An inflammatory process in the lungs that produces excess fluid and exudate that fill the alveoli
Classified as bacterial, viral, fungal, or chemical
Pneumonia is triggered by infectious organisms or by the aspiration of an irritant, such as fluid or a foreign object
Can be a primary disease of a complication of another disease or condition
Young clients, older adult clients, and clients who are immunocompromised are more susceptible
TYPES OF PNEUMONIA
Ventilator associated pneumonia (VAP):
Occurs 48 to 72 hr after endotracheal intubation
Community acquired pneumonia (CAP):
The most common type and often occurs as a complication of influenza
Health care acquired pneumonia (HAP):
Has a higher mortality rate and is more likely to be resistant to antibiotics. It usually takes more than 48 hr from the time the client is exposed to acquire HAP.
No pneumococcal vaccination within the last 5 years
No influenza vaccine within the last year
Chronic lung disease
Enteral tube feeding
Chest discomfort due to coughing
Confusion from hypoxia is a common manifestation of pneumonia in older adult clients
Shortness of breath or difficulty breathing
Pleuritic chest pain (sharp)
Sputum production (yellow-tinged)
Dull chest percussion over areas of consolidation
Decreased oxygen saturation levels
Purulent, blood tinged or rust colored sputum
(Might not be present in older adult clients)
(PaO2 less than 80 mm Hg)
To rule out organisms in the blood
To identify dehydration
Sputum culture and sensitivity:
Obtain specimens before starting antibiotic therapy
Obtain specimen by suctioning if the client is unable to cough
Will show consolidation (solidification, density) of lung tissue
Might not indicate pneumonia for a few days after manifestations develop
Clients who have pneumonia usually have oximetry levels less than the expected reference range of 95-100%
Position the client to maximize ventilation (high-Fowler's) unless contraindicated
Encourage coughing or suction to remove secretions
Administer breathing treatments & medications
Adminiter oxygen therapy
Monitor for skin breakdown around the ears, nose, and mouth from the oxygen device
Encourage deep breathing with an incentive spirometer to prevent alveolar collapse
Determine the client's physical limitations and structure activity to include periods of rest
Encourage fluid intake of 2.5 to 3 L/day to promote hydration and thinning of secretions, unless contraindicated due to another condition
Provide rest periods for clients who have dyspnea
Reassure the client who is experiencing respiratory distress
Antibiotics are given to destroy infectious pathogens.
Commonly used antibiotics include fluoroquinolone, penicillins, and cephalosporins.
Antibiotics are often initially given via IV and then switched to an oral form as the condition improves.
Obtain any culture specimens prior to giving the first dose of an antibiotic. Once the specimen is obtained, the antibiotics can be given while waiting for the results of the culture.
Observe clients taking cephalosporins for frequent stools
Monitor kidney function, especially older adults who are taking penicillins and cephalosporins
Encourage clients to take penicillins and cephalosporins with food
Some penicillins should be taken 1 hr before meals or 2 hr after
Bronchodilators are given to reduce bronchospasm and reduce irritation.
Short-acting beta2 agonists, such as albuterol, provide rapid relief.
Cholinergic antagonists (anticholinergic medications), such as ipratropium, block the parasympathetic nervous system, allowing for increased bronchodilator and decreased pulmonary secretions.
Nursing Actions (Albuterol):
Increase fluid intake if not contraindicated
Can cause hypokalemia, insomnia, headache, or nausea
Monitor for tremors, tachycardia, hypertension, nervousness, palpitations, and dry mouth
Nursing Actions (Ipratropium):
Observe for dry mouth and difficulty with urination
Monitor heart rate
Adverse effects can include headache, blurred vision, and palpitations, which can indicate toxicity
Reinforce teaching on how to use a metered-dose inhaler (MDI)
Encourage clients to suck on hard candies to moisten dry mouth while taking ipratropium
Encourage increased fluid intake unless contraindicated
Anti-inflammatories decrease airway inflammation.
Glucocorticosteroids, such as fluticasone (MDI) and prednisone (oral), are prescribed to reduce inflammation.
Monitor for immunosuppression, fluid retention, hyperglycemia, hypertension, hypokalemia, and poor wound healing.
Monitor for decreased immunity function and infection
Monitor for hyperglycemia
Monitor for hypertension
Advise the pt to report black, tarry stools
Observe for fluid retention and weight gain
Monitor for electrolyte imbalance
Monitor the client's throat and mouth for aphthous lesions (canker sores)
Drink plenty of fluids to promote hydration
Take glucocorticosteroids with food
Avoid discontinuing glucocorticosteroids without consulting provider
Rinse mouth and gargle after inhaled glucocorticoids to reduce the risk of dysohonia and candidiasis
Consult with respiratory services for inhalers, breathing treatments, and suctioning for airway management.
Consult with nutritional services for weight loss or gain related to medications or diagnosis.
Consult with rehabilitation care if the client has prolonged weakness and needs assistance with increasing level of activity.
Continue medications for treatment of pneumonia
Rest as needed
Maintain hand hygiene to prevent infection
Avoid crowded areas to reduce the risk of infection
Receive immunizations for influenza and pneumonia
COMPLICATIONS OF PNEUMONIA
Airway inflammation and edema lead to alveolar collapse and increase the risk of hypoxemia
The pt reports shortness of breath and exhibits findings of hypoxemia
The pt has diminished or absent breath sounds over the affected area
A chest x-ray shows an area of density
This occurs if pathogens enter the bloodstream from the infection in the lungs
Acute respiratory distress syndrome:
Hypoxemia persists despite oxygen therapy
Dyspnea worsens as bilateral pulmonary edema develops that is non cardiac related
A chest x-ray shows an area of density with a ground-glass appearance
Blood gas findings demonstrate high arterial blood levels of carbon dioxide (hypercarbia) and pulse oximetry shows decreased saturation
1. A nurse is monitoring a group of clients for increased risk for developing pneumonia. Which of the following clients should the nurse expect to be at risk? (select all that apply)
A. client who has dysphagia
B. client who has AIDS
C. client who received vaccines for pneumoccocus and influenza 6 months ago
D. client who is ambulatory after receiving a local anesthesia
E. client who has a closed head injury
F. client who has myasthenia graves
2. A nurse is caring for a client who has pneumonia. Data collection findings include temperature 37.8 C (100 F), respirations 30/min, blood pressure 130/76, heart rate 100/min, and SaO2 91% on room air. Which of the following actions is the nurse's priority?
A. administer antibiotics
B. administer oxygen therapy
C. perform a sputum culture
D. administer antipyretic medication to promote client comfort