HESI Patient Review: Respiratory - Mr. Hannigan
Mr. Hannigan, a 75-year-old man is examined by his healthcare provider (HCP) in the office and he is diagnosed with right lower lobe pneumonia. He is admitted to the Medical Unit in the hospital where you work.
Mr. Hannigan has community-acquire...
HESI Patient Review: Respiratory - Mr. Hannigan
Mr. Hannigan, a 75-year-old man is examined by his healthcare provider (HCP) in
the office and he is diagnosed with right lower lobe pneumonia. He is admitted to
the Medical Unit in the hospital where you work.
Mr. Hannigan has community-acquired pneumonia (CAP), a bacterial pneumonia
found in the lower respiratory tract of non-hospitalized persons. Risk factors for
CAP include advanced age older than 65, immunocompromised host, or
comorbidities such as diabetes or COPD.
Mr. Hannigan has acute symptoms that increase his risks for fatal complications
of pneumonia. It was decided that he should be hospitalized and receive IV
antibiotics.
Mr. Hannigan is accompanied by his wife and daughter, who are very upset about
his hospital admission because of his confusion, increased heart rate, and
shortness of breath.
You review the rationale for Mr. Hannigan's nursing care. What is the underlying
pathophysiology of pneumonia?
inflammation and/or infection of the lung
The pathophysiology of pneumonia involves excess fluid in the lungs associated with an
acute inflammatory process that is usually a result of infection. Microorganisms
(bacteria, viruses, fungi, parasites) gain entry into the respiratory tract either by
inhalation (from airborne transmission with talking, sneezing, coughing) or aspiration
(secretions from the oropharynx or nasopharynx). The organisms are not successfully
cleared, and they become established.
Which considerations are critical for the nurse to make when assigning a room to
a client with community acquired pneumonia (CAP)?
Mr. Hannigan's confusion
Mr. Hannigan's confusion is an important consideration for room assignment. The fact
that Mr. Hannigan is confused places him at risk for injury. An initial assessment found
Mr. Hannigan to be disoriented to time, place, and person. Bed placement as close to
the nurses' station as possible is important.
Infection control
Infection control is an important consideration for room assignment. Mr. Hannigan has
pneumonia, although the specific organism responsible for infection is not known at this
time. The means of transmission is not yet known. To decrease risk for hospital-
acquired pneumonia or other nosocomial infections in other clients, Mr. Hannigan was
assigned to a private room.
, According to Centers for Disease Control (CDC) guidelines, which isolation
precautions are indicated for Mr. Hannigan at this time?
Droplet Precautions
Centers for Disease Control (CDC) Guidelines for Isolation Precautions in Hospitals
require that Droplet Precautions be used with persons who have suspected or known
infections that are transmitted by large particle droplets, including some pneumonias.
These pneumonias are contagious with coughing, sneezing, talking, and procedures
requiring close contact. Usually transmission is by nasopharyngeal/respiratory
secretions and/or sometimes saliva. It is possible that Mr. Hannigan has a pneumonia
that will not require Droplet Precautions. However, it is prudent that Droplet Precautions
be instituted to prevent transmission of infection until such time that a diagnosis
suggesting otherwise is determined.
Contact Precautions
Centers for Disease Control (CDC) Guidelines for Isolation Precautions in Hospitals
require that Contact Precautions be used with persons who have suspected or known
infections that can be transmitted by direct (personal) or indirect (environmental
surfaces) contact. Some pneumonias spread easily through direct contact with infected
persons or indirect contact with contaminated objects or surfaces. For these
pneumonias, transmission is usually by nasopharyngeal/respiratory secretions. It is
possible that Mr. Hannigan has a pneumonia that will not require Contact Precautions.
However, it is prudent that Contact Precautions be instituted to prevent transmission of
infection until such time that a diagnosis suggesting otherwise is determined.
Standard Precautions
Centers for Disease Control (CDC) Guidelines for Isolation Precautions in Hospitals
require that Standard Precautions be used with all hospitalized persons, regardless of
diagnosis or presumed diagnosis.
Standard precautions, droplet precautions, and contact precautions apply for Mr.
Hannigan. Besides a private room, which of the following infection control
requirements are indicated?
Wear a mask with close contact
When providing close-contact (within three feet) direct care with clients on droplet
precautions, the health care provider should wear a face mask. Often, this means
wearing a mask when in the client's room
Wear a gown when assisting Mr. Hannigan with bathing
A gown should be worn when assisting Mr. Hannigan with bathing. A gown is required
with substantial physical contact as part of contact precautions. Client-care activities
that might involve splashes of body fluids or secretions require a gown as part of
standard precautions.
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