Rationale: May prevent recurrence of pneumonia and/or related complications. Which information is most important to communicate to the physician? Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection. Monitor for labored respirations, cyanosis, and cold and clammy skin. Rationale: To prevent aspiration. Management of Pneumonia Introduction. Analgesics are given to improve cough effort by reducing discomfort, but should be used cautiously because they can decrease cough effort and depress respirations. It may be caused by: Physiotherapy is often beneficial to help teach patients how to breathe properly, control their breathing and optimise their posture to promo… Symptoms of pneumonia include cough with sputum production, fever, and sharp chest pain on inspiration (breathing in). 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. Splinting reduces chest discomfort and an upright position favors deeper and more forceful cough effort. It would be MOST important for a nurse to monitor which of the following laboratory values in this patient? Risk for Imbalanced Nutrition Less Than Body Requirements, Increased metabolic needs secondary to fever and infectious process, Anorexia associated with bacterial toxins, the odor and taste of sputum, and certain aerosol treatments, Abdominal distension/gas associated with swallowing air during dyspneic episodes. Rationale: Shock and pulmonary edema are the most common causes of death in pneumonia and require immediate medical intervention. She holds Bachelor of Nursing degree from Charles Darwin University, a Postgraduate Certificate in E-Health (Health Informatics) from the University of Tasmania and a Certificate in Clinical Governance for Patient Safety and Quality Care. Identify interventions to prevent/reduce risk/spread of/secondary infection. Nursing Management of Pneumonia In this post, we will review the nursing management of pneumonia. Viral pneumonia does not result in consolidation. Repositioning every 2 hours around the clock is not specific for prevention of complications associated with the lung. Provide covered container for sputum and remove at frequent intervals. and demand. Review importance of cessation of smoking. Legionnaires’ disease accounts for 15% of community-acquired pneumonias. Nursing management of the aspiration pneumonia patient: A case study. Smoking causes lung damage and results in the lungs being more suspectable to infection. Mattila JT, Fine MJ, Limper AH, Murray PR, Chen BB, Lin PL. Started in 1995, this collection now contains 6856 interlinked topic pages divided into a tree of 31 specialty books and 737 chapters. Any items you have not completed will be marked incorrect. Provide a balance of rest and activity, increasing activity gradually. In accordance with the guidelines developed by the American Thoracic Society for the management of CAP patients should be treated for the possibility of an atypical pathogen infection (Niederman et al., 2001). Which is the most appropriate nursing diagnosis for this patient? Blood glucose is 55 mg/dL after the medication administration. The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Pneumonia is an acute infection of the lungs that causes the alveoli in one or both lungs to fill with pus and fluids. This has contributed to the problem of antibiotic resistance and patient harm. The following antivirals are examples of those used to treat viral pneumonia: Fungi is the least common cause of pneumonia, however, Mattila et al. Elevate the patient’s head and neck, and check for tube’s position during NG tube feedings. In this post, we will review the nursing management of pneumonia. Confucius say: "Man who want pretty nurse, must be patient." Bradley, J.S., Byington, C.L., Shah, S.S. Severe pneumonia requires urgent referral to a hospital. Pneumonia: classification, diagnosis and nursing management Liz Dunn Clinical nurse manager, Haemostasis and thrombosis, Guy’s and St Thomas’ Foundation Trust, London Auscultate for bowel sounds. Rationale: Minimizes exhaustion and helps balance oxygen supply and demand. The dorsal surface best feels warmth. Assess skin turgor, moisture of mucous membranes. Pneumonia is defined as respiratory infection (features may include cough, purulent sputum, fever, pleurisy) with focal abnormalities on chest x-ray (CXR). 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. Pneumonia may be classified as: Community Acquired Pneumonia (CAP) - present on admission to hospital or developing within 48 hours of admission, or Pneumonia is an infection in one or both of the lungs. Contact or Body Substance Isolation (BSI) involves the use of barrier protection (e.g. <. According to the World Health Organization (2019) pneumonia accounts for 15% of all deaths worldwide in children under the age of five years. 