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Pneumonia overview and ncp
Pneumonia is an infection of the lungs that can be caused by viruses, bacteria, fungi or other pathogens. It is classified based on location and cause. The main types are bronchopneumonia, lobular pneumonia, and lobar pneumonia. Pneumonia can also be primary, secondary, or due to aspiration. Clinical manifestations include fever, cough, chest pain, and difficulty breathing. Diagnosis involves chest x-rays, sputum tests, and blood tests. Treatment consists of antibiotics, oxygen therapy, and airway clearance techniques. Nursing care focuses on improving gas exchange, enhancing airway clearance, relieving pain, and monitoring for complications like pleural effusions or respiratory failure.
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Introduction to pneumonia, types (viral, bacterial, etc.), classifications, risks, and prognosis.
Key symptoms include sudden onset fever, cough with sputum, dyspnea, and chest pain.
Diagnostic tools: chest X-ray, sputum tests, blood cultures for identifying pneumonia.
Treatment through antimicrobial therapy and oxygen therapy for gas exchange improvement.
Possible complications include pleural effusion, hypotension, superinfection, and delirium.
Assessment techniques: patient history, physical signs, breath sounds, and sputum analysis.
Identified diagnoses include Impaired Gas Exchange and Ineffective Airway Clearance.
Interventions focus on improving gas exchange, clearing airways, and managing pain.
Techniques for pain management: positioning, analgesics, and breathing methods.
Vital signs monitoring and special attention for high-risk patients to detect complications.
Expected outcomes include improved oxygen levels, controlled fever, and absence of complications.
References for further information on nursing care and pneumonia management.
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Pneumonia overview and ncp
- 1. Pneumonia:Overview & NursingCare PlanReynel Dan L. Galicinao
- 2. PNEUMONIAAn acute infectionof the lung parenchyma that often impairs gas exchangeClassification based on microbiological etiology:Viral
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- 9. involves distal airwaysand alveoli
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- 11. part of alobe
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- 13. entire lobeThree types:Primarypneumonia results directly from inhalation or aspiration of a pathogen (bacteria, virus)
- 14. pneumococcal and viralpneumoniaSecondary pneumoniamay follow initial lung damage from a noxious chemical or other insult (superinfection)
- 15. may result fromhematogenous spread of bacteria from a distant area3. Aspiration pneumonia results from inhalation of foreign matter (vomitus, food particles) into the bronchi
- 16. more likely tooccur in elderly or debilitated patients, those receiving NGT feedings, and those with an impaired gag reflex, poor oral hygiene, or a decreased level of consciousnessGood prognosis for patients with normal lungs and adequate immune systemsIn debilitated patients, bacterial pneumonia ranks as the leading cause of death
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- 18. Sudden onset; shakingchillRapidly rising fever of 101° F to 105° F (38.3° C to 40.5° C)Cough productive of purulent sputumPleuritic chest pain aggravated by respiration/coughingDyspnea, tachypnea accompanied by respiratory grunting, nasal flaring, use of accessory muscles of respiration, fatigueRapid, bounding pulse
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- 20. Chest X-ray showspresence/extent of pulmonary disease, typically consolidation.Gram stain and culture and sensitivity tests of sputum - may indicate offending organism.Blood culture detects bacteremia (bloodstream invasion) occurring with bacterial pneumonia.Immunologic test detects microbial antigens in serum, sputum, and urine.
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- 22. Antimicrobial therapy -depends on laboratory identification of causative organism and sensitivity to specific antimicrobials, or presumptive therapy with broad spectrum agent in milder cases.Oxygen therapy if patient has inadequate gas exchange
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- 24. Pleural effusion.Sustained hypotensionand shock, especially in gram-negative bacterial disease, particularly in elderly patients.Superinfection: pericarditis, bacteremia, and meningitis.Delirium - this is considered a medical emergency.Atelectasis - due to mucous plugs.Delayed resolution.
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- 26. Take a carefulhistory to help establish etiologic diagnosis.History of recent respiratory illness including mode of onset
- 27. Presence of purulentsputum, increased amount of sputum, fever, chills, chest pain, dyspnea, tachypnea
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- 29. Medications, alcohol, tobacco,or I.V. drug useObserve for anxious, flushed appearance, shallow respirations, splinting of affected side, confusion, disorientation.Auscultate for crackles overlying affected region, and for bronchial breath sounds when consolidation (filling of airspaces with exudate) is present.
