Learning about Pneumonia for Nursing Students
In the patients diagnosed with pneumonia that I have personally cared for as a nurse, there are multiple things that come to mind. One of the stand-out points is that the patient will be physically weak and lose energy quickly, which makes it difficult to increase treatment compliance with movement and lung exercises like incentive spirometry.
The other is that often times these patients will tell me they are scared or that they simply feel as though they can’t breathe! Emotional support and encouragement go a long way for these patients and educating them about what is expected is key!
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Overview on Pneumonia
1. Inflammatory condition of the lungs
2. Primarily affecting the alveoli→ May fill with fluid or pus
3. Infectious vs Noninfectious
a. Infectious→ Bacterial, Viral
b. Non-infectious→ Aspiration
General information on Pneumonia
1. Diagnosis
a. Chest X-ray
b. Sputum culture to identify the organism
Nursing Assessment for Pneumonia
1. Viral
a. Low-grade fever
b. Nonproductive cough
c. WBCs normal to low elevation
d. Chest X-ray shows minimal changes
e. Less severe than bacterial
2. Bacterial
a. High fever
b. Productive cough
c. WBCs elevated
d. Chest X-ray shows infiltrate
e. More severe than viral
3. Both
a. Chills
b. Rhonchi/Wheezes
c. Sputum production
Therapeutic Management for Pneumonia
1. Medications
a. Antibiotics
b. Analgesics
c. Antipyretics
2. Supplemental O2
3. Assess and maintain the respiratory status
4. Encourage activity as soon as possible
5. Instruct on chest expansion exercises→ Incentive spirometry, turn, cough, deep breathe
6. Encourage 3 L/day of fluids unless contraindicated→ Thin secretions
Nursing Case Study for Pneumonia
Mr. Williams is a 67 year old male who has been hospitalized with pneumonia. His most recent set of vitals is as follows;
- O2 sat 87%
- HR 110
- BP 160/90
- Temp. 101.6 temporal
- RR 24
He is demonstrating signs of confusion and his urine is amber with an output of 28ml in the last hour. The handoff report stated that his last antibiotic was administered at 12:00 and it is now 20:00 and two hours overdue.
He last used his incentive spirometer at 18:00, only 2 times of the 10 ordered per hour, and stated that he was simply too tired to complete more. He has not gotten up to walk since 17:00 and is refusing oral fluids at this time.
- What will be his plan of care for your shift?
- What will you do first as his nurse?
Answers to Nursing Case Study On Pneumonia
Immediate Priorities:
Assessment: Conduct a thorough assessment of the patient’s mental status, vital signs, urine output, and overall condition to determine the extent of his confusion and potential complications.
Urgent Medication: Administer the overdue antibiotic as per the prescribed schedule to ensure continuous treatment of the pneumonia infection.
Fluid Management: Address his dehydration by encouraging and administering fluids, either orally if possible or through intravenous route if necessary, to maintain adequate hydration and improve urine output.
Respiratory Care: Assist him in using the incentive spirometer to encourage proper lung expansion and prevent complications like atelectasis.
Mobility: Plan for regular mobility breaks, assisting him with getting out of bed and walking as tolerated to prevent complications like pneumonia-associated atelectasis and venous thromboembolism.
Nutrition: Evaluate his nutritional intake and explore strategies to encourage oral fluid intake and nourishment.
Immediate Nursing Actions:
Administer Antibiotics: Administer the overdue antibiotic dose promptly to maintain the effectiveness of treatment.
Hydration: Initiate fluid administration through oral intake or intravenous route if necessary to improve urine output and address dehydration.
Assessment: Perform a comprehensive assessment of the patient’s mental status and confusion level, and document any changes.
Communication: Communicate with the healthcare team, particularly the physician, about the patient’s condition, dehydration, and delayed antibiotic administration.
Encourage Respiratory Care: Encourage the patient to use the incentive spirometer more frequently to ensure proper lung function and minimize respiratory complications.
Mobility Support: Assist the patient in getting out of bed and walking to prevent complications related to immobility.
Nutritional Support: Offer oral fluids and nourishment options while addressing any concerns he might have about intake.
*NCLEX focuses heavily on priority for common illnesses such as pneumonia, especially in the geriatric population
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