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. The nurse should; Have arterial blood gases performed again to check for accuracy. Almost all major decisions regarding management of pneumonia address the initial assessment of severity. You can also get pneumonia by inhaling a liquid or chemical. Instruct patient to avoid using antibiotics indiscriminately during minor viral infections. Fungal pneumonia may be caused by a variety of different fungi including Histoplasma capsulatum and mucormycosis. Pneumonia is an important cause of morbidity and mortality in nursing home residents, with 30-day mortality rates ranging from 10 to 30 percent. Which complication may arise if the client receives a high oxygen concentration? Provide information about how to stop smoking. Review breathing including, rhythm, work of breathing: – spontaneous/ labored/supported/ ventilator-dependent, oxygen requirement and delivery mode. Also referred to as nosocomial pneumonia. Teach and assist patient with proper deep-breathing exercises. Goal: Effective airway, pulmonary ventilation is adequate and there is no secret buildup. Rationale: Reduces effects of nausea associated with these treatments. Pilcher J, Beasley R. Acute use of oxygen therapy. Pneumonia is a major cause of morbidity and mortality among nursing home residents. If you continue to use this site we will assume that you are happy with it. Rationale: Fatigue and depression can affect ability to assimilate information and follow therapeutic regimen. Fluid intake should be maintained at approximately 3000 mL/day so that the secretions remain thin. Encourage him to do so often. Although most types of pneumonia have a sudden onset, a few (such as anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an insidious onset. Encourage use of stress management and diversional activities as appropriate. Per se, some of the goals and objectives of a nursing care plan for pneumonia include: 1. Lung abscesses are rare any generally only occur in people with serious pre-existing illnesses and those who have a history of severe alcohol misuse. It does not respond to antibiotics; therefore, the management is focused on symptom control and may also include the use of an antiviral drug. Check pulses (location, rate, rhythm and strength); temperature (peripheral and central), skin color and moisture, skin turgor, capillary refill time (central and Peripheral); skin, lip, oral mucosa and nail bed color. Which of the following signs will indicate that a young child is suffering from severe pneumonia? Discuss debilitating aspects of disease, length of convalescence, and recovery expectations. 2015; 16(8): 35-42<. These factors may be associated with depression and the need for various forms of support and assistance. Outline steps to enhance general health and well-being: balanced rest and activity, well-rounded diet, avoidance of crowds during cold/flu season and persons with URIs. The fingertips and finger pads best distinguish texture and shape. Pneumonia is a major cause of morbidity and mortality among nursing home residents. A client with pneumacystis carini pneumonia is receiving trimetrexate. We will begin by reviewing the pathophysiology, risk factors, signs and symptoms, and nursing interventions for pneumonia. Increase feeding after the illness. Although most symptoms ease in a few days or weeks, the feeling of tiredness can persist for a month or more. The low blood pressure suggests that the IV infusion rate may need to be slowed. Nursing diagnoses reflect the potential causes and contributing factors of the health condition. Pneumonia is a common complication of influenza. Healthcare-Associated Pneumonia. 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). Administer medications as indicated: mucolytics, expectorants, bronchodilators, analgesics. • the young infant is less than 2 months- 60 bpm or more Many germs, such as bacteria, viruses, and fungi, can cause pneumonia. Pneumonia is suspected when a doctor hears abnormal sounds in the chest, and the diagnosis is confirmed by a … after IV infusion, draw blood for trough just before next dose. Rationale: Delayed recovery or increase in severity of symptoms suggests resistance to antibiotics or secondary infection. Note reports of dyspnea, increased weakness and fatigue, changes in vital signs during and after activities. ... Watson, D 2008, ‘Pneumonia 2: Effective Nursing Assessment and Management’, Nursing Times, vol. Thich Nhat Hanh Learning Outcomes 1. Using IMCI guidelines, you classify a child as having severe pneumonia. Promote adequate nutritional intake. The components of a physical assessment should include: The act of observing for visible external signs of respiratory function, reviewing chest symmetry and appearance and inspecting for accessory muscle usage. It occurs outside of hospitals or other health care facilities. These pneumonia classification and management guidelines had been developed based on evi-dence generated in the 1970s and early 1980s, and were incorporated into the original version of Integrated Management of Childhood Illness (IMCI). Rationale: Aids in control of chest discomfort while enhancing effectiveness of cough effort. 