Nursing Care Plans for Pneumonia

Respiratory System

Nursing Care Plans for Pneumonia. Pneumonia, acute infection of the lung parenchyma, interstitial lung tissue in which fluid and blood cells escape into the alveoli. that often impairs gas exchange. Pneumonia classified in several ways. 

Based on microbiological etiology origin: Viral Bacterial Fungal Protozoa Mycobacterium Mycoplasmal Rickettsial 

Based in location, pneumonia can be classified: Bronchopneumonia, Bronchopneumonia involves distal airways and alveoli Lobular pneumonia or lobar pneumonia. In this pneumonia involves part of a lobe; and lobar pneumonia, an entire lobe 

The infection is also classified as one of three types: 

• Primary pneumonia, Primary pneumonia results directly from inhalation or aspiration of a pathogen, such as bacteria or a virus; it includes pneumococcal and viral pneumonia. 
• Secondary pneumonia, Secondary pneumonia may follow initial lung damage from a noxious chemical or other insult (superinfection) or may result from hematogenous spread of bacteria from a distant area. 
• Aspiration pneumonia, Aspiration pneumonia results from inhalation of foreign matter, such as stomach contents vomitus or food particles, into the bronchi. It’s more likely to occur in elderly or debilitated patients, those receiving nasogastric tube feedings, higher prevalence those with an impaired gag reflex, poor oral hygiene, or a decreased level of consciousness 

Causes for pneumonia 

• In bacterial pneumonia, the most common cause of bacterial pneumonia in adults is a bacteria called Streptococcus pneumoniae or Pneumococcus. Usually occurs when the lungs’ defense mechanisms are impaired by such factors as suppressed cough reflex, decreased cilia action, decreased activity of phagocytic cells, and the accumulation of secretions. Pneumococcal pneumonia occurs only in the lobar form.which can occur in any part of the lungs, an infection initially triggers alveolar inflammation and edema. As the alveolocapillary membrane breaks down, alveoli fill with blood and exudate, resulting in atelectasis. In severe bacterial infections, the lungs assume a heavy, liverlike appearance, as in acute respiratory distress syndrome (ARDS). 
• Viral pneumonia occurs when a virus attacks bronchiolar epithelial cells and causes interstitial inflammation and desquamation, which eventually spread to the alveoli 
• In aspiration pneumonia, aspiration of gastric juices or hydrocarbons triggers similar inflammatory changes and inactivates surfactant over a large area. Decreased surfactant leads to alveolar collapse. Acidic gastric juices may directly damage the airways and alveoli. Particles with the aspirated gastric juices may obstruct the airways and reduce airflow. 

Predisposing factors increase the risk of pneumonia. 

For bacterial and viral pneumonia, these include chronic illness and debilitation, Cancer (particularly lung cancer) Abdominal and thoracic surgery Atelectasis Common colds or other viral respiratory infections Chronic respiratory disease (chronic obstructive pulmonary disease, asthma, bronchiectasis, cystic fibrosis), influenza, Smoking, Malnutrition, Alcoholism, Sickle cell disease, Tracheotomy, exposure to noxious gases Immunosuppressive therapy. 

Complications for Pneumonia 

Without proper treatment, pneumonia can lead to such life-threatening complications as Septic shock, Hypoxemia, and Respiratory failure. Empyema or lung abscess. Bacteremia Endocarditi Pericarditis Meningitis 

Diagnostic tests 

Chest X-rays. Sputum specimen for Gram stain and culture and sensitivity. White blood cell count Blood cultures. Arterial blood gas (ABG). Bronchoscopy or transtracheal aspiration. Pleural fluid culture. Pulse oximetry. 

Nursing Assessment Nursing Care Plans for Pneumonia 

Focused Nursing assessment in pneumonia care plans Vital sign: blood pressure, body temperature, the pulse or rate of heartbeats, the respiration or rate of breathing Crackles, wheezing, or rhonchi over the affected lung area Dullness when you percuss Presence of cyanosis, and presence of dyspnea or tachypnea
Patient’s history The patient may have a history of a recent upper respiratory infection, influenza, or a viral syndrome. Elicit a history of a chronic pulmonary disease, such as asthma, bronchitis, or tuberculosis; prolonged immobility; sickle cell anemia; neurological disorders that cause paralysis of the diaphragm; surgery of the thorax or abdomen; smoking; alcoholism; IV drug therapy or abuse; and malnutrition. Establish any history of exposure to noxious gases, aspiration, or immunosuppressive therapy Bacterial pneumonia, the patient may report pleuritic chest pain, a cough, excessive sputum production, and chills. On Nursing assessment, you may note that the patient has a fever. In inspection, you may found that the patient is shaking and coughs up sputum. In advanced cases of all types of pneumonia, you hear dullness when you percuss. Auscultation may disclose crackles, wheezing, or rhonchi over the affected lung area as well as decreased breath sounds and decreased vocal fremitus. 

Nursing diagnosis Nursing Care Plans for Pneumonia 

Common Nursing Diagnosis found in Nursing Care Plans for Pneumonia 

• Ineffective airway clearance 
• Acute pain 
• Anxiety 
• Hyperthermia 
• Imbalanced nutrition: Less than body requirements 
• Impaired gas exchange 
• Ineffective coping 
• Risk for deficient fluid volume 
• Risk for infection 

Nursing Key outcomes, interventions and patient teaching Nursing Care Plans for Pneumonia