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- 31. Impaired Gas Exchangerelated to decreased ventilation secondary to inflammation and infection involving distal airspacesIneffective Airway Clearance related to excessive tracheobronchial secretionsAcute Pain related to inflammatory process and dyspneaRisk for Injury secondary to complications
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- 33. Improving Gas ExchangeObservefor cyanosis, dyspnea, hypoxia, and confusion, indicating worsening condition.Follow ABG levels/Sao2 to determine oxygen need and response to oxygen therapy.Administer oxygen at concentration to maintain Pao2 at acceptable level. Hypoxemia may be encountered because of abnormal ventilation-perfusion ratios in affected lung segments.Avoid high concentrations of oxygen in patients with COPD, particularly with evidence of CO2 retentionuse of high oxygen concentrations may worsen alveolar ventilation by depressing the patient's only remaining ventilatory drive. If high concentrations of oxygen are given, monitor alertness and Pao2 and Paco2 levels for signs of CO2 retention.
- 34. Place patient inan upright position to obtain greater lung expansion and improve aeration. Frequent turning and increased activity (up in chair, ambulate as tolerated) should be employed.
- 35. Enhancing Airway ClearanceObtainfreshly expectorated sputum for gram stain and culture, preferably early morning specimen as directed. Instruct the patient as follows:Rinse mouth with water to minimize contamination by normal flora.
- 36. Breathe deeply severaltimes.
- 37. Cough deeply andexpectorate raised sputum into sterile container.Encourage patient to cough; retained secretions interfere with gas exchange. Suction as necessary.Encourage increased fluid intake, unless contraindicated, to thin mucus and promote expectoration and replace fluid losses caused by fever, diaphoresis, dehydration, and dyspnea.
- 38. Humidify air oroxygen therapy to loosen secretions and improve ventilation.Employ chest wall percussion and postural drainage when appropriate to loosen and mobilize secretions.Auscultate the chest for crackles and rhonchi.
- 39. Administer cough suppressantswhen coughing is nonproductive only if there is no evidence of retained secretions.Mobilize patient to improve secretion clearance and reduce risk of atelectasis and worsening pneumonia.
- 40. Relieving Pleuritic PainPlacein a comfortable position (semi-Fowler's) for resting and breathingEncourage frequent change of position to prevent pooling of secretions in lungs.Demonstrate how to splint the chest while coughing.Avoid suppressing a productive cough.
- 41. Administer prescribed analgesicagent to relieve pain. Avoid opioids in patients with a history of COPD.Apply heat and/or cold to chest as prescribed.Assist with intercostal nerve block for pain relief.
- 42. Encourage modified bedrest during febrile period.Watch for abdominal distention or ileus, which may be due to swallowing of air during intervals of severe dyspnea. Insert a nasogastric (NG) or rectal tube as directed.
- 43. Monitoring for ComplicationsRememberthat fatal complications may develop during the early period of antimicrobial treatment.Monitor temperature, pulse, respiration, blood pressure, and oximetry at regular intervals to assess the patient's response to therapy.Auscultate lungs and heart. Heart murmurs or friction rub may indicate acute bacterial endocarditis, pericarditis, or myocarditis.Employ special nursing surveillance for patients with:Alcoholism, COPD, immunosuppression - these people as well as elderly patients, may have little or no fever.
- 44. Chronic bronchitis -it is difficult to detect subtle changes in condition, because the patient may have seriously compromised pulmonary function.
- 45. Epilepsy - pneumoniamay result from aspiration after a seizure.
- 46. Delirium - maybe caused by hypoxia, meningitis, delirium tremens of alcoholism.Assess these patients for unusual behavior, alterations in mental status, stupor, and heart failure.Assess for resistant fever or return of fever, potentially indicating bacterial resistance to antibiotics.
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- 48. Cyanosis and dyspneareducedABG levels and Sao2 improvedCoughs effectivelyAbsence of cracklesAppears more comfortableFree of painFever controlledNo signs of resistant infection
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