all the medication gets into his lungs. The patient will also need to be educated on pulmonary rehabilitation. The pulmonary rehab program will help the patient to improve his symptoms and will involve education on his condition, exercise training, breathing techniques, and social support. For pulmonary rehab, the patient will be required to attend weekly meetings once a week for 12 weeks. At the end of the program, the patient will be given a prescription that will allow him to continue with the exercises un-assisted. Han (n.d) points out that pulmonary rehab is effective in improving patients’ ability to exercise, decreasing the exacerbation frequency of COPD, and increasing the quality of life.

Moreover, the patient will be educated on the importance of getting all the recommended vaccines in managing any future pneumococcal infection. These vaccines include the pneumococcal vaccine, the flu vaccine, and the pertussis vaccine. Lastly, the patient will need to watch his body weight to ensure he does not get malnutrition. He will need to increase his daily calorie intake and to do so, the patient will be advised to eat frequent yet small amounts of foods that are dense in nutrients, such as eggs; eat meals that need little preparation; rest prior to taking any meals; take a multivitamin daily; incorporate nutritional supplements with high calories, and stimulate the appetite by taking prescription medication recommended by the physician.

References

Han, M. K. Patient education: Chronic obstructive pulmonary disease (COPD) (Beyond the Basics).

Li, M., Wang, Z., Han, W. J., Lu, S. Y., & Fang, Y. Z. (2015). Effect of feeding management on aspiration pneumonia in elderly patients with dysphagia. Chinese Nursing Research, 2(2-3), 40-44.