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Pneumonia Cheat Sheet by

fluid     nursing     medical     healthcare     pneumonia     lungs     inflammation

PNEU­MONIA

An inflam­matory process in the lungs that produces excess fluid and exudate that fill the alveoli
Classified as bacterial, viral, fungal, or chemical
Pneumonia is triggered by infectious organisms or by the aspiration of an irritant, such as fluid or a foreign object
Can be a primary disease of a compli­cation of another disease or condition
Young clients, older adult clients, and clients who are immuno­com­pro­mised are more suscep­tible

TYPES OF PNEUMO­NIA

Vent­ilator associated pneumonia (VAP):
Occurs 48 to 72 hr after endotr­acheal intubation
Comm­unity acquired pneumonia (CAP):
The most common type and often occurs as a compli­cation of influenza
Health care acquired pneumonia (HAP):
Has a higher mortality rate and is more likely to be resistant to antibi­otics. It usually takes more than 48 hr from the time the client is exposed to acquire HAP.

CONT­RIB­UTING FACTORS

Advanced age
No pneumo­coccal vaccin­ation within the last 5 years
No influenza vaccine within the last year
Chronic lung disease
Immu­noc­omp­rom­ised
Mechanical ventil­ation
Post­ope­rat­ive
Sedation
Opioid use
Prol­onged immobi­lity
Tobacco use
Enteral tube feeding

EXPECTED FINDINGS

Anxiety
Fatigue
Weakness
Chest discomfort due to coughing
Confusion from hypoxia is a common manife­station of pneumonia in older adult clients

MANI­FES­TAT­IONS

Fever
Chills
Flushed face
Diapho­resis
Shortness of breath or difficulty breathing
Tachypnea
Pleuritic chest pain (sharp)
Sputum production (yello­w-t­inged)
Crackles
Wheezes
Dull chest percussion over areas of consol­idation
Coughing
Decreased oxygen saturation levels
Purulent, blood tinged or rust colored sputum

LABO­RATORY TESTS

CBC:
Elevated WBC
 
(Might not be present in older adult clients)
ABGs:
Hypoxemia
 
(PaO2 less than 80 mm Hg)
Blood culture:
To rule out organisms in the blood
Serum electr­oly­tes:
To identify dehydr­ation
Sputum culture and sensit­ivi­ty:
Obtain specimens before starting antibiotic therapy
 
Obtain specimen by suctioning if the client is unable to cough

DIAG­NOSTIC PROCED­URES

Chest x-ray:
Will show consol­idation (solid­ifi­cation, density) of lung tissue
 
Might not indicate pneumonia for a few days after manife­sta­tions develop
Pulse oximet­ry:
Clients who have pneumonia usually have oximetry levels less than the expected reference range of 95-100%

NURSING CARE

Position the client to maximize ventil­ation (high-­Fow­ler's) unless contra­ind­icated
Encourage coughing or suction to remove secretions
Administer breathing treatments & medica­tions
Adminiter oxygen therapy
Monitor for skin breakdown around the ears, nose, and mouth from the oxygen device
Encourage deep breathing with an incentive spirometer to prevent alveolar collapse
Determine the client's physical limita­tions and structure activity to include periods of rest
Encourage fluid intake of 2.5 to 3 L/day to promote hydration and thinning of secret­ions, unless contra­ind­icated due to another condition
Provide rest periods for clients who have dyspnea
Reassure the client who is experi­encing respir­atory distress

MEDI­CAT­IONS

Antibi­otics
Bronch­odi­lators
Anti-i­nfl­amm­atories

ANTI­BIO­TICS

Antibi­otics are given to destroy infectious pathogens.
Commonly used antibi­otics include fluoro­qui­nolone, penici­llins, and cephal­osp­orins.
Antibi­otics are often initially given via IV and then switched to an oral form as the condition improves.
Obtain any culture specimens prior to giving the first dose of an antibi­otic. Once the specimen is obtained, the antibi­otics can be given while waiting for the results of the culture.
Nursing Actions:
Observe clients taking cephal­osp­orins for frequent stools
 
Monitor kidney function, especially older adults who are taking penici­llins and cephal­osp­orins
Client Educat­ion:
Encourage clients to take penici­llins and cephal­osp­orins with food
 
