Side effects: neuromuscular blockage, ototoxic to eighth cranial nerve (tinnitus, vertigo, ataxia, nystagmus, hearing loss), nephrotoxic. Rationale: Decreased airflow occurs in areas with consolidated fluid. Treatment of atelectasis, pleural effusion, shock, respiratory failure, superinfection is instituted, if needed. Rationale: Prevents over exhaustion and reduces oxygen demands to facilitate resolution of infection. Severe pneumonia requires urgent referral to a hospital. Rationale: Presence of chronic conditions (COPD or alcoholism) or financial limitations can contribute to malnutrition, lowered resistance to infection, and/or delayed response to therapy. Patient involvement in pain control measures promotes independence and enhances sense of well-being. Placing the head of the bed flat may increase the frequency of his cough and his work of breathing. Unanswered Questions. The care plan should be updated as required, The use of any airway or respiratory devices should be recorded as should any aids or equipment, Administration of medications should be clearly documented including the patient’s response to medication and any adverse reactions. Identify interventions to prevent/reduce risk/spread of/secondary infection. Most of the interventions and prevention strategies are part of routine nursing care. The target saturation range for patients with acute medical conditions, pneumonia, asthma, and acute coronary syndrome is 92–96% (Pilcher & Beasley 2015). The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Pneumonia is characterized as a type of lung infection, most commonly caused by bacteria or a virus. Rationale: Prompt evaluation and timely intervention may prevent complications. Good hygiene practices, including following hand hygiene principles such as regular hand washing and the use of alcohol-based hand sanitizer, will help protect against respiratory infections that may lead to pneumonia. Assist and encourage oral hygiene after emesis, after aerosol and postural drainage treatments, and before meals. Patient education is essential to ensuring satisfactory health outcomes. Most of the interventions and prevention strategies are part of routine nursing care. Pneumonia is one of the most common respiratory problems and it affects all stages of life. The client at the highest risk for developing nosocomial pneumonia is the one who: is receiving feedings through a jejunostomy tube. Nursing Management of Pneumonia Pathophysiology: Pneumonia can be caused by a variety of microorganisms that enter the airway and invade the alveolar space. Rationale: Promotes expectoration, clearing of infection. 1, pp. Rationale: During this period of time, potentially fatal complications (hypotension, shock) may develop. You are evaluating an HIV-positive patient who is receiving IV pentamidine (Pentam) as a treatment for Pneumocystis carinii pneumonia. Explain importance of rest in treatment plan and necessity for balancing activities with rest. Encourage pneumovax and annual flu shots for high-risk patients. This client will quickly develop profound atelectasis and eventually pneumonia without adequate gas exchange. An acute lower respiratory tract infection that is acquired at least 48 hours after admission to the hospital and is not incubating at the time of admission (Forest 2020). Which information is most important to communicate to the physician? A client with AIDS develops bacterial pneumonia is admitted in the emergency department. Demonstrate and encourage good hand washing technique. Pneumonitis is a more general term that describes the inflammatory process in the lung tissue that may … Switching from one therapy to another will be determined by the progress of the patient. Different types of pneumonia are classified into various groups. Despite improvements in the management of community-acquired pneumonia (CAP), morbidity and mortality are still high, especially in patients with more severe disease. Smoke cessation will help to prevent respiratory infections such as pneumonia. Braguda brought her 5-month old daughter in the nearest RHU because her baby sleeps most of the time, with decreased appetite, has colds and fever for more than a week. Discuss debilitating aspects of disease, length of convalescence, and recovery expectations. Oxygen therapy is an essential component of treatment for all patients with pneumonia (Royal College of Surgeons, 2004). Rationale: Non-analgesic measures administered with a gentle touch can lessen discomfort and augment therapeutic effects of analgesics. A thorough nursing assessment is necessary to establish nursing diagnoses, plan nursing care, set realistic goals, implement nursing interventions and to enable the evaluation process. Rationale: Chest pain, usually present to