Pneumonia Nursing Care Plans and Complications

This essay discusses pneumonia as a respiratory condition caused by infection in lungs, often due to bacteria or viruses. It highlights various health complications such as pleural effusion, lung abscess, respiratory failure, hypoxemia, and bacteremia if left untreated. The focus is on medical-surgical patients who require constant attention from nurses, emphasizing the importance of proper care and support.

Summative project on one medical
condition

Summative project on one medical condition
Pneumonia is a respiratory condition that affects primarily the lungs and then whole body
of the individual. The essay makes a comprehensive discussion regarding, various examinations
that are required to be conducted by the nurses. The essay will then discuss regarding various
nursing interventions that may be taken in case of the patient suffering from acute ailment of
pneumonia.
Pneumonia is an inflammatory condition of lungs which is responsible for affecting small
air sacs, that is, alveoli. Typical symptoms of this disease are chest pain, dry cough, trouble
breathing and fever. Some people may also experience shaking chills and increased rate of
breathing as well. It is caused due to infection of bacteria or virus and less commonly occur due
to presence of other organisms. There are other risk factors involved with the condition of
pneumonia as well related to lungs. These are COPD, cystic fibrosis, poor ability of coughing,
asthma, diabetes, heart failure, leading to weakening overall the immune system. The disease is
generally diagnosed through physical examination. Other tests that help in confirming the
existence of disease include blood examinations, Chest X-Ray and sputum assessment as well.
There are certain vaccines available that can help in preventing specific types of pneumonia.
Other preventive methods include hand washing and not smoking. The main cause behind
pneumonia helps in deciding that which type of treatment must be given to patient (Butcher and
et.al., 2018). In maximum cases, it occurs due to bacterial infection and hence is treated with the
help of antibiotics. In severe cases, the individual is also hospitalized. If patient faces continuous
problems with breathing, then in certain conditions, oxygen therapy is also given.
Pneumonia, which is caused by Legionella may have symptoms such as abdominal pain,
confusion and diarrhoea. If it has occurred due to Klebsiella, patient may experience bloody
sputum. Lung abscesses may lead to chronic bronchitis. When pneumonia is caused due to
Mycoplasma pneumoniae, it has direct association to swelling of the lymph nodes in neck.
Predicting the underlying cause may prove to be difficult in some cases as patient may
experience combination of symptoms. There are more than 100 strains of infection agents
present that are identified to be pneumonia causing representatives. However, only few of them
are responsible in majority of the cases (Sørensen and et.al., 2013). Mixed infections are prone in
45% of children and 15% in adults. Risk factors related to predisposing condition of pneumonia
include chronic obstructive pulmonary disease, chronic kidney illness, alcoholism,
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immunodeficiency, smoking, asthma and liver ailment. Extreme use of acid suppressing
medicines in form of proton pump inhibitors or H2 blockers can lead to increase the overall risk
of pneumonia.
The origin of pneumonia is from upper respiratory tract that move towards lower
respiratory region. In the normal body, upper airway helps in giving protection and competing
with pathogens for adequate amount of nutrients. Lower airway is responsible for reflexes of
glottis which includes the actions of complementing proteins and immunoglobulin which play an
important role in protection aspects. Micro aspirations of contaminated secretions can further
lead to create infections in lower airways, ultimately causing pneumonia. Physical examination
may disclose low blood pressure, low oxygen saturation and high heart rates. The respiratory rate
can also become a quite faster, which can occur a little early in comparison to the other signs that
are revealed by the body (Van Ness, Peduzzi and Quagliarello, 2012). The affected side of chest
may experience decreased expansion. Chest radiography is generally used by health care
professionals for diagnosis of pneumonia. There is other type of pneumonia as well which is
health care associated. It is a type of infection which is generally associated to recent exposure to
health care system. It is inclusive of outpatient clinic, hospital, dialysis centre, nursing home,
home care and chemotherapy treatment. Pneumonia can also be acquired through the hospital
which occurs in 48 hours or more, after getting admitted in the hospital. The disease may not be
incubating at time of admission. In maximum of cases, it is due to presence of infection in
hospital with high risk of multidrug resistant pathogens. As patients who are admitted to the
hospital generally have lower immunity level; they are at the high probability of catching a
disease.
Prevention criteria includes adoption of environmental measures, vaccination and giving
appropriate of health issue in which a patient may be constantly dwelling. Immunizing
individuals and care workers can help in reducing the incidence of pneumonia to the minimum.
A strong recommendation has been given to preferably vaccinate children below the age of 2
years. In order to treat the condition of pneumonia, health care professionals tend to involve in
providing oral antibiotics, simple analgesics, proper rest and fluids to the patient so as to move
towards complete recovery (Morinec, Iacaboni and McNett, 2012). However, elderly people who
may face trouble in breathing may require advanced care as well. If symptoms worsen even after
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taking treatments, patient can then be hospitalized for observational purposes. Pneumonia
Severity Index (PSI) helps in identifying level of severity level in the situation of patient.
