Nursing Intervention and Care Plans for Bilateral Lower Lobe Pneumonia

This essay discusses nursing interventions and care plans for Bilateral Lower Lobe Pneumonia. It covers A-E assessment, pharmacological intervention, and recommendations. The essay also provides a case study of a 65-year-old patient diagnosed with Bilateral Lower Lobe Pneumonia. The multidisciplinary approach to treatment and holistic care is also discussed.

Essay

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
A-E assessment reflecting pathophysiology...........................................................................4
The nursing intervention for Bilateral Lower Lobe Pneumonia............................................4
Nursing care plans for Pneumonia.........................................................................................5
RECOMMENDATIONS.................................................................................................................7
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................9

INTRODUCTION
Bilateral pneumonia is a serious infectious disease that affects the lungs. In this disease,
peripheral tissues around the air sacs of the lungs get irritated and infected by pus and other body
fluids. Privacy and confidentiality maintenance of patients is a big concern related to safety.
Important ways of maintaining confidentiality to ensure the safety of the patient are Through
creating policies and agreement of confidentiality; Documents covering all information regarding
policies must be read carefully by every individual indulged in practice. All documents should be
signed and simultaneously patients need to be informed regularly about confidentiality
procedures that the organization upholds. In this, it can include training should be provided;
Regular training sessions must be provided to all staff members including doctors, nurses, and
other administrators. Explaining to them the importance of confidentiality maintenance and
seriousness towards the privacy of the patient. Training must include practices followed by staff
members to provide complete safety to the patient. In addition to this, it can also have All
information should be stored in a secure system; It is a challenging task for many organizations
to maintain and store a huge amount of data correctly. Alongside all these difficulties; the highest
level of protection needs to be used to access the personal data of patients by applying passwords
and security pins that control access. In this essay, there is a discussion about the case study to
Stephen Wright who is 65-years-old and having a medical history of chesty cough and mild fever
and is diagnosed with Bilateral Lower Lobe Pneumonia. In the essay, there are various points
that have been covered like definition, pathophysiology, A-E assessment reflecting
pathophysiology, pharmacological intervention, and nursing intervention (Dondorp et. al., 2020).
MAIN BODY
Lobar pneumonia is an inflammatory disease that affects intra-alveolar space. If the
disease remains untreated for a long period, pneumonia may get worsen and leads to the
development of permanent scars in the lungs. Scarred lungs cause breathing problems and even
can get worsen to the level of respiratory failure. Imbalance within organisms residing in the
lower region of the respiratory tract and systemic defense mechanism leads to inflammation
response in the lung parenchyma. The protective macrophages in the lungs oppositely provoke
the histopathological response seen in pneumonia. The macrophages perform engulfing of the
pathogens and provoke cytokines to the site of infection. Macrophages present these antigens in
front of T cells which trigger cellular and humoral defense mechanisms.

