OBJECTIVES 1. Give a short overview of pneumonia including types 2. Discuss the assessment findings and their relevance to the case of any 3. What treatment is expected for this patient? 4. Discuss the nursing management of the following:
Impaired Gas Exchange
Acute Pain
Fatigue What Is Pneumonia?
Pneumonia is a lower respiratory lung infection that causes inflammation in one or both lungs. It causes the air sacs
(alveoli) of the lungs to fill up with fluid or pus (purulent material) causing flu-like symptoms that can persist for
weeks or cause rapid deterioration of breathing leading to hospitalization.
Pneumonia comes in different forms and is caused primarily by bacteria or viruses. When these germs enter the
lungs, they can overwhelm the immune system and invade nearby lung tissues, which are very sensitive. Once
infected, the air sacs in the lungs become inflamed, causing coughing, fever, chills, and breathing problems. Types of Pneumonia
Community-Acquired Pneumonia (CAP) This is the most common form of pneumonia because you can catch it in
public places, such as at school or work. It can be caused by bacteria, viruses, or fungi.
Hospital-Acquired Pneumonia As the name suggests, this develops during a hospital stay for a different health
problem. People who are on machines to help them breathe are particularly prone to developing hospital-acquired
pneumonia. CONT’D
Aspiration Pneumonia This can develop after a person inhales food, drink, vomit, or saliva into their lungs. Once your lungs
have been irritated by breathing in food or stomach contents, a bacterial infection can develop.
Opportunistic Infection This is a fungal pneumonia that is extremely rare in healthy people but develops in people with a
weakened immune system; it’s often referred to as an opportunistic infection. You’re at risk for this type of pneumonia if
you have a chronic lung disease, have HIV or AIDS, or have had an organ transplant. Findings and Relevance
Normal body temperature range-36.5-37.5 degrees celsius.Temperature of 38.9 degrees celsius suggest a fever as an inflammatory response,mild erythema of the mucosa of the nose and posterior oropharynx is a sign of inflammation or infection process.
Normal WBC range 4500-11000, Polymorphonuclears cells 40%-80%, band forms less than 10% and lymphocytes 20%-40%.With the WBC at 13500 leukocytosis takes effect because of the infection,the elevated polymorphonuclears at 82% trying to destroy infectious microorganisms,elevated band form suggest the presence of bacteria and lymphocytes level deplete because of the infection .
A normal pulse range 60-100 bpm,hemoglobin for male adult 13.5-17.5 and hematocrit 41%-50%
A pulse of 110bpm suggest a low hemoglobin of 12.5 and hematocrit of 36% caused anemia which tachycardia is response too. CONT’D
Normal respiratory rate 12-20 breaths per minute and SPO2 saturation at room air is above 95 %
Respiration of 18 breaths per minute is normal,however SPO2 is low and can be identified as a response action to
insufficient oxygenated blood flow, the inspiration rales heard at the right lung base suggest the airways and alveoli are
compromised by fluid and can also be the reason for a low SPO2.
The chest radiography document also shows bilateral lower lobe infiltrates more pronounced on the right side,which
suggest there is evidence of substance in the lungs denser than air,which is affecting the small airways and alveoli. Treatment for Patient The patient should be started on an appropriate antibiotic therapy based on the likely pathogens involved in community- acquired pneumonia.
Antibiotic therapy is based on the presentation of a respiratory infection with symptoms of fever, cough, and productive sputum,
Smoking cessation is recommended to help manage SpO2 level, reduce the risk of further respiratory infections and improve overall lung health.
Nebulizer should also be an option to help loosen lung secretions/mucus.
IV fluids (0.9% normal saline solution) is also recommended to treat with his high fever.
Reposition in a high fowler's position to help open the airway.
Educate the patient's family about hand hygiene and respiratory etiquette will help prevent the spread of infection within the household.
The patient should also follow up with his healthcare provider to monitor his symptoms and response to treatment. Nursing Management for Acute Pain Acute Pain: Related to inflammation and irritation of lung tissue, as evidenced by the patient's self-report of chest pain and discomfort.
Desired Outcome: -The patient will experience pain relief or a reduction in discomfort, as evidenced by a pain rating within a tolerable range.
Nursing Orders: - Instruct and assist the patient in chest splinting techniques during coughing episodes.Aids in control of chest discomfort while enhancing the effectiveness of cough effort.
- Administer analgesics as prescribed. Encourage the patient to take analgesics before discomfort becomes severe.Medications allow for pain relief and the ability to deep breathe and cough. Analgesics help prevent peak periods of pain.
Monitor vital signs.Changes in heart rate or BP may indicate that patient is experiencing pain Nursing Management for Fatigue Fatigue: Related to increased work of breathing, limited mobility and illness as evidenced by a patient’s self report of fatigue and low energy levels.
Desired Outcome:The patient will report reduced fatigue and demonstrate increased energy levels and participation in activities of daily living.
Nursing Management
● Monitor Vital Signs- regularly assess vital signs, including temperature, pulse, respiratory rate, and blood pressure, to track the patient's condition and response to treatment. ● Oxygen Therapy- Administer supplemental oxygen as prescribed to maintain adequate oxygen saturation levels and relieve respiratory distress. Additional oxygen may be necessary when engaging in activity and assist patient with completing more activity. ● Develop activity plan.- this will allow the nurse and patient to have a plan that will gradually increase the patient’s activity level and strength. ● Treat underlying causes of fatigue- treatment of underlying causes can improve and increase patient’s activity level thereby decreasing the fatigue the patient is experiencing. ● Educate patient on lifestyle habits to lessen fatigue Nursing Management for Impaired Gas Exchange Impaired gas exchange- related to the presence of lung consolidation, as evident by decreased oxygen saturation, increased respiratory rate and shortness of breath.
Desired outcome-the patient will achieve improved gas exchange with normalized oxygen saturation, and respiratory rate.
Nursing orders- - Monitor respiratory rate, depth and effort, assess for presence of secretions and respiratory rate . - Administer supplemental oxygen as prescribed to maintain adequate oxygen saturation - Encourage and assist with positioning to optimize lung expansion. - Teach the patient to perform deep breathing exercises and diaphragmatic breathing.