There is another CURB – 65 score which helps in taking into account the severity level of
its symptoms, age and other underlying diseases. Pneumonia can also lead to respiratory failure
due to trigger of Acute Respiratory Distress Syndrome (ARDS). The lungs may become stiff as
they may get filled with fluid where patient may find difficulty in extracting oxygen due to
presence of alveolar liquid. It may require to keep the patient on ventilator for longer period so as
to ensure survival. Potential complications of pneumonia that is found to be present in various
patients is the form of poor immunity or hypersplenism. Other causing effects may include
pulmonary embolism, myocardial infraction, hypoxemia, increased coagulability and
inflammation (Moorhead and et.al., 2018).
The pathophysiology of pneumonia helps in understanding process and clinical
manifestations related to it. The organisms may enter through respiratory tract, with the help of
aspiration of inspiration of oral secretions. It then reaches to lungs with the help of circulation in
blood stream. The normal pulmonary defence mechanism may try to protect the body from
outside organism into the body that may infect it. In the invading process from that organism,
there are chances that body may try to release damaging toxins ultimately causing oedema and
inflammation which may result in accumulation of debris and exudates. The tissues in lungs may
get filled with fluid which lead to bring change in overall air state of lungs in the body ( Cooper
and Haut, 2013).
There are various nursing interventions that are required to be taken by the nurses so as to
control the overall condition of patient. Nurses are responsible for administrating antibiotics with
respect to causative organism being identified through culture and sensitivity test. The nurse will
then be responsible for controlling the overall body temperature of the body. Further, nurses
must be involved in preparing an assessment of vital sign and symptoms, which may differ from
individual to individuals. Also, monitoring respiratory status of the patient is another important
task that is required to be conducted by the nurses in a health care set up. He / she must also
involve in monitoring pulse oximetry, exercise tolerance trajectory, sound of breathing and
sputum production. These aspects may play an important role in understanding that what type of
treatment is required to be initiated for the patient. It is important for the nurse to provide
bronchial hygiene to the patients so that clean air can be circulated in their airway. Further,
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maintaining adequate amount of fluid intake is another important aspect that is related to nursing
interventions, when one is involved in dealing with a patient suffering from pneumonia. It is the
duty of nurse to perform chest physiotherapy, as directed by the physician in order to ensure that
the overall condition of patient is at improving side (Bail and et.al., 2013).
The nurse is also required to take action in order to prevent the occurrence of pneumonia in
the patients with susceptible hosts. For instance, if the patients are involved in frequent
positioning, constant coughing exercises and deep breathing in the post-operative state. Them in
that case, there are higher chances that the patient may get caught with pneumonia. If the patient
is involved in taking Chest physiotherapy for improved breathing and removal of mucus from
breathing passage, can be susceptible host of pneumonia. It is important for the patients who may
carry susceptible host of pneumonia must ensure that they avoid contact with individuals who are
carrying any type of respiratory infections. Also, they must avoid visiting to places, such as,
malls, crowdy places and shopping centres.
Since, the main symptoms of pneumonia are, shaking chills, fever, shortness of breath,
sputum production, coughing, pleuritic chest pain and rapid swallow breathing as well. If the
conditions are ultimately left untreated, it can lead to various health complications, such as,
pleural effusion, lung abscess, respiratory failure, hypoxemia and bacteraemia. When it is
diagnosed that the patient has ineffective airway clearance, then the patient must be in the
condition of pleuritic pain, fatigue, decreased energy in production of sputum, oedema formation
and tracheal bronchial inflammation (Juthani-Mehta and et.al., 2014). It is generally evidenced
by depth of respiration, changes in rate of respiration, effective or ineffective coughing with or
without the production of sputum. The condition can also be observed in the form of abnormal
breath sound. In this scenario, it is important for the nurse to opt for certain assessment aspects
so as to ascertain the ongoing condition of the patient. The first assessment that is required to be
made is monitoring rate and depth of respirations and chest movement. The second important
aspect to be considered by the nurse is to analyse the field of lungs, where monitoring can be
performed by noting the areas of absent or decreased air flow, where sound of crackle or wheeze
can be noticed. The nurse can elevate the head of patient and change the position frequently
which can help the patient to lie down in comfortable position. It is also important for the nurse
to teach proper deep breathing exercise to the patient and effective coughing in appropriate
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position. It will help in reducing chest discomfort and upright position will help in ensuring deep
as well as forceful cough efforts.
Due to decreased immunity in the patient, the patient suffering from pneumonia is always at
greater risk of infection. It is due to their inadequate primary defences in the form of stasis in
respiratory secretions (van der Maarel‐Wierink and et.al., 2013). The patient may also face
inadequate secondary defences, which can be in the form of, immunosuppression and existence
of infection of the body in greater amount. It requires appropriate steps to be taken from the side
of nurse that can help in dealing with the situation and timely resolution of existing infection
without any complications. It is also important for the nurse to initiate interventions that can help
in preventing and reducing the risk of any type of secondary infection in the body. In order to
perform this function, nurse must initiate isolation precaution that can help in keeping the patient
away from any type of infection (Stauber, 2013). Further, the nurse can also initiate to limit the
visitors in patient’s room so as to keep him away from any kind of allergy. She must also
encourage its patient to adequately rest and only involve in moderate activities which can help in
facilitating healing process. She must also motivate the patient to indulge in high nutritional
intake son that immune system can be built back. Investigation of sudden change in patient’s
condition is also an important aspect which must eb initiated. It can be, extra heart sound,
recurring fever, noticeable changes in the characteristics of sputum, altered sensorium and chest
pain. It is also important for the nurse to prepare and assist in diagnostic studies as indicated by
health care professionals. One of the important test to be performed in fibreoptic bronchoscopy
must be done in the patient will pneumonia in 1 to 3 days. It helps in understanding diagnosis as
well as therapy needs of the patient.