Some penici­llins should be taken 1 hr before meals or 2 hr after
 

BRON­CHO­DIL­ATORS

Bronch­odi­lators are given to reduce bronch­ospasm and reduce irrita­tion.
Short-­acting beta2 agonists, such as albuterol, provide rapid relief.
Cholin­ergic antago­nists (antic­hol­inergic medica­tions), such as ipratr­opium, block the parasy­mpa­thetic nervous system, allowing for increased bronch­odi­lator and decreased pulmonary secret­ions.
Nursing Actions (Albut­ero­l):
Increase fluid intake if not contra­ind­icated
 
Can cause hypoka­lemia, insomnia, headache, or nausea
 
Monitor for tremors, tachyc­ardia, hypert­ension, nervou­sness, palpit­ations, and dry mouth
Nursing Actions (Iprat­rop­ium):
Observe for dry mouth and difficulty with urination
 
Monitor heart rate
 
Adverse effects can include headache, blurred vision, and palpit­ations, which can indicate toxicity
Client Educat­ion:
Reinforce teaching on how to use a metere­d-dose inhaler (MDI)
 
Encourage clients to suck on hard candies to moisten dry mouth while taking ipratr­opium
 
Encourage increased fluid intake unless contra­ind­icated

ANTI­-IN­FLA­MMA­TOR­IES

Anti-i­nfl­amm­atories decrease airway inflam­mation.
Glucoc­ort­ico­ste­roids, such as flutic­asone (MDI) and prednisone (oral), are prescribed to reduce inflam­mation.
Monitor for immuno­sup­pre­ssion, fluid retention, hyperg­lyc­emia, hypert­ension, hypoka­lemia, and poor wound healing.
Nursing Actions:
Monitor for decreased immunity function and infection
 
Monitor for hyperg­lycemia
 
Monitor for hypert­ension
 
Advise the pt to report black, tarry stools
 
Observe for fluid retention and weight gain
 
Monitor for electr­olyte imbalance
 
Monitor the client's throat and mouth for aphthous lesions (canker sores)
Client Educat­ion:
Drink plenty of fluids to promote hydration
 
Take glucoc­ort­ico­ste­roids with food
 
Avoid discon­tinuing glucoc­ort­ico­ste­roids without consulting provider
 
Use MDI
 
Rinse mouth and gargle after inhaled glucoc­ort­icoids to reduce the risk of dysohonia and candid­iasis

INTE­RPR­OFE­SSIONAL CARE

Consult with respir­atory services for inhalers, breathing treatm­ents, and suctioning for airway manage­ment.
Consult with nutrit­ional services for weight loss or gain related to medica­tions or diagnosis.
Consult with rehabi­lit­ation care if the client has prolonged weakness and needs assistance with increasing level of activity.

CLIENT EDUCAT­ION

Continue medica­tions for treatment of pneumonia
Rest as needed
Maintain hand hygiene to prevent infection
Avoid crowded areas to reduce the risk of infection
Receive immuni­zations for influenza and pneumonia
Stop smoking

COMP­LIC­ATIONS OF PNEUMO­NIA

Atel­ect­asis:
Airway inflam­mation and edema lead to alveolar collapse and increase the risk of hypoxemia
 
The pt reports shortness of breath and exhibits findings of hypoxemia
 
The pt has diminished or absent breath sounds over the affected area
 
A chest x-ray shows an area of density
Bact­eremia (sepsi­s):
This occurs if pathogens enter the bloods­tream from the infection in the lungs
Acute respir­atory distress syndro­me:
Hypoxemia persists despite oxygen therapy
 
Dyspnea worsens as bilateral pulmonary edema develops that is non cardiac related
 
A chest x-ray shows an area of density with a ground­-glass appearance
 
Blood gas findings demons­trate high arterial blood levels of carbon dioxide (hyper­carbia) and pulse oximetry shows decreased saturation

APPL­ICATION EXERCI­SES

1. A nurse is monitoring a group of clients for increased risk for developing pneumonia. Which of the following clients should the nurse expect to be at risk? (select all that apply)
A. client who has dysphagia
B. client who has AIDS
C. client who received vaccines for pneumo­ccocus and influenza 6 months ago
D. client who is ambulatory after receiving a local anesthesia
E. client who has a closed head injury
F. client who has myasthenia graves
2. A nurse is caring for a client who has pneumonia. Data collection findings include temper­ature 37.8 C (100 F), respir­ations 30/min, blood pressure 130/76, heart rate 100/min, and SaO2 91% on room air. Which of the following actions is the nurse's priori­ty?
A. administer antibi­otics
B. administer oxygen therapy
C. perform a sputum culture
D. administer antipy­retic medication to promote client comfort

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