some degree with pneumonia, may also herald the onset of complications of pneumonia, such as pericarditis and endocarditis. Prevention is the key to protecting against infection. Lesley-Anne is currently studying a Masters in Health Service Management. Encourage adequate rest balanced with moderate activity. Pneumonia, which is an infection, causes lobar consolidation thus impairing gas exchange between the alveoli and the blood. Force fluids to at least 3000 mL/day or as individually appropriate. For example, the hospitalized patient may commence on IV antibiotic therapy, but when discharged from the healthcare setting may commence oral antibiotics. Pneumonia may be classified as: Community Acquired Pneumonia (CAP) - present on admission to hospital or developing within 48 hours of admission, or Assist with self-care activities as necessary. Within three to five days of commencing antibiotic treatment for bacterial pneumonia symptoms should start to improve. A rare but serious complication of pneumonia. 2015; 16(8): 35-42<. Rationale: To promote full aeration and drainage of secretions. Dyspnea, shortness of breath and chest pain are indications of this complication. Pneumonia At A Glance: Pneumonia is a lung infection that can be caused by different types of microorganisms, including bacteria, viruses, and fungi. Nursing management of the pneumonia patient is critical to patient recovery. It does not respond to antibiotics; therefore, the management is focused on symptom control and may also include the use of an antiviral drug. Community Acquired Pneumonia (CAP) - present on admission to hospital or developing within 48 hours of admission, or 2. Legionnaires’ disease accounts for 15% of community-acquired pneumonias. MANAGEMENT OF PNEUMONIA 1. The patient and family are instructed about the cause of pneu-monia, management of symptoms of pneumonia, and the need for follow-up (discussed later). [Context Link] Other antibiotics: Penicillin G for streptococcal pneumonia; nafcillin or oxacillin for staphylococcal pneumonia; aminoglycoside or a cephalosporin for klebsiella pneumonia; penicillin G or clindamycin for aspiration pneumonia .Alternatives: amoxicillin and clavulanate (Augmentin); doxycycline; trimethoprim and sulfamethoxazole (Bactrim DS, Septra); levofloxacin (Levaquin). Physical assessment is key in the assessment of patients with respiratory complaints, such as pneumonia. Rationale: High fever (common in bacterial pneumonia and influenza) greatly increases metabolic demands and oxygen consumption and alters cellular oxygenation. 2. Pneumonia is an infection that inflames the air sacs in one or both lungs. Decrease the tension of oxygen in the plasma. This will only be achieved with the appropriate pain management. A 20-year-old patient is being treated for pneumonia. The white blood cells and the erythrocyte sedimentation rate are elevated. Antibiotic therapy is the primary treatment for most types of pneumonia; however, the antibiotic must be specific for the causative agent, which may not be responsive to penicillin. A client with pneumonia is receiving supplemental oxygen, 2 L/min via nasal cannula. Coordination of treatments and oral intake reduces likelihood of vomiting with coughing, expectorations. Be aware of insensible losses. Nursing interventions for pneumonia and care plan goals for patients with pneumonia include measures to assist in effective coughing, maintain a patent airway, decreasing viscosity and tenaciousness of secretions, and assist in suctioning. The approach to managing these patients has lacked uniformity because of the paucity of clinical trials, complexity of underlying comorbid diseases, and heterogeneity of administrative structures. Keeping the immune system strong by staying healthy through adequate sleep, a healthy diet and regular exercise. Pentamidine can cause fatal hypoglycemia, so the low blood glucose level indicates a need for a change in therapy. Perform treatments between meals and limit fluids when appropriate. Coughing is a reflex and a natural self-cleaning mechanism that assists the cilia to maintain patent airways. 