The Application of Neuman Systems Theory for Nursing Care of Elderly Patients with COVID–19 Pneumonia and Pre–existing Chronic Kidney Disease: 2 Case Studies

Abstract

Pneumonia caused by COVID–19 infection in elderly patients with chronic kidney disease has the potential to worsen the disease and cause complications in various systems that are important to life. This study aimed to compare the nursing care of two case studies of elderly patients with chronic kidney disease who had pneumonia caused by COVID–19. The Neuman’s Systems Theory was applied to provide nursing care to the patients. The case studies were selected specifically from patients admitted to the COVID–19 ward at Sakan Nakhon Hospital in July 2023. Two patients were included. Data were collected from the patient’s medical record, additional history, physical examination, and assessment of health threats, both internal, interpersonal, and external.

The study found that the two case studies of patients with pneumonia caused by COVID–19 were elderly patients of similar age with chronic kidney disease. Case study 1 had end–stage chronic kidney disease and was treated with hemodialysis. The patient had a history of receiving two doses of COVID–19 vaccine. Case study 2 had stage 4 chronic kidney disease and was treated with supportive care and monitoring. The patient had never received a COVID–19 vaccine. Comparison of severity of illness. Case study 1 had less severe hypoxemia and could be resolved with O2 cannula. Case study 2 had acute and more severe hypoxemia, as evidenced by an oxygen saturation level of less than 92% on admission and the need for high–flow oxygen therapy. Development of complications. Case study 1 developed a complication of myocardial infarction on the 8th day of treatment. Both case studies had similar pathologies related to high blood sugar levels and anemia. Psychosocial and developmental aspects. As elderly patients who were separated from their families and treated in an isolation room, both case studies felt isolated and anxious. Assessment of health threats. The study team identified 12 nursing diagnoses and provided nursing care that allowed the patients to be discharged from the hospital. Case study 1 and case study 2 were discharged after 14 and 10 days, respectively.

This study suggested that nurses can apply Neuman’s Systems Theory as a framework for providing nursing care to patients with pneumonia caused by COVID–19 in elderly patients with chronic kidney disease.