Pneumonia -Overview and NCP

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Pneumonia: Overview & Nursing Care Plan:

Pneumonia: Overview & Nursing Care Plan Reynel Dan L. Galicinao

PNEUMONIA:

PNEUMONIA An acute infection of the lung parenchyma that often impairs gas exchange Classification based on microbiological etiology : Viral Bacterial Fungal Protozoal Mycobacterial Mycoplasmal Rickettsial

Based on location::

Based on location: Bronchopneumonia involves distal airways and alveoli Lobular pneumonia part of a lobe Lobar pneumonia entire lobe

Three types::

Three types: Primary pneumonia results directly from inhalation or aspiration of a pathogen (bacteria, virus) pneumococcal and viral pneumonia Secondary pneumonia m ay follow initial lung damage from a noxious chemical or other insult ( superinfection ) may result from hematogenous spread of bacteria from a distant area

Slide 5:

3. Aspiration pneumonia results from inhalation of foreign matter ( vomitus , food particles) into the bronchi more likely to occur in elderly or debilitated patients, those receiving NGT feedings , and those with an impaired gag reflex, poor oral hygiene, or a decreased level of consciousness

Slide 6:

Good prognosis for patients with normal lungs and adequate immune systems In debilitated patients, bacterial pneumonia ranks as the leading cause of death

Clinical Manifestations:

Clinical Manifestations

Slide 8:

Sudden onset; shaking chill Rapidly rising fever of 101° F to 105° F (38.3° C to 40.5° C) Cough productive of purulent sputum Pleuritic chest pain aggravated by respiration/coughing Dyspnea, tachypnea accompanied by respiratory grunting, nasal flaring, use of accessory muscles of respiration, fatigue Rapid, bounding pulse

Diagnostic Evaluation:

Diagnostic Evaluation

Slide 10:

Chest X-ray shows presence/extent of pulmonary disease, typically consolidation. Gram stain and culture and sensitivity tests of sputum - may indicate offending organism. Blood culture detects bacteremia (bloodstream invasion) occurring with bacterial pneumonia. Immunologic test detects microbial antigens in serum, sputum, and urine.

Management :

Management

Slide 12:

Antimicrobial therapy - depends on laboratory identification of causative organism and sensitivity to specific antimicrobials, or presumptive therapy with broad spectrum agent in milder cases. Oxygen therapy if patient has inadequate gas exchange

Complications:

Complications

Slide 14:

Pleural effusion. Sustained hypotension and shock, especially in gram-negative bacterial disease, particularly in elderly patients. Superinfection : pericarditis , bacteremia , and meningitis. Delirium - this is considered a medical emergency. Atelectasis - due to mucous plugs. Delayed resolution.

Nursing Assessment:

Nursing Assessment

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Take a careful history to help establish etiologic diagnosis. History of recent respiratory illness including mode of onset Presence of purulent sputum, increased amount of sputum, fever, chills, chest pain, dyspnea, tachypnea Any family illness Medications, alcohol, tobacco, or I.V . drug use

Slide 17:

Observe for anxious, flushed appearance, shallow respirations, splinting of affected side, confusion, disorientation. Auscultate for crackles overlying affected region, and for bronchial breath sounds when consolidation (filling of airspaces with exudate ) is present.

Nursing Diagnoses:

Nursing Diagnoses

Slide 19:

Impaired Gas Exchange related to decreased ventilation secondary to inflammation and infection involving distal airspaces Ineffective Airway Clearance related to excessive tracheobronchial secretions Acute Pain related to inflammatory process and dyspnea Risk for Injury secondary to complications

Nursing Interventions:

Nursing Interventions

Improving Gas Exchange:

Improving Gas Exchange Observe for cyanosis, dyspnea, hypoxia, and confusion, indicating worsening condition. Follow ABG levels/ Sao 2 to determine oxygen need and response to oxygen therapy. Administer oxygen at concentration to maintain Pao 2 at acceptable level. Hypoxemia may be encountered because of abnormal ventilation-perfusion ratios in affected lung segments.

Slide 22:

Avoid high concentrations of oxygen in patients with COPD , particularly with evidence of CO 2 retention use of high oxygen concentrations may worsen alveolar ventilation by depressing the patient's only remaining ventilatory drive. If high concentrations of oxygen are given, monitor alertness and Pao 2 and Paco 2 levels for signs of CO 2 retention.

Slide 23:

Place patient in an upright position to obtain greater lung expansion and improve aeration. Frequent turning and increased activity (up in chair, ambulate as tolerated) should be employed.

Enhancing Airway Clearance:

Enhancing Airway Clearance Obtain freshly expectorated sputum for gram stain and culture, preferably early morning specimen as directed. Instruct the patient as follows: Rinse mouth with water to minimize contamination by normal flora. Breathe deeply several times. Cough deeply and expectorate raised sputum into sterile container.

Slide 25:

Encourage patient to cough; retained secretions interfere with gas exchange. Suction as necessary. Encourage increased fluid intake, unless contraindicated, to thin mucus and promote expectoration and replace fluid losses caused by fever, diaphoresis, dehydration, and dyspnea.

Slide 26:

Humidify air or oxygen therapy to loosen secretions and improve ventilation. Employ chest wall percussion and postural drainage when appropriate to loosen and mobilize secretions. Auscultate the chest for crackles and rhonchi .

Slide 27:

Administer cough suppressants when coughing is nonproductive only if there is no evidence of retained secretions. Mobilize patient to improve secretion clearance and reduce risk of atelectasis and worsening pneumonia.

Relieving Pleuritic Pain:

Relieving Pleuritic Pain Place in a comfortable position (semi-Fowler's) for resting and breathing Encourage frequent change of position to prevent pooling of secretions in lungs. Demonstrate how to splint the chest while coughing. Avoid suppressing a productive cough.

Slide 29:

Administer prescribed analgesic agent to relieve pain. Avoid opioids in patients with a history of COPD . Apply heat and/or cold to chest as prescribed. Assist with intercostal nerve block for pain relief.

Slide 30:

Encourage modified bed rest during febrile period. Watch for abdominal distention or ileus , which may be due to swallowing of air during intervals of severe dyspnea. Insert a nasogastric (NG) or rectal tube as directed.

Monitoring for Complications:

Monitoring for Complications Remember that fatal complications may develop during the early period of antimicrobial treatment. Monitor temperature, pulse, respiration, blood pressure, and oximetry at regular intervals to assess the patient's response to therapy. Auscultate lungs and heart. Heart murmurs or friction rub may indicate acute bacterial endocarditis , pericarditis , or myocarditis .

Slide 32:

Employ special nursing surveillance for patients with: Alcoholism, COPD , immunosuppression - these people as well as elderly patients, may have little or no fever. Chronic bronchitis - it is difficult to detect subtle changes in condition, because the patient may have seriously compromised pulmonary function. Epilepsy - pneumonia may result from aspiration after a seizure. Delirium - may be caused by hypoxia, meningitis, delirium tremens of alcoholism.

Slide 33:

Assess these patients for unusual behavior, alterations in mental status, stupor, and heart failure. Assess for resistant fever or return of fever, potentially indicating bacterial resistance to antibiotics.

Evaluation: Expected Outcomes :

Evaluation: Expected Outcomes

Slide 35:

Cyanosis and dyspnea reduced ABG levels and Sao 2 improved Coughs effectively Absence of crackles Appears more comfortable Free of pain Fever controlled No signs of resistant infection

THANK YOU! Have a nice day : ):

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