8.List the preventive measures and complications of pneumonia in children. Rationale: Tachycardia is usually present as a result of fever and/or dehydration but may represent a response to hypoxemia. … 7.Explain the medical and nursing management for pneumonia in children. Nurse Betty is assessing tactile fremitus in a client with pneumonia. If symptoms do not improve it is possible that the antibiotic treatment selected is not the right treatment for the pathogen causing bacterial pneumonia. You can also get pneumonia by inhaling a liquid or chemical. This has contributed to the problem of antibiotic resistance and patient harm. Inadequate primary defenses (decreased ciliary action, stasis of respiratory secretions), Inadequate secondary defenses (presence of existing infection, immunosuppression), chronic disease, malnutrition. Pneumonia can be contracted by people of any age or health status; however, pneumonia is more common in: Treatment for pneumonia is dependent on the individual, the classification and the organism responsible. The nursing care plan is based on the nursing diagnosis. Employee selection in India is a process of elimination and not an evaluation? Just like adults, bacterial causes of pneumonia in children may be treated with antibiotics. We use cookies to ensure that we give you the best experience on our website. Postural drainage may not be as effective in interstitial pneumonias or those causing alveolar exudate or destruction. Rationale: Stimulates cough or mechanically clears airway in patient who is unable to do so because of ineffective cough or decreased level of consciousness. Which of the following signs will indicate that a young child is suffering from severe pneumonia? The priority is postoperative respiratory toilet. Contact or Body Substance Isolation (BSI) involves the use of barrier protection (e.g. Rationale: The purpose of oxygen therapy is to maintain PaO, Excessive fluid loss (fever, profuse diaphoresis, mouth breathing/hyperventilation, vomiting). Monitor body temperature, as indicated. Ask the dietary department to provide a high-calorie, high-protein diet consisting of soft, easy-to-eat foods. The nursing goal should be to reduce the FIO2 to no greater than: An FO2 greater than 0.5 for as little as 16 to 24 hours can be toxic and can lead to decreased gas diffusion and surfactant activity. Investigate sudden change in condition, such as increasing chest pain, extra heart sounds, altered sensorium, recurring fever, changes in sputum characteristics. It occurs outside of hospitals or other health care facilities. He has a persistent cough and complains of severe pain on coughing. However, recent studies suggest that 1 in 4 non-hospitalized patients with community-acquired pneumonia are prescribed inappropriate treatment. Fungal pneumonia may be caused by a variety of different fungi including Histoplasma capsulatum and mucormycosis. Providing reassurance and enhancing sense of security can reduce the psychological component, thereby decreasing oxygen demand and adverse physiological responses. nursing management of pneumonia ppt is an acute inflammatory disorder of lung parenchyma that results in edema of lung tissues and movement of fluid into the alveoli. If community-acquired pneumonia is suspected, effective management hinges on the decision regarding where the patient should be treated: in hospital or in the community. 12-15. Although pneumonia usually causes an elevated WBC count, some types, such as mycoplasmal pneumonia, don’t. Rationale: Manifestations of respiratory distress are dependent on/and indicative of the degree of lung involvement and underlying general health status. Rationale: Although patient may find expectoration offensive and attempt to limit or avoid it, it is essential that sputum be disposed of in a safe manner. and demand. Choose the letter of the correct answer. The others are more stable. Rationale: Information can enhance coping and help reduce anxiety and excessive concern. Imbalance between oxygen supply and demand, Exhaustion associated with interruption in usual sleep pattern because of discomfort, excessive coughing, and dyspnea, Verbal reports of weakness, fatigue, exhaustion. Rationale: May prevent recurrence of pneumonia and/or related complications. Augmenting holistic care: This objective focuses on providing health care that is inclusive of the spiritual, physical, social, and psychological elements of a human being. Log in to view full text. Administer analgesics and antitussives as indicated. Its prevention is a significant concern in every hospital. Which of the following would be an appropriate nursing diagnosis for a hospitalized client with bacterial pneumonia and shortness of breath? Rationale: Fiberoptic bronchoscopy (FOB) may be done in patients who do not respond rapidly (within 1–3 days) to antimicrobial therapy to clarify diagnosis and therapy needs. Abdominal distension may occur as a result of air swallowing or reflect the influence of bacterial toxins on the gastrointestinal (GI) tract. Rationale: Tachypnea, shallow respirations, and asymmetric chest movement are frequently present because of discomfort of moving chest wall and/or fluid in lung. Administer medications as indicated: antipyretics, antiemetics. Admission to the hospital will be required if any of the above complications are present. :-). Perform nasotracheal suctioning if the client is unable to clear secreations. Lesley-Anne Morgan is a Registered Nurse from Melbourne, Australia. 