NR 536 Week 5 Develop an Evolving Case Study

NR 536 Week 5 Develop an Evolving Case Study

Student Name

Chamberlain University

NR-536: Advanced Health Assessment, Pathophysiology & Pharmacology for Advanced Nursing Practice

Prof. Name:

Date

Development of an Evolving Case Study: NR 536 Week 5

Overview of Evolving Case Study

This case study aims to develop a comprehensive treatment plan to prevent and manage ventilator-associated pneumonia (VAP) in intensive care units (ICU) within acute healthcare settings. Targeted at nursing staff with at least three years of ICU experience, the case study highlights essential concepts such as patient safety, infection control, and evidence-based practices for preventing VAP. Strategies include oral hygiene protocols (Hua et al., 2016), addressing antibiotic resistance (Khan et al., 2017), sedation management, and physical assessment techniques (Álvarez-Lerma et al., 2018). Additional measures such as physiotherapy (Zampieri et al., 2015) and the judicious use of medical devices aim to enhance patient care and minimize the risk of VAP.

Case Study Setting

The scenario is set in the ICU of an acute care facility, focusing on a patient with respiratory failure who requires oxygen supplementation, intubation, and mechanical ventilation. The patient is under sedation and receives IV anticoagulants, fluid infusions, and continuous monitoring. Equipment includes cardiac and pulmonary monitors, vital sign machines, and wall suction.

Patient Profile

Name: Mr. XYZ
Gender/Age/Weight/Height: Male, 65 years, 252 lbs, 5’10”
Allergies: Codeine
Past Medical History: Diabetes, asthma, ischemic stroke (December 2019), paroxysmal atrial fibrillation, coronary artery bypass surgery (2016), 40-pack-year smoking history, and alcohol use.
Present Illness History: Admitted on February 8, 2020, with complaints of tachypnea, shortness of breath, and chest pain. Rapid desaturation led to respiratory distress and subsequent intubation in the emergency department.
Social History: Retired software engineer living with his wife; two adult children reside out of state.
Primary Medical Diagnosis: Pulmonary embolism complicated by pleural effusion, respiratory failure, and hypoxemia.
Surgeries and Procedures: CT scan, blood and urine cultures, arterial blood gas testing, COVID-19 test, daily EKGs, blood tests, and chest X-rays.

Evolving Case Study: Table Format

Debriefing

• Stage 1 Focus: Effective preventive measures for reducing VAP in chronically ill patients.
• Stage 2 Focus: Frequency of implementing VAP bundle components such as oral hygiene and head inclination.
• Stage 3 Focus: Strategies for rapid bacterial growth control in the lungs and trachea.
• Overall Focus: Comprehensive methods for preventing and treating VAP in bed-bound patients.

References

Álvarez-Lerma, F., Palomar-Martínez, M., Sánchez-García, M., Martínez-Alonso, M., Álvarez-Rodríguez, J., & Lorente, L. et al. (2018). Prevention of ventilator-associated pneumonia. Critical Care Medicine, 46(2), 181-188. https://doi.org/10.1097/ccm.0000000000002736

Bardia, A., Blitz, D., Dai, F., Hersey, D., Jinadasa, S., Tickoo, M., & Schonberger, R. (2019). Preoperative chlorhexidine mouthwash to reduce pneumonia after cardiac surgery: A systematic review and meta-analysis. The Journal Of Thoracic And Cardiovascular Surgery, 158(4), 1094-1100. https://doi.org/10.1016/j.jtcvs.2019.01.014

Fortaleza, C., Filho, S., Silva, M., Queiroz, S., & Cavalcante, R. (2020). Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units. The Brazilian Journal Of Infectious Diseases, 24(5), 373-379. https://doi.org/10.1016/j.bjid.2020.08.004

NR 536 Week 5 Develop an Evolving Case Study

 Hellyer, T., Ewan, V., Wilson, P., & Simpson, A. (2016). the intensive care society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. Journal Of The Intensive Care Society, 17(3), 238-243. https://doi.org/10.1177/1751143716644461

Hua, F., Xie, H., Worthington, H., Furness, S., Zhang, Q., & Li, C. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Of Systematic Reviews. https://doi.org/10.1002/14651858.cd008367.pub3

NR 536 Week 5 Develop an Evolving Case Study

Khan, Z., Ceriana, P., & Donner, C. (2017). Ventilator-associated pneumonia or ventilator-induced pneumonia. Multidisciplinary Respiratory Medicine, 12. https://doi.org/10.4081/mrm.2017.224

Olanipekun, T., & Snyder, R. (2019). Mortality risk in ventilator-acquired bacterial pneumonia and nonventilator icu-acquired bacterial pneumonia. Critical Care Medicine, 47(10), e851-e852. https://doi.org/10.1097/ccm.0000000000003662

Pinho, R., Tanure, L., Pessoa, J., Santos, L., Couto, B., & Starling, C. (2020). Impact of each component of a ventilator bundle on preventing ventilator-associated pneumonia and lower respiratory infection. Infection Control & Hospital Epidemiology, 41(S1), s259-s260. https://doi.org/10.1017/ice.2020.824

Prasad, R., Daly, B., & Manley, G. (2019). The impact of 0.2% chlorhexidine gel on oral health and the incidence of pneumonia amongst adults with profound complex neurodisability. Special Care In Dentistry, 39(5), 524-532. https://doi.org/10.1111/scd.12414

NR 536 Week 5 Develop an Evolving Case Study

Vieira, P., de Oliveira, R., & da Silva Mendonça, T. (2020). Should oral chlorhexidine remain in ventilator-associated pneumonia prevention bundles?. Medicina Intensiva. https://doi.org/10.1016/j.medin.2020.09.009

Xie, X., Lyu, J., Hussain, F., & Li, M. (2019). Drug prevention and control of ventilator-associated pneumonia. Front Pharmacol, 10(298). https://doi.org/10.3389/fphar.2019.00298

Zampieri, F., Nassar Jr, A., Gusmao-Flores, D., Taniguchi, L., Torres, A., & Ranzani, O. (2015). Nebulized antibiotics for ventilator-associated pneumonia: a systematic review and meta-analysis. Critical Care, 19(1). https://doi.org/10.1186/s13054-015-0868-y

Zhao, J., Li, L., Chen, C., Zhang, G., Cui, W., & Tian, B. (2020). Do probiotics help prevent ventilator-associated pneumonia in the critically ill patients? A systematic review with meta-analysis. ERJ Open Research, 00302-2020. https://doi.org/10.1183/23120541.00302-2020