12-15. What is the best management for the child? Tracheal bronchial inflammation, edema formation, increased sputum production, Abnormal breath sounds, use of accessory muscles, Cough, effective or ineffective; with/without sputum production. Heart rate, respiratory rate, oxygen saturation rate and temperate should also be accurately documented in the health record, With pneumonia patients, it is important that the details of breath sounds including the presence and characteristics of secretions and accessory muscles usage are recorded, The color and consistency of sputum should be recorded and monitored on an ongoing basis, A plan for each patient’s care should be documented. It may be either primary influenza viral pneumonia or pneumonia secondary to a bacterial infection. Rationale: During this period of time, potentially fatal complications (hypotension, shock) may develop. Instruct and assist patient in chest splinting techniques during coughing episodes. • if the child is 12 months to 4 y/o- 40 bpm or more. What is the most common complication of influenza? Oral antibiotics are most commonly used to treat bacterial pneumonia. The Pneumococcal vaccine helps to reduce the risk of bacterial pneumonia. If you leave this page, your progress will be lost. Assess the rate and depth of respirations and chest movement. Monitor effectiveness of antimicrobial therapy. then arterial blood gases are drawn again and the level is reduced from 80 mmHg to 65 mmHg. Provide supplemental IV fluids as necessary. Antibiotics also referred to as antibacterials, are the mainstay treatment for bacterial pneumonia. Rationale: Eliminates noxious sights, tastes, smells from the patient environment and can reduce nausea. Manipulations of the artificial airway sometimes allow secretions into the lower airways. Pneumonia is a major cause of morbidity and mortality among nursing home residents. Antibiotics fight against the bacteria by: Destroying or inhibiting bacteria growth helps the body’s natural immune system to fight the bacterial infection. Nursing Interventions: Acute respiratory distress syndrome (ARDS). The others are more stable. Change position frequently and provide good pulmonary toilet. Rationale: High fever (common in bacterial pneumonia and influenza) greatly increases metabolic demands and oxygen consumption and alters cellular oxygenation. Instruct the mother to increase fluid intake. Prevention is the key to protecting against infection. Please wait while the activity loads. A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula. These goals are based on the outcome of assessments and the diagnoses. Monitor and record color, consistency, and amount of sputum. Staphylococcus aureus 6. Best rest is recommended until infection shows signs of clearing. Evaluate general nutritional state, obtain baseline weight. Healthcare-Associated Pneumonia. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. Deficient Knowledge regarding condition, treatment, self-care, and discharge needs, Requests for information; statement of misconception. Nurse Oliver learns that the client lives alone and hasn’t been eating or drinking. Although pneumonia usually causes an elevated WBC count, some types, such as mycoplasmal pneumonia, don’t. Maternal and Child Health Nursing (NCLEX Exams), Medical and Surgical Nursing (NCLEX Exams), Pharmacology and Drug Calculation (NCLEX Exams). Be sure the patient understands all medications, including dosage, route, action, and adverse effects. 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. Nursing management of the pneumonia patient is critical to patient recovery. Assess anxiety level and encourage verbalization of feelings and concerns. :-). Nurse Betty is assessing tactile fremitus in a client with pneumonia. Definition of pneumonia Image credit: newtimes.co.rw. Rationale: To help prevent occurrence of the disease. 2014). Antifungals are used to treat fungal pneumonia. A 65-year-old patient with pneumonia is receiving garamycin (Gentamicin). Clear the nose if it interferes with feeding. Azithromycin and Ceftriaxone are broad-spectrum antibiotics commonly prescribed to treat bacterial pneumonia. A firefighter who was involved in extinguishing a house fire is being treated for smoke inhalation. For groups of high risk for community-acquired pneumonia, pneumococcal vaccination is advised. