High Blood Pressure Makes Pneumonia Deadlier

Elevated blood sugar levels may help predict death in pneumonia patients, researchers say.

The new study included nearly 6,900 patients, average age 60, with community-acquired pneumonia who were admitted to hospitals and private practices in Austria, Germany and Switzerland between 2003 and 2009.

Community-acquired pneumonia, one of the leading infectious diseases in industrialized nations, is a major cause of illness and death, according to background information in the study published online May 29 in the journal BMJ.

Compared to patients with normal glucose levels at admission, those with elevated levels had a higher risk of death within 28 and 90 days. The higher a patient's glucose levels, the greater the risk of death, the investigators said in a journal news release.

The death rate within 90 days was 3 percent for patients without diabetes and normal glucose levels, 10 percent for those without diabetes but with elevated glucose levels, and 14 percent for patients with diabetes, regardless of their glucose levels on admission, the study revealed.

The findings show the necessity of glucose testing and close glucose monitoring after patients with community-acquired pneumonia are discharged from hospital, in order to diagnose diabetes and to prevent further complications, concluded Dr. Philipp Lepper, of the University Hospital of Saarland in Germany, and colleagues.

Dose of Zinc Helps Sick Babies Recover

A simple, cheap dose of zinc helps the recovery of newborns suffering from bacterial infections such as pneumonia and meningitis, according to an Indian study reported on Thursday in The Lancet.

Doctors gave 10-milligram daily supplements of zinc to 332 babies who were being given antibiotic treatment at hospitals in New Delhi, and compared the outcome against 323 infants who were given a placebo as well as antibiotics.

The three-year probe, running from 2005 to 2008, focussed on babies aged between one week and four months.

Compared to the non-zinc group, children who were given the supplements were 40-percent less likely to experience treatment failure.

This was defined as needing a second course of antibiotics within a week or intensive care, or culminating in death, the study found.

In the zinc group, 34 treatment failures occurred, compared to 55 in the placebo group.
Use of zinc also reduced the number of deaths, but not by a margin considered statistically significant.

"Zinc is an accessible, low-cost intervention that could add to the effect of antibiotic treatment and lead to substantial reductions in infant mortality," said lead researcher Shinjini Bhatnagar from the All India Institute of Medical Sciences.

The benefit would be highest in developing countries where several million children die from infection each year and where second-line antibiotics and intensive care may be unavailable, he said.

Zinc can be easily administered, either as a syrup or as a soluble tablet, according to the investigation.

Previous research has found that zinc supplements help cure diarrhoea and pneumonia in small children younger than five years old.

Still unclear is why zinc works. One theory is that the mineral has a moderating influence on the immune system, preventing over-inflammation that disrupts drug therapy and leads to tissue injury.

Nursing Research Bowel Elimination Among Elder Adults

Bowel elimination is the end process of digestion resulting from interactions of the central and autonomic nervous systems, and endocrine, gastrointestinal and musculoskeletal systems. Three major bowel elimination problems have been studied and consistently have been shown to affect the older population: constipation, incontinence, and colorectal cancer (American Cancer Society, 2003a; Hogstel, 2001; Memorial Sloan-Kettering Cancer Center, 2003; Vogelzang 1999).

Constipation, defined as the accumulation of feces in the lower intestines with difficulty evacuating this waste, is the most common complaint among older adults (Abrams, Beers, Berkow,&Fletcher, 1995). According to Annells and Koch (2002), laxatives have become the most commonly sought treatment for constipation. More than one third of older adults use weekly laxatives to reduce strain and enhance fecal elimination (Reiss & Evans, 2002). Research findings demonstrate that increasing fiber and fluid in the diet significantly decreases the need for laxative use and stool softeners (Howard, West, & OssipKlein, 2000; Robinson & Rosher, 2002).

Vogelzang (1999) cited seven reasons for constipation in the elderly. Multiple medications (polypharmacy) had been identified as a primary reason for constipation, especially in nursing home residents. Six or more medications have been shown to adversely effect motility of the digestive tract (Vogelzang). Older adults living at home may be at an even higher risk for overdose related to self medication with over-the-counter drugs (Vogelzang). In addition, limited income influences the quality of food purchased and the degree of fiber-rich foods incorporated into the older adult’s diet. Annual income is less than $6,000 in 40%of olderAmericans, leaving them limited funds for groceries. Most do not take advantage of funded food programs. Selection of the same foods is common, leading to a poorly balanced diet (Vogelzang). Non-healthy snacking throughout the day also counteracts appetite as well as bowel regularity. Lack of social interaction, physical inactivity, nausea caused by contaminated food due to unclean food preparation, and inadequate cooking skills also have been identified as contributing factors to risk for constipation (Vogelzang). Constipation can be controlled by a well-balanced diet high in fiber, adequate hydration (at least 6–8 eight ounce glasses of water/day), along with increased activity (Hinrichs, Huseboe, Tang, & Titler, 2001).

