Pneumonia

Pneumonia Overview

Assessment Expected Findings

  • Common Symptoms:

    • Anxiety

    • Fatigue

    • Weakness

    • Chest discomfort due to coughing

    • Confusion from hypoxia (most common in older adults)

Physical Assessment Findings

  • Vital Signs and Symptoms:

    • Fever

    • Chills

    • Flushed face

    • Diaphoresis (excessive sweating)

    • Shortness of breath or difficulty breathing

    • Tachypnea (rapid breathing)

    • Pleuritic chest pain (sharp pain in chest with breathing)

    • Sputum production (yellow-tinged)

    • Crackles and wheezes in lung examination

    • Coughing

    • Dull percussion note over areas of lung consolidation

    • Decreased oxygen saturation levels (typically < 95%)

    • Potentially purulent or blood-tinged rust-colored sputum

Laboratory Tests

  • Sputum Culture and Sensitivity:

    • Collect before starting antibiotics; may require suctioning for those unable to cough

    • Older adults may have difficulty expectorating due to decreased cough reflex and muscle strength

  • Complete Blood Count (CBC):

    • Elevated WBC count (may not be evident in older adults)

  • Arterial Blood Gases (ABGs):

    • Hypoxemia (PaO2 < 80 mm Hg)

  • Blood Cultures:

    • To rule out bacteremia (presence of bacteria in blood)

  • Electrolytes:

    • To detect dehydration (elevated BUN, hypernatremia)

Diagnostic Procedures

  • Chest X-ray:

    • Shows lung consolidation (increased density) and may not indicate pneumonia initially

    • Valuable for older adults due to vague early symptoms

  • Pulse Oximetry:

    • Usually shows levels below 95% in pneumonia cases

Patient-Centered Care

Nursing Care

  • Client Positioning:

    • Position to maximize ventilation (high-Fowler’s position, 90°)

  • Secretions Management:

    • Encourage coughing or suction to clear secretions

  • Treatment & Medications:

    • Administer breathing treatments, medications, and oxygen therapy

    • Monitor for skin breakdown from oxygen devices

    • Promote deep breathing with an incentive spirometer to prevent alveolar collapse

  • Activity Structuring:

    • Assess physical limitations and plan rest periods

  • Nutrition and Hydration:

    • Ensure adequate fluid intake (2-3 L/day) and nutrition to support healing

    • Provide rest periods for dyspnea patients

  • Reassurance:

    • Support clients experiencing respiratory distress

Medications

  • Antibiotics:

    • Used to treat infections; common types include penicillins and cephalosporins

    • Administer IV initially, switch to oral forms as condition improves

    • Collect cultures before administering first dose

  • Nursing Actions for Antibiotics:

    • Monitor for side effects, especially in older adults

    • Observe for frequent stools and kidney function

  • Bronchodilators:

    • Reduce bronchospasms and irritation; include albuterol (short-acting)

    • Monitor blood levels for theophylline due to narrow therapeutic range

    • Safety measure against adverse effects such as tachycardia and nausea

  • Anti-inflammatories:

    • Reduce airway inflammation; corticosteroids are common

    • Monitor for adverse effects such as immunosuppression and fluid retention

Interprofessional Care

  • Involvement of respiratory services for inhalers and treatments, nutrition services for dietary needs, and rehabilitation services for increased activity following prolonged illness.

Client Education

  • Importance of continuing medications, maintaining hand hygiene, rest, vaccination updates, and avoiding crowded areas to reduce reinfection likelihood.

Complications of Pneumonia

Common Complications

  • Atelectasis:

    • Alveolar collapse from inflammation; presents with hypoxemia and reduced breath sounds

  • Bacteremia (Sepsis):

    • Occurs if pathogens enter bloodstream from lung infection

  • Acute Respiratory Distress Syndrome (ARDS):

    • Hypoxemia persists despite oxygen therapy; characterized by reduced lung capacity and worsening dyspnea

Application Exercises (NCLEX Questions)

  • Identify at-risk clients for pneumonia (e.g., clients with dysphagia, AIDS, mechanical ventilation)

  • Determine nursing priorities for disoriented clients with pneumonia symptoms

  • Prioritize nursing interventions for clients with pneumonia based on assessment findings

  • Use appropriate assessment techniques for other respiratory disorders (e.g., sinusitis)

  • Discuss effective infection prevention strategies for influenza interactions among client groups.