A-E assessment reflecting pathophysiology
Airway: Infections like flu and pneumonia are majorly responsible for obstructing the
airway. These viruses invade the human body via the airway and infect the lungs. Characterized
by inflamed lungs, air sacs, filled with pus and body fluid obstruct breathing, coughing, and
cause respiratory problems.
Breathing: Fluid exudate through air sacs affect the amount of oxygen transferred to the
bloodstream due to the obstructive path of air by mucus. It leads to an insufficient supply of
oxygen to the body and results in difficulty in breathing.
Circulation: Pneumonia infection can even get worst and is life-threatening if remain
untreated. Infection can travel to another body organ through the bloodstream which causes
serious complications and even can cause organ damage. Septic shock can impact blood pressure
and even can put the patient at risk of a heart attack.
Disability: There is no disability in the client.
Exposure: Inflammatory lung disease is caused when patients come in the exposure to
environmental factors like farming, hairdressing, fungal, bacterial, animal, organic, and inorganic
material (Gattinoni et. al., 2020).
Pharmacology of Bilateral Lower Lobe Pneumonia
Bilateral interstitial pneumonia or Lobar pneumonia is a form of pneumonia
characterized by inflammatory exudate within the intra-alveolar space resulting in consolidation
that affects the large and continuous area of the lobe of a lung. It’s one of the three anatomic
classifications of pneumonia and the other being bronchopneumonia and atypical pneumonia) In
children, round pneumonia develops instead because the pores of Kohn that allow the lobar
spread of infection is underdeveloped. Bacterial pneumonia is treated with antibiotics, that work
by stopping the growth of bacteria. Antibiotics can be taken orally or given intravenously by a
healthcare professional. The commonly prescribed antibiotics include Cipro (Ciprofloxacin),
Levaquin (Levofloxacin), Oracea (Doxycycline), and Relenza (Zanamivir).
The nursing intervention for Bilateral Lower Lobe Pneumonia
Nursing interventions are the actions a nurse takes to implement their patient care plan,
which includes any treatment, procedures, or teaching moments intended to improve the patient’s
comfort and health. Some of the supportive interventions include oxygen therapy, coughing,
deep breathing, adequate hydration, and mechanical ventilation. (Majmundar et, al., 2020)

Nursing care plans for Pneumonia
Pneumonia Nursing Care Plan 1
Nursing Diagnosis: Hyperthermia related to the disease process of bacterial pneumonia SAS
evidenced by a temperature of 38.5 degrees Celsius, which leads to rapid and shallow breathing,
flushed skin, and profuse sweating.
Desired Outcome: Within 4 hours of nursing interventions, the patient will have a
stabilized temperature within the normal range.
Pneumonia Nursing Care Plan 2
Nursing Diagnosis: Ineffective Airway Clearance related to the disease process of
bacterial pneumonia as evidenced by shortness of breath, wheeze, SpO2 level of 85%, productive
cough, and difficulty to expectorate greenish phlegm.
Desired Outcome: The patient will be able to maintain the airway patency and improved
airway clearance as evidenced by being able to expectorate phlegm effectively, have respiratory
rates between 12 to 20 breaths per minute, SpO2 level above 96%, and verbalizes the ease of
breathing.
SBAR: It is generally a tool that is given to help in facilitating as well as can strengthening the
communication among the care nurses as well as the prescribers throughout the implementation
of such quality enhancement initiatives as well. SBAR is known for Situation, Background,
Assessment, and Recommendations. As per the provided case scenario of Stephen, he has a
history of chest cough and has mild fever for about the last 3 days. After the referral, he was
admitted immediately to an acute medical Unit where he was formally diagnosed to have
bilateral lower lobe pneumonia. The assessment in his case was the ward baseline observation
such as his temperature was 38.3 degrees Celsius, Oxygen saturation level is 93% on 2 liters that
are 24%, his pulse rate is 106 per minute, blood pressure level is 110/60 mm Hg, respiratory rate
is 28 breath per minute. As per the scenario, it is recommended to Stephen the medications
which can help him to overcome his illness more appropriately. The care treatment of pneumonia
can include curing the contamination as well as can prevent the complications. There are some
the interventions such as antibiotics, the medications are generally used to treat pneumonia. It
generally means taking time to determine the specific types of bacteria that can cause pneumonia
as well as to select the best possible medication to treat effectively. the medications which are
recommended in the given case scenario were Co-amoxiclav (1000/200) 1.2 g Intravenous three