2005;171(4):388-416. Which of the following community-acquired pneumonias demonstrates the highest occurrence during summer and fall? ", "Splint your chest wall with a pillow for comfort.". The fingertips and finger pads best distinguish texture and shape. Maternal and Child Health Nursing (NCLEX Exams), Medical and Surgical Nursing (NCLEX Exams), Pharmacology and Drug Calculation (NCLEX Exams). Ventilator-associated pneumonia (VAP) is one of the most frequent nosocomial infections among ventilated patients in ICUs, associated with an increase in days of ICU stay, morbidity, and mortality. Instruct patient to avoid using antibiotics indiscriminately during minor viral infections. Deficient Knowledge regarding condition, treatment, self-care, and discharge needs, Requests for information; statement of misconception. The choice of oral pharmacologic therapy or the use of intravenous therapy is dependent on several factors. Am J Respir Crit Care Med . Review normal lung function, pathology of condition. Pneumonia may be classified as: 1. Rationale: Followers progress and effects of the disease process, therapeutic regimen, and may facilitate necessary alterations in therapy. Because of restricted respiratory movement, a recumbent, immobilize patient is at particular risk for respiratory acidosis from poor gas exchange; atelectasis from reduced surfactant and accumulated mucus in the bronchioles, and hypostatic pneumonia from bacterial growth caused by stasis of mucus secretions. Fever, chills, hemoptysis, dyspnea, cough, and pleuric chest pain are the common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response. Observe color of skin, mucous membranes, and nailbeds, noting presence of peripheral cyanosis (nail beds) or central cyanosis (circumoral). after IM and 30 min – 1 hr. Provide a quiet environment and limit visitors during acute phase as indicated. The client at highest risk for complications is the client with multiple sclerosis who is being treated with cortisone via the central line. Pneumonia is responsible for substantial morbidity and mortality rates around the world. Holding in his coughs will only increase his pain. Provide covered container for sputum and remove at frequent intervals. Based on this data given by Braguda, you can classify Braguda’s daughter to have: For a child aging 2months up to 5 years old can be classified to have severe pneumonia when he have any of the following danger signs: Not able to drink, Convulsions, Abnormally sleepy or difficult to wake, Stridor in calm child or, Severe under-nutrition. In a client with COPD, high oxygen concentrations decrease the ventilatory drive, leading to respiratory acidosis, not alkalosis. Good luck! Which complication may arise if the client receives a high oxygen concentration? The low blood pressure suggests that the IV infusion rate may need to be slowed. Assist and monitor effects of nebulizer treatment and other respiratory physiotherapy: incentive spirometer, IPPB, percussion, postural drainage. http://www.nlm.nih.gov/medlineplus Rationale: Anxiety is a manifestation of psychological concerns and physiological responses to hypoxia. In the intervening time, new evidence has Pneumonia is a major cause of morbidity and mortality among nursing home residents. Rationale: Presence of these symptoms reduces oral intake. Pneumonia is defined as respiratory infection (features may include cough, purulent sputum, fever, pleurisy) with focal abnormalities on chest x-ray (CXR). Demonstrate relaxed manner, resting/sleeping and engaging in activity appropriately. The ideal oxygen source is room air F IO 2 0.18 to 0.21. Veterinary Nursing Journal: Vol. Assist with comfort measures to reduce fever and chills: addition or removal of bedcovers, comfortable room temperature, tepid or cool water sponge bath. Rationale: Fluids, especially warm liquids, aid in mobilization and expectoration of secretions. Bacterial pneumonia is commonly caused by the Streptococcus pneumoniae (pneumococcus) bacteria. The following are examples of antibiotics that may be used to treat bacterial pneumonia: Narrow-spectrum antibiotics are effective in targeting specific types of bacteria. Administer antipyretics, bronchodilators, cough suppressants, mucolytic agents, and expectorants as prescribed. The following are examples of antifungal treatments used to treat fungal pneumonia: Supportive oxygen therapy will be required if the patient has oxygen saturations under 92%. Rationale: To help prevent occurrence of the disease. Provide small, frequent meals, including dry foods (toast, crackers) and/or foods that are appealing to patient. Encourage coughing and deep breathing and use of incentive