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.Pneumonia can range in seriousness from mild to life-threatening. Using critical thinking and problem-solving skills the nurse makes clinical decisions and plans care for the patient accordingly. Nephrotoxic; will see proteinuria, oliguria, hematuria, thirst, increased BUN, decreased creatine clearance. A client with pneumonia is receiving supplemental oxygen, 2 L/min via nasal cannula. Medical Management of Pneumonia for age 2 months to 5 years: 1. These are infrequent, but serious, complications of pneumonia. 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. 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. Pneumonia Care Plan - Scribd. Achieve timely resolution of current infection without complications. However, when combined with influenza, pneumonia is the leading cause of death by infectious disease in the United States (Jones et al. Demonstrate fluid balance evidenced by individually appropriate parameters, e.g., moist mucous membranes, good skin turgor, prompt capillary refill, stable vital signs. Pentamidine can cause fatal hypoglycemia, so the low blood glucose level indicates a need for a change in therapy. Because of these history findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Reinforce importance of continuing effective coughing and deep-breathing exercises. This then causes capillary leak, edema, and exudate. 2009. Following diagnostic testing, if it is confirmed that the cause of the pneumonia is a viral infection, then antiviral therapy will be prescribed to treat viral pneumonia. Based on the information gained through the nursing assessment the nursing diagnoses related to the patient with pneumonia include: Nurses set to achieve goals in conjunction with the patient. When assessing him for dehydration, nurse Oliver would expect to find: With an extracellular fluid or plasma volume deficit, compensatory mechanisms stimulate the heart, causing an increase in heart rate. Rationale: Reduces likelihood of exposure to other infectious pathogens. This client will quickly develop profound atelectasis and eventually pneumonia without adequate gas exchange. Monitor vital signs closely, especially during initiation of therapy. Antibiotics are prescribed based on Gram stain results and antibiotic guidelines (resistance patterns, risk factors, etiology must be considered). The patient is complaining of pain at the site of the infusion. (2015). Display patent airway with breath sounds clearing; absence of dyspnea, cyanosis. Ineffective airway clearance related to inflammation, secret buildup. Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses. These exercises are crucial for clearing excess secretion, they improve lung function and help to strengthen the diaphragm and the accessory muscles around the lungs. If the patient then develops pneumonia, the organisms producing the pneumonia may require treatment with more toxic antibiotics. A balanced diet, including adequate servings of fruit and vegetables, promotes recovery from illness. Unless a healthcare professional tells you otherwise, you should always finish taking a prescribed course of antibiotics, even if you feel better. Note any changes. Admission to the hospital will be required if any of the above complications are present. Side effects: neuromuscular blockage, ototoxic to eighth cranial nerve (tinnitus, vertigo, ataxia, nystagmus, hearing loss), nephrotoxic. Advise small, frequent meals to maintain adequate nutrition. Community-acquired pneumonia is the most common type of pneumonia. ADAM for image. Elsevier Limited. Vancomycin is the drug of choice and is given at scheduled times to maintain blood levels of the drug. Rationale: Changes in heart rate or BP may indicate that patient is experiencing pain, especially when other reasons for changes in vital signs have been ruled out. Elevate head and encourage frequent position changes, deep breathing, and effective coughing. Antifungals work by stopping the growth of fungi. The following aspects are key to the discharge process and home care guidelines: Providing patients with education is integral to the discharge process. Pleurisy is a condition where the pleura (thin linings between the lungs and ribcage) becomes inflamed. Calculate fluid balance. Rationale: Information can enhance coping and help reduce anxiety and excessive concern. The patient is not taking in an adequate amount of oral fluids. Each lung is made up of thousands of bronchi and alveoli. Pneumonia is classified according to the types of germs that cause it and where you got the infection. Dyspnea, shortness of breath and chest pain are indications of this complication. Pneumonia is classified based on the type of organisms responsible for the infection and the location where or the