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Saturday, February 28, 2009

Nursing care plans for Pneumonia

Nursing care plan for Pneumonia
Pneumonia is an infection of the lower respiratory tract most commonly due to bacterial or viral pathogens and much less commonly the result of invasion by fungi, parasites or other organisms.
The inflammatory process causes the lung tissue to stiffen, thus resulting in a decrease in lung compliance and an increase in the work of breathing. The fluid-filled alveoli cause a physiological shunt, and venous blood passes unventilated portions of lung tissue and returns to the left atrium unoxygenated. As the arterial oxygen tension falls, the patient begins to exhibit the signs and symptoms of hypoxemia. In addition to hypoxemia, pneumonia can lead to respiratory failure and septic shock. Infection may spread via the bloodstream and cause endocarditis, pericarditis, meningitis, or bacteremia

Based on location, pneumonia may be classified as bronchopneumonia, lobular pneumonia, or lobar pneumonia. Bronchopneumonia involves distal airways and alveoli; lobular pneumonia, part of a lobe; and lobar pneumonia, an entire lobe
Prior to the discovery of antibiotics, one-third of all people who developed pneumonia subsequently died from this infection.

In bacterial pneumonia, which can occur in any part of the lungs, an infection initially triggers alveolar inflammation and edema
Viral infection, which typically causes diffuse pneumonia, first attacks bronchiolar epithelial cells, causing interstitial inflammation and desquamation
In aspiration pneumonia, aspiration of gastric juices or hydrocarbons triggers similar inflammatory changes and also inactivates surfactant over a large area.

Community-acquired pneumonia is caused by bacteria that are divided into two groups: typical and atypical. Organisms that cause typical pneumonia include Streptococcus pneumoniae (pneumococcus) and Haemophilus and Staphylococcus species. Organisms that cause atypical pneumonia include Legionella, Mycoplasma, and Chlamydia species.

Certain 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, tracheostomy, exposure to noxious gases, aspiration, and immunosuppressive therapy.

Without proper treatment, pneumonia can lead to such life-threatening complications as septic shock, hypoxemia, and respiratory failure. The infection can also spread within the patient's lungs, causing empyema or lung abscess.

Assessment Nursing care plans for Pneumonia
Observe the patient’s general appearance and respiratory pattern to determine level of fatigue, presence of cyanosis, and presence of dyspnea or tachypnea. Examine the patient’s extremities, torso, and face for rash. Assess vital signs for rapid, weak, thready pulse; fever; and blood pressure changes such as hypotension and orthostasis (postural hypotension). Palpate the chest to determine any areas of consolidation or tactile fremitus. Percuss the chest to detect dullness over the area of consolidation.
When you auscultate the patient’s breathing, listen for rales, crackles, ronchi, and wheezes; “E” to “A” changes; and whispered pectoriloquy. On assessment, you may note that the patient has a fever. During inspection, you may observe that the patient is shaking and coughs up sputum. Creamy yellow sputum suggests staphylococcal pneumonia; green sputum denotes pneumonia caused by Pseudomonas organisms; and sputum that looks like currant jelly indicates pneumonia caused by Klebsiella.

Diagnostic tests Nursing care plans for Pneumonia

  • Chest X-rays disclose infiltrates, confirming the diagnosis
  • Sputum cultures and sensitivities
  • White blood cell count indicates leukocytosis in bacterial pneumonia and a normal or low count in viral or mycoplasmal pneumonia. Blood cultures reflect bacteremia and help to determine the causative organism.

Nursing Diagnosis: Nursing care plans for Pneumonia
  • ineffective Airway Clearance may be related to excessive, thickened mucous secretions, possibly evidenced by presence of rhonchi, tachypnea, and ineffective cough.
  • Activity Intolerance [specify level] may be related to imbalance between O2 supply and demand, possibly evidenced by reports of fatigue, dyspnea, and abnormal vital sign response to activity.
  • acute Pain may be related to localized inflammation, persistent cough, aching associated with fever, possibly evidenced by reports of discomfort, distraction behavior, and facial mask of pain.
  • impaired Gas Exchange may be related to inflammatory process, collection of secretions affecting O2 exchange across alveolar membrane, and hypoventilation, possibly evidenced by restlessness/changes in mentation, dyspnea, tachycardia, pallor, cyanosis, and ABGs/oximetry evidence of hypoxia.
  • risk for Infection [spread]: risk factors may include decreased ciliary action, stasis of secretions, presence of existing infection.
  • Anxiety
  • Hyperthermia
  • Imbalanced nutrition: Less than body requirements
  • Impaired gas exchange
  • Ineffective coping
  • Risk for deficient fluid volume

Key outcomes Nursing care plans for Pneumonia
  1. Patient will express feelings of comfort and relief of pain.
  2. Patient will identify measures to reduce anxiety.
  3. Patient will identify measures to reduce anxiety.
  4. Patient will maintain a normal body temperature.
  5. The patient will consume a specific number of calories daily.
  6. The patient will maintain adequate ventilation and oxygenation.
  7. The patient will maintain a patent airway.
  8. The patient will use support systems to assist with coping.
  9. The patient will maintain adequate fluid balance.
  10. The patient will remain free from signs or symptoms of infection.

Nursing interventions rationale
Find Nursing Interventions and rationale Nursing Care plan for Pneumonia Related to Nursing Diagnoses Here.


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