Since medical surgical patients are acutely ill and require constant attention from the side of
nurse, the nurse is required to take extreme care of the patient. There are chances that the patient
may suffer from impaired dentition which can be affected due to erosion of tooth enamel, poor
oral hygiene, chronic vomiting and abraded teeth. Impaired oral mucous membrane may also be
the other aspect that is related to swollen salivary glands, sore or inflamed bucca mucosa,
ulceration and sore mouth. In this scenario, it is important for the nurse to intervene its patients
so that the condition can be brought under control (Baird, 2015).
Deficient knowledge is the other common condition that can be noticed in the patient who
suffer from pneumonia. Patient and his family may not be having adequate amount of knowledge
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regarding condition, treatment to be given, self-care to be extended and discharge requirements.
It can be due to lack of exposure they must have received. The issue can also be related to
misinterpretation of information and altered recall. In this scenario, it is the duty of nurse to
ensure that patient and his family is having adequate knowledge regarding the prevailing
condition of the patient. The nurse can promote understanding of current situation by making
them aware regarding importance of cooperating with treatment aspects. The family and patient
himself must be able to review normal lung function and pathologic condition of the patient. The
nurse must also share information regarding coping up with anxiety of the patient and show
excessive concern. The symptoms related to respiratory may require certain time so as to resolve
them and weakness can persist for a longer period. It can lead to depression in some patients,
which may require constant support and assistance. There is a requirement of constant support
from the side of family, which can only be extended by them if they are actually aware regarding
the condition of patient.
It can be concluded from the above essay that pneumonia is a respiratory condition which
occurs due to infection in lungs. It is generally caused by bacteria or viruses and in some rare
cases it can also be caused due to parasites and fungi (8+ Pneumonia Nursing Care Plans, 2013).
The essay outlined regarding various conditions of the health that can be faced by the individual
while suffering from pneumonia. It can be in the form of short breath, fever, constant coughing,
shaking chills etc. If the conditions are ultimately left untreated, it can lead to various health
complications, such as, pleural effusion, lung abscess, respiratory failure, hypoxemia and
bacteraemia. Since medical surgical patients are acutely ill and require constant attention from
the side of nurse, the nurse is required to take extreme care of the patient.
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REFERENCES
Books and Journals
Bail, K. & et.al. (2013). Potentially preventable complications of urinary tract infections,
pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective
cohort study. BMJ open. 3(6). e002770.
Baird, M. S. (2015). Manual of Critical Care Nursing-E-Book: Nursing Interventions and
Collaborative Management. Elsevier Health Sciences.
Butcher, H. K. & et.al. (2018). Nursing Interventions classification (NIC)-E-Book. Elsevier
Health Sciences.
Cooper, V. B., & Haut, C. (2013). Preventing ventilator-associated pneumonia in children: an
evidence-based protocol. Critical care nurse. 33(3). 21-29.
Juthani-Mehta, M. & et.al. (2014). A cluster-randomized controlled trial of a multicomponent
intervention protocol for pneumonia prevention among nursing home elders. Clinical
Infectious Diseases. 60(6). 849-857.
Moorhead, S. & et.al. (2018). Nursing Outcomes Classification (NOC)-E-Book: Measurement of
Health Outcomes. Elsevier Health Sciences.
Morinec, J., Iacaboni, J., & McNett, M. (2012). Risk factors and interventions for ventilator-
associated pneumonia in pediatric patients. Journal of Pediatric Nursing: Nursing Care
of Children and Families. 27(5). 435-442.
Sørensen, R. T. & et.al. (2013). Dysphagia screening and intensified oral hygiene reduce
pneumonia after stroke. Journal of Neuroscience Nursing. 45(3). 139-146.
Stauber, M. A. (2013). Advanced nursing interventions and length of stay in the emergency
department. Journal of Emergency Nursing. 39(3). 221-225.
van der Maarel‐Wierink, C. D. & et.al. (2013). Oral health care and aspiration pneumonia in frail
older people: a systematic literature review. Gerodontology. 30(1). 3-9.
Van Ness, P. H., Peduzzi, P. N., & Quagliarello, V. J. (2012). Efficacy and effectiveness as
aspects of cluster randomized trials with nursing home residents: methodological insights
from a pneumonia prevention trial. Contemporary clinical trials. 33(6). 1124-1131.
Online
8+ Pneumonia Nursing Care Plans. 2013. [Online]. Available through
<https://nurseslabs.com/8-pneumonia-nursing-care-plans/>
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