times a day. There is also a tablet recommended such as paracetamol 4 times a day. In addition to
this, there must be recommended a cough medication for Stephen to calm the cough so that he
can rest. It is because coughing can effectively aid in losing as well as can aid in loosening and
can move from the lungs, it is generally a good notion not to eliminate the cough.
A multidisciplinary approach is required for providing comprehensive care to the patient
by physicians from every disciplinary. The multidisciplinary team for this particular presented
the following observations-
Department of Radiology- The chest computer tomography revealed the presence of
centrilobular nodules and the presence of lower zone predominance of abnormalities. There was
also found the presence of cysts in the honeycomb structure and the bronchial vascular bundle
was surrounded by lesions.
Department of radiology- Hyperplasia of alveolar adenoma was observed on performing
thoracoscopic lung biopsy of lower lungs. It was also observed that the macrophages have
invaded the alveolar spaces and lymphocytes which is pieces of evidence of chronic
hypersensitive pneumonitis.
Department of Rheumatology- Though being a 65-year-old patient, he did not have any
symptoms related to joint pain. He did show symptoms of dry mouth and also had a fever for the
last 3 days. There was no abnormality found neither in renal function tests nor in routine urine
tests. The connective tissue disease test was also negative which is again evidence of
pneumonitis.
Department of pulmonary and critical care medicine- The patient was old aged and was
having a chesty cough which was getting worse with time. Bilateral computer tomography
revealed the presence of lesions, ground-glass opacities, and fibrosis mainly in the lower lobe of
the lungs. The results obtained from lung computer tomography and pathology seem to be
evidence for bilateral lower lobe pneumonia. Therefore, he needs to get started with the
treatment involving glucocorticoids and anti-fibrotic drugs.
A holistic approach to the treatment of pneumonia takes care of the social, emotional,
intellectual, physical, and spiritual healing of the patient. Stephen was told about all the
complementary treatments required for the management of pneumonia.
As a part of home remedies and lifestyle changes, he was advised to:
 Give body as much rest as possible

 Increase intake of fluids as it would help in expelling more amount of cough
 Start caffeine intake as caffeine act as a mild bronchodilator
 Use humidifiers to avoid dryness in the airways
 Develop a habit of gargling with saltwater
 Avoid smoking
Regarding the odd ones to the prescription, he was given knowledge about the antibiotics,
nebulizers, antivirals, and antifungals that he might require due to compromised immunity
He was provided with the information regarding the side effects of over-the-counter drugs which
might prove fatal in his case so that he can avoid using those drugs and should remember to
consult a physician before using these medications. At last, he was also informed of the herbal
therapies that can help him in the management of pneumonia-like drinking tea of fenugreek
seeds.
RECOMMENDATIONS
The possible recommendations that can be provided to the patient to overcome his
conditions can involve:
 The antibiotics are prescribed which is based on the gram stains outcomes as well as the
antibiotic guidelines. The combination therapy can be used in his case.
 He must given a supportive care treatment which can involve antipyretics, hydration,
anti-histamine or the nasal decongestants as well.
 Stephen is recommended a bed rest till his infection or contamination can exhibit the
signs of clearing.
 He must be provided with oxygen therapy for hypoxemia.
 The respiratory support can involve an endotracheal intubation, the high inspiratory
oxygen concentrations as well as the mechanical ventilation.
 In case, if Stephen is having high risk for pneumonia, then the pneumococcal vaccination
is mainly advised.
 If patient needed, the care treatment of atelectasis, pleural effusion is provided in severe
cases.
CONCLUSION
From the above discussion, it is concluded that pneumonitis is mainly a general form of lung
infection. A patient having such inflammation may suffer from difficulty in breathing as well as

is frequently accompanied by a cough. In this, disease peripheral tissues around the air sacs of
the lungs get irritated and infected by pus and other body fluids. It is determined by the
discussion that the lobar pneumonia can influence one or various other parts of the lungs
adversely. And to overcome such painful and difficult conditions, there are given an A to E
assessment of care nursing which can provide an effective care treatment as well as
recommendations to the patient called Stephen so that he can able to recover from his adverse
condition. It is concluded that there are the care treatments such as treatment of atelectasis, and
pleural effusion may help the patient to clear his airway passage as well. As the care treatment of
atelectasis can help to clear the blockage such as mucus and the pleural effusion can help to
effectively buildup of the excess fluids among the layers of the pleura outside of the lungs.

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