Fecal incontinence has been shown to contribute to decreased social activity (Giebel, Lefering, Troidl, & Blochl, 1998). Older adults are embarrassed that incontinence may occur in public, so they tend to limit outside activity with friends and family. There exists a strong correlation between urinary and fecal incontinence (Chassagne et al., 1999). In a survey conducted by Giebel and colleagues, 500 randomly selected older adults in Germany responded to a questionnaire about bowel habits. It was found that 4.8% were unable to control solid stool, whereas 19.6% experienced at least one type of incontinence. Women had more of a problem with pasty or liquid stools. They also experienced an urgent sensation to quickly reach the toilet. Men described soiling their underwear as most problematic. Controlling flatus was also described as a concern. Findings suggest that the lack of control associated with bowel habits plus the reduction in activities necessitate interventions aimed at education about intestinal health and dietary change. Another study done on fecal incontinence enrolling 1,186 older adults 60 years of age and older in a long-term care setting identified five risk factors associatedwith fecal incontinence: (1) history of urinary incontinence, (2) neurological disease, (3) poor mobility, (4) severe cognitive decline, and (5) age greater than 70 (Chassagne et al.). Fecal incontinence associated with impaction and diarrhea occurred in 234 (20%) of the sample. The study showed an association between permanent fecal incontinence and overall poor health in older adults.

In summary, older adults are at risk for developing bowel elimination complications, which may be associated with the physiological changes occurringwith advancing age and lack of screening. Screening for cancer needs to be done on all elderly, regardless of advanced age. Diets high in fiber, adequate hydration, increased activity, and education programs encourage prevention of complications.

Nursing Care Plan Severe Hypertension | Activity Intolerance

Nursing Diagnosis: Activity intolerance may be related to generalized weakness and imbalance between oxygen supply and demand possibly evidenced by verbal report of fatigue or weakness; abnormal heart rate or BP response to activity; exertional discomfort or dyspnea; and electrocardiogram (ECG) changes reflecting ischemia; dysrhythmias.

Desired Outcomes:
Participate in necessary/desired activities.
Report a measurable increase in activity tolerance.
Demonstrate a decrease in physiologic signs of intolerance.

Nursing Intervention with Rationale:
1. Assess the client’s response to activity, noting pulse rate more than 20 beats/min faster than resting rate; marked increase in BP during/after activity (systolic pressure increase of 40 mm Hg or diastolic pressure increase of 20 mm Hg); dyspnea or chest pain; excessive fatigue and weakness; diaphoresis; dizziness or syncope.
Rationale: The stated parameters are helpful in assessing physiologic responses to the stress of activity and, if present, are indicators of overexertion.

2. Instruct client in energy-conserving techniques; e.g., using chair when showering, sitting to brush teeth or comb hair, carrying out activities at a slower pace.
Rationale: Energy-saving techniques reduce the energy expenditure, thereby assisting in equalization of oxygen supply and demand.

3. Encourage progressive activity/self-care when tolerated. Provide assistance as needed.
Rationale: Gradual activity progression prevents a sudden increase in cardiac workload. Providing assistance only as needed encourages independence in performing activities.

Nursing Care Plan Hypertension | Acute Headache Pain

Nursing diagnosis: Acute headache pain may be related to increased cerebral vascular pressure possibly evidenced by reports of throbbing pain located in suboccipital region, present on awakening, and disappearing spontaneously after being up and about; reluctance to move head, rubbing head, avoidance of bright lights and noise, wrinkled brow, clenched fists; and reports of stiffness of neck, dizziness, blurred vision, nausea, and vomiting.

Desired Outcomes
Report pain/discomfort is relieved/controlled.
Verbalize methods that provide relief.
Follow prescribed pharmacologic regimen.

Nursing Intervention with Rationale:
1. Determine specifics of pain; e.g., location, characteristics, intensity (0–10 scale), onset/duration. Note nonverbal cues.
Rationale: Facilitates diagnosis of problem and initiation of appropriate therapy. Helpful in evaluating effectiveness of therapy.

2. Encourage/maintain bedrest during acute phase.
Rationale: Minimizes stimulation/promotes relaxation.

3. Provide/recommend nonpharmacologic measures for relief of headache; e.g., cool cloth to forehead; back and neck rubs; quiet, dimly lit room; relaxation techniques (guided imagery, distraction); and diversional activities.
Rationale: Measures that reduce cerebral vascular pressure and that slow/block sympathetic response are effective in relieving headache and associated complications.

4. Eliminate/minimize vasoconstricting activities that may aggravate headache; e.g., straining at stool, prolonged coughing, bending over.
Rationale: Activities that increase vasoconstriction accentuate the headache in the presence of increased cerebral vascular pressure.

5. Assist client with ambulation as needed.
Rationale: Dizziness and blurred vision frequently are associated with vascular headache. Client may also experience episodes of postural hypotension, causing weakness when ambulating.

6. Provide liquids, soft foods, frequent mouth care if nosebleeds occur or nasal packing has been done to stop bleeding.
Rationale: Promotes general comfort. Nasal packing may interfere with swallowing or require mouth breathing, leading to stagnation of oral secretions and drying of mucous membranes.

7. Administer medications as indicated: analgesics
Rationale: Reduce/control pain and decrease stimulation of the sympathetic nervous system.

8. Administer Antianxiety agents; e.g., lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium)
Rationale: May aid in the reduction of tension and discomfort that is intensified by stress.