spirometer. Bronchial breath sounds can also occur in these consolidated areas. Azithromycin and Ceftriaxone are broad-spectrum antibiotics commonly prescribed to treat bacterial pneumonia. Pneumonia is an important cause of morbidity and mortality in nursing home residents, with 30-day mortality rates ranging from 10 to 30 percent. Recent viral respiratory infection (common cold, laryngitis, influenza), Difficulty swallowing (due to stroke, dementia, Parkinson’s disease, or other neurological conditions), Chronic lung disease (COPD, bronchiectasis, cystic fibrosis), Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes mellitus, Impaired consciousness (loss of brain function due to dementia, stroke, or other neurologic conditions), Respiratory failure, which requires a breathing machine or ventilator. Change client’s position frequently and ambulate as tolerated to mobilize secretions. People who have community-acquired pneumonia usually can be treated at home with medication. Antifungals work by stopping the growth of fungi. She currently works for government in a healthcare management position. The nurse is caring for four clients on a stepdown intensive care unit. Ventilator-associated pneumonia (VAP) is one of the most frequent nosocomial infections among ventilated patients in ICUs, associated with an increase in days of ICU stay, morbidity, and mortality. Pharmacologic therapy for pneumonia differs depending on the causative agent, the type of infection as well as the age of the patient. Antifungals are used to treat fungal pneumonia. Many germs, such as bacteria, viruses, and fungi, can cause pneumonia. Although most symptoms ease in a few days or weeks, the feeling of tiredness can persist for a month or more. However,  general pneumonia treatment includes: Most pneumonia cases can also be treated in the community, providing the patient access to good medical and nursing care. Which complication may arise if the client receives a high oxygen concentration? Nursing management of the aspiration pneumonia patient: A case study. The rationale for administering leucovorin calcium to a client receiving Methotrexate is to: Increase the number of white blood cells. Rationale: Deep breathing exercises facilitates maximum expansion of the lungs and smaller airways. Ineffective cardiopulmonary tissue perfusion related to myocardial damage, Risk for self-care deficit related to fatigue, Deficient fluid volume related to nausea and vomiting, Disturbed thought processes related to inadequate relief of chest pain. These goals are based on the outcome of assessments and the diagnoses. Pneumonia can be community acquired or hospital acquired. Administer medications as indicated: mucolytics, expectorants, bronchodilators, analgesics. then arterial blood gases are drawn again and the level is reduced from 80 mmHg to 65 mmHg. Limiting alcohol consumption should also be encouraged. The 78-year-old who had a gastrectomy 3 weeks ago and has a PEG tube, The 5-month-old discharged 1 week ago with pneumonia who is being treated with amoxicillin liquid suspension, The 50-year-old with MRSA being treated with Vancomycin via a PICC line, The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a centrally placed venous catheter. Best rest is recommended until infection shows signs of clearing. Announcement!! Nursing Management of Pneumonia In this post, we will review the nursing management of pneumonia. The technique of tapping the surface of a body part to learn the condition of the parts beneath by the resultant sound, Auscultation is the act of listening to sounds arising within organs, such as the lungs. The chest x-ray film shows diffuse patches throughout the lungs or consolidation in a lobe. Monitor oxygen saturation, noting oxygen requirement and delivery mode if required. Rationale: Fatigue and depression can affect ability to assimilate information and follow therapeutic regimen. Weigh as indicated. When inflamed, the air sacs may produce fluid or pus which can cause productive cough and difficulty of … Nurse Oliver learns that the client lives alone and hasn’t been eating or drinking. Cultures identify organism; sensitivity testing identifies how resistant or sensitive the bacteria are to antibiotics. Provide supplemental IV fluids as necessary. Rationale: This may results in upper airway colonization with antibiotic resistant bacteria. Institute isolation precautions as individually appropriate. The priority nursing concepts for pneumonia are pretty obvious. Myocarditis, pericarditis, transverse myelitis, and encephalitis are rare complications of influenza. Current situation and importance of continuing medical follow-up and obtaining vaccinations as appropriate inflammatory... 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