Nursing Management of Pneumonia

Nursing
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Introduction
Pneumonia is an infection that leads to inflammation of the air sacs of either
one lung or both. It can be a bacterial, viral or fungal infection and may
result in accumulation of fluid or pus in the lung tissues (Ranzani.et.al 2017).
These, therefore, result in problems with breathing. Pneumonia can either be
community acquired or hospital-acquired.
Primary survey
Pneumonia is a life-threatening condition and the purpose of applying the
primary survey is to immediately identify and treat life-threatening
conditions and thus avoid complications. The primary survey follows the
ABCDE to quickly assess for any life-threatening conditions (Zanobetti.et.al
2018). The main pathways to cardiac arrest to the patient are airway
blockage, breathing problems and circulatory problems and neurologic
failure. The primary survey has six components which include; assessing the
general appearance or impression of the patient, assessing the patient's
airway, breathing, and circulation, assessing the mental status of the patient
or any disabilities and finally making decisions on the priority or urgency for
attendance. The general appearance of the patients can give a clear
impression of the seriousness of the disease. The patient may be restless or
may present with other signs of distress which can be easily observed. From
the case study, John is sitting at the edge of the bed with difficulty in
communication in long sentences and unable to lie down. Positioning the
patient in an upright posture enhances lung expansion as compared to lying
down. Therefore, helping the patient breathe more easily. On observing this,
it helps healthcare practitioner to deduce where the problem might be and
act accordingly.
The patient's airway is assessed for any signs of blockage. Any evidence of
blockages such as noisy breathing, wheeze or any other abnormal sounds
should be noted. From the case study, crackles were heard on auscultation.

This is an abnormal sound that is produced when there is an accumulation of
mucus in the airway either due to increased mucus production or due to
impaired airway clearance. This is very common, especially in bacterial
pneumonia. John, therefore, has difficulty in breathing due to obstructed
airflow. Any signs of failure of airway protection can be observed in pooling
of secretions in the airway and absence of swallowing reflex. Any evidence of
mucosal edema should be checked as it can cause chronic obstruction
especially in burns patients (Douglas et.al 2016).
To assess for breathing any sign of increased work of breathing should be
noted. Any sign of intercostal retraction, abnormal breathing rate and use of
accessory muscles or nasal flaring indicate difficulty in breathing. Any
evidence of fatigue or hypoxia, asthma, pneumonia and other conditions
such as chronic obstructive pulmonary disease impair breathing. John is
experiencing tachypnea with a respiratory rate of 28breaths per minute. This
is increased compared to the normal range of 16-20b/min in an adult.
Increased breathing rate is a compensatory mechanism to increase air and
oxygen supply to the tissues and increased carbon (IV) oxide. John also has
signs of central cyanosis. This is due to decreased oxygenation and therefore
reduced hemoglobin and oxyhemoglobin in superficial capillaries
(Steinemann et.al 2016).
According to Considine and Currey (2015), circulatory assessment is also
crucial in identifying any threats to the patient. This is achieved by looking
for any evidence of active bleeding, any evidence of shock such as
decreased blood pressure, increased heart rate, tachycardia, decreased
capillary refill and increased respiratory rate. Any evidence of sepsis such as
high temperature and systemic symptoms should be observed. John has not
been eating or drinking enough for two days. His blood pressure is
100/58mmHg which is lower than the normal range of 120/80mmHg to
140/90mmHg in a normal person. He also has tachycardia of 115 beats per
minute which is higher than the normal range of 60-100 beats per minute (El

Ayadi et al 2016). Poor fluid intake can lead to low blood pressure as a fluid
volume in the body decreased. Cardiac output eventually decreases and
results in a fast and pounding heartbeat. These are signs of shock together
with a decreased capillary refill. In an event of an infection, the body's
immune system tries to combat the infection leading to a rise in body
temperature. The most common cause of bacterial pneumonia is
Streptococcus pneumoniae and it presents by thick green to yellow sputum.
John has a temperature of 38.2 degrees Celsius which is higher than the
normal range of 36-37 degrees Celsius. Fever is a common indication of
infection which can either be bacterial, viral or even fungal.
To assess for disability, note for any signs of altered level of consciousness
using the AVPU scale to classify the patient (Thomson et al 2016). Any fit or
signs of hypoglycemia are also important. All cranial nerves should be
assessed to elicit any abnormality noting any signs of meningism. Finally,
exposure assessment is done to check for any rash, fever or any sign of
stigma or chronic disease. In addition to the primary survey assessment,
sputum should be taken to the laboratory for culture and sensitivity. This will
help to know the appropriate antibiotic to be used if it is a bacterial infection
as John has been using his medication but he is still having problems. Also,
assess for any other causes of poor food and fluid intake other than the
underlying disease condition. After assessment and identifying the
seriousness of the problem, appropriate interventions are implemented and
any referrals made if need be.
Pathophysiology
Community-acquired pneumonia (CAP) is pneumonia that is contracted when
the person has had very minimal contact with the healthcare system. The
specific pathogen for community-acquired pneumonia is not identified in
50% of the individuals presenting with pneumonia. The etiology can,
therefore, be classified into four groups basing on causes which include;