Pneumonia

  1. General information
    1. An inflammation of the alveolar spaces of the lung, resulting in consolidation of lung tissue as the alveoli fill with exudate
    2. The various types of pneumonias are classified according to the offending organism.
    3. Bacterial pneumonia accounts for 10% of all hospital admissions; affects infants and elderly most often, and most often occurs in winter and early spring
    4. Caused by various organisms: D. pneumoniae, S. aureus, E. coli, H. influenzae
  2. Assessment findings
    1. Cough with greenish to rust-colored sputum production; rapid, shallow respirations with an expiratory grunt; nasal flaring; intercostal rib retraction; use of accessory muscles of respiration; dullness to flatness upon percussion; possible pleural friction rub; high-pitched bronchial breath sounds; rales or crackles (early) progressing to coarse (later)
    2. Fever, chills, chest pain, weakness, generalized malaise
    3. Tachycardia, cyanosis, profuse perspiration, abdominal distension
    4. Diagnostic tests
      1. Chest x-ray shows consolidation over affected areas
      2. WBC increased
      3. pO2 decreased
      4. Sputum specimens reveal particular causative organism
  3. Nursing interventions
    1. Facilitate adequate ventilation.
      1. Administer oxygen as needed and assess its effectiveness.
      2. Place client in semi-Fowler's position.
      3. Turn and reposition frequently clients who are immobilized/obtunded.
      4. Administer analgesics as ordered to relieve pain associated with breathing (codeine is drug of choice).
      5. Auscultate breath sounds every 2-4 hours.
      6. Monitor ABGs.
    2. Facilitate removal of secretions (general hydration, deep breathing and coughing, tracheobronchial suctioning as needed, expectorants as ordered, aerosol treatments via nebulizer, humidification of inhaled air, chest physical therapy).
    3. Observe color, characteristics of sputum and report any changes; encourage client to perform good oral hygiene after expectoration.
    4. Provide adequate rest and relief/control of pain.
      1. Provide bed rest with limited physical activity.
      2. Limit visits and minimize conversations.
      3. Plan for uninterrupted rest periods.
      4. Institute nursing care in blocks to ensure periods of rest.
      5. Maintain pleasant and restful environment.
    5. Administer antibiotics as ordered, monitor effects and possible toxicity.
    6. Prevent transmission (respiratory isolation may be required for clients with staphylococcal pneumonia).
    7. Control fever and chills: monitor temperature and administer antipyretics as ordered, maintain increased fluid intake, provide frequent clothing and linen changes.
    8. Provide client teaching and discharge planning concerning prevention of recurrence.
      1. Medication regimen/antibiotic therapy
      2. Need for adequate rest, limited activity, good nutrition with adequate fluid intake, and good ventilation
      3. Need to continue deep breathing and coughing for at least 6-8 weeks after discharge
      4. Availability of vaccines (pneumonococcal pneumonia, influenza)
      5. Techniques that prevent transmission (use of tissues when coughing, adequate disposal of secretions)
      6. Avoidance of persons with known respiratory infections
      7. Need to report signs and symptoms of respiratory infection (persistent or recurrent fever; changes in characteristics, color of sputum; chills; increased pain; difficulty breathing; weight loss; persistent fatigue)
      8. Need for follow-up medical care and evaluation.

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