Nursing Management for Pneumonia

Pneumonia is an inflammation of the lung parenchyma commonly caused by microbial agents. Classically, pneumonia has been categorized as being bacterial or typical, atypical, anaerobic/cavitary, or opportunistic. Another classification scheme categorizes pneumonias as community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP or nosocomial), pneumonia in the immunocompromised host, and aspiration pneumonia.

Assessment

  • Assess for fever, chills, night sweats, pleuritic-type pain, fatigue, tachypnea, use of accessory muscles, bradycardia or relative bradycardia, coughing, and purulent sputum, and auscultate breath sounds for consolidation
  • Note changes in temperature; pulse; amount, odor, and color of secretions; and breath sounds
  • Frequency and severity of cough
  • Degree of tachypnea or shortness of breath
  • Changes in chest x-ray findings
  • Assess for complications, including continuing or recurring fever, failure to resolve, atelectasis, pleural effusion, cardiac complications, and superinfection
  • Assess the elderly patient for altered mental status, dehydration (excessive fatigue), and congestive heart failure

Nursing Diagnoses

  • Ineffective airway clearance related to copious tracheobronchial secretions
  • Risk for deficient fluid volume related to fever and dyspnea
  • Activity intolerance related to impaired respiratory function
  • Imbalanced nutrition: Less than body requirements
  • Deficient knowledge about treatment regimen and preventive health measures

Nursing Interventions

Improve Airway Patency

  • Encourage hydration: fluid intake (2 to 3 L/day) to loosen secretions
  • Provide humidified air using high-humidity face mask
  • Encourage patient to cough effectively, and provide correct positioning, chest physiotherapy, and incentive spirometry
  • Provide nasotracheal suctioning if necessary
  • Provide appropriate method of oxygen therapy
  • Monitor effectiveness of oxygen therapy

Promoting Activity Tolerance

  • Counsel patient to rest and to avoid overexertion, which may exacerbate symptoms
  • Assist patient into a comfortable position that maximizes breathing (eg. semi-Foweler’s position or moderate high back rest)
  • Change position frequently (particularly in elderly patients)

Promoting Fluid Intake and Maintaining Nutrition

  • Encourage fluids (2 L/day minimum with electrolytes and calories)
  • Administer intravenous fluids and nutrients, if necessary

Informing Patient

  • Instruct on cause of pneumonia and management of symptoms
  • Explain treatments in simple manner and using appropriate language
  • Repeat instructions and explanations as needed

Monitoring and Preventing Potential Complications

  • Assess for signs and symptoms of shock, multisystem organ failure, and respiratory failure
  • Administer intravenous fluids and medications and respiratory support as ordered
  • Initiate preventive measures for atelectasis
  • Assess for atelectasis and pleural effusion
  • Assist with thoracentesis, and monitor patient for pneumothorax after procedure
  • Monitor for superinfection (rise in temperature, increased cough), and assist in therapy
  • Assess for confusion or cognitive changes; assess underlying factors

Photo Credit: medtogo.com
Info Credit: Brunner & Suddarth’s textbook of Medical-Surgical Nursing

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