way in which the infection was acquired. Which of the following would be an appropriate nursing diagnosis for a hospitalized client with bacterial pneumonia and shortness of breath? Elevate head of bed, change position frequently. Draw blood for peak levels 1 hr. Combination therapy may be used. Institute isolation precautions as individually appropriate. In the United States pneumonia is the eighth most common cause of death (CDC 2018). Nursing Management Congress; Advanced Search Home > August 2003 - Volume 34 - Issue 8 > Taking charge of ventilator-associated pneumonia. Many nurses are playing now! Rationale: Meets basic fluid needs, reducing risk of dehydration and to mobilize secretions and promote expectoration. To assist the patient with expectoration, humidified oxygen therapy may be beneficial. A client with AIDS develops bacterial pneumonia is admitted in the emergency department. The nurse should ensure that all the necessary information has been collected, is complete, and has been documented appropriately. Rationale: This may results in upper airway colonization with antibiotic resistant bacteria. The bronchi are tiny tubes and alveoli are the small sacs at the end of the bronchi tube. Viral pneumonia. Palpation is the act of examination by touch. Veterinary Nursing Journal: Vol. Its aim is to maintain their saturations above 93%. Rationale: Bedrest is maintained during acute phase to decrease metabolic demands, thus conserving energy for healing. 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. Rationale: Dependent on type of infection, response to antibiotics, patient’s general health, and development of complications, isolation techniques may be desired to prevent spread from other infectious processes. Encourage pneumovax and annual flu shots for high-risk patients. Teach the patient to maintain pulmonary hygiene measures of coughing, deep breathing, and incentive spirometry at home. 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. Nursing Management of Pneumonia: Various nursing management ways have discussed in the following: 1. Nursing evaluation is the process whereby the success of the goals and outcomes are reviewed, and factors identified which are positively or negatively influencing the goal achievement. Identify signs and symptoms requiring notification of health care provider: increasing dyspnea, chest pain, prolonged fatigue, weight loss, fever, chills, persistence of productive cough, changes in mentation. 7.Explain the medical and nursing management for pneumonia in children. Advice the mother on home care: a. Prepare and assist with diagnostic studies as indicated. In the case of a patient with bacterial pneumonia, the alveoli in the affected lung or lungs become solid as they fill with exudate such as fluid or pus. It is important that the multidisciplinary team are involved in the discharge planning process to ensure that all discharge needs and priorities are identified. A client is diagnosed with methicillin resistant staphylococcus aureus pneumonia. Ask the dietary department to provide a high-calorie, high-protein diet consisting of soft, easy-to-eat foods. Which complication may arise if the client receives a high oxygen concentration? Be aware of insensible losses. Rationale: Fluids, especially warm liquids, aid in mobilization and expectoration of secretions. Assess bilateral air entry and movement, breath sounds and count the patients’ respiratory rate for one full minute and assess any respiratory distress. Abdominal distension may occur as a result of air swallowing or reflect the influence of bacterial toxins on the gastrointestinal (GI) tract. The client’s arterial blood gases is drawn and the result is PaO2 80mmHg. An acute infection of the lower respiratory tract, mostly caused by bacteria and occurring in a patient who has not resided in a hospital or healthcare facility in the previous 14 days (Johnson, Irving & Turnidge 2020). People who have community-acquired pneumonia usually can be treated at home with medication. Reports of pleuritic chest pain, headache, muscle/joint pain. These may sometimes need to be drained with surgery. Rationale: Promotes expectoration, clearing of infection. Am J Respir Crit Care Med . 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. An elderly client with pneumonia may appear with which of the following symptoms first? Guidelines for Preventing Health-Care-Associated Pneumonia, 2003 pdf icon [179 pages] CDC and the Healthcare Infection Control Practices Advisory Committee developed these recommendations. Check for residual formula regular intervals. Participate in actions to maximize oxygenation. Streptococcus pneumoniae 5. Investigate changes in character, location, or intensity of pain. 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