NCP Pneumonia

Pneumonia is an inflammation of the lung parenchyma, associated with alveolar edema and congestion that impair gas exchange.
Primary pneumonia is caused by the patient’s inhaling or aspirating a pathogen. Secondary pneumonia ensues from lung damage
caused by the spread of bacteria from an infection elsewhere in the body. Likely causes include various infectious agents, chemical
irritants (including gastric reflux/aspiration, smoke inhalation), and radiation therapy. This plan of care deals with bacterial and viral
pneumonias, e.g., pneumococcal pneumonia, Pneumocystis carinii, Haemophilus influenzae, mycoplasma, and Gram-negative
microbes.

CARE SETTING institutionalization, general debilitation

Most patients are treated as outpatients; however, persons at Fever (e.g., 1028F–1048F/398C–408C)
higher risk (e.g., with ongoing/chronic health problems) are May exhibit: Diaphoresis
treated in the hospital, as are those already hospitalized for Shaking
other reasons. Rash may be noted in cases of rubeola or varicella

RELATED CONCERNS
AIDS TEACHING/LEARNING
Chronic obstructive pulmonary disease (COPD) and asthma May report: History of recent surgery; chronic alcohol use;
Psychosocial aspects of care intravenous (IV) drug therapy or abuse; immunosuppressive
Sepsis/septicemia therapy
Surgical intervention
Patient Assessment Database Discharge plan
DRG projected mean length of inpatient stay: 4.3–8.3 days
ACTIVITY/REST Assistance with self-care, homemaker tasks.
May report: Fatigue, weakness Oxygen may be needed, especially if recovery is prolonged or
Insomnia other predisposing condition exists.
May exhibit: Lethargy Refer to section at end of plan for postdischarge
Decreased tolerance to activity considerations.

CIRCULATION DIAGNOSTIC STUDIES

May report: History of recent/chronic heart failure (HF) Chest x-ray: Identifies structural distribution (e.g., lobar,
May exhibit: Tachycardia bronchial); may also reveal multiple abscesses/infiltrates,
Flushed appearance or pallor empyema (staphylococcus); scattered or localized infiltration
(bacterial); or diffuse/extensive nodular infiltrates (more often
EGO INTEGRITY viral). In mycoplasmal pneumonia, chest x-ray may be clear.
May report: Multiple stressors, financial concerns
Fiberoptic bronchoscopy: May be both diagnostic (qualitative
FOOD/FLUID cultures) and therapeutic (re-expansion of lung segment).
May report: Loss of appetite, nausea/vomiting
May exhibit: Distended abdomen ABGs/pulse oximetry: Abnormalities may be present,
Hyperactive bowel sounds depending on extent of lung involvement and underlying lung
Dry skin with poor turgor disease.
Cachectic appearance (malnutrition)
Gram stain/cultures: Sputum collection; needle aspiration of
empyema, pleural, and transtracheal or transthoracic fluids;
lung biopsies and blood cultures may be done to recover
PAIN/DISCOMFORT causative organism. More than one type of organism may be
May report: Headache present; common bacteria include Diplococcus pneumoniae,
Chest pain (pleuritic), aggravated by cough; substernal chest Staphylococcus aureus, ahemolytic streptococcus,
pain (influenza) Haemophilus influenzae; cytomegalovirus (CMV). Note:
Myalgia, arthralgia Sputum cultures may not identify all offending organisms.
May exhibit: Splinting/guarding over affected area (patient Blood cultures may show transient bacteremia.
commonly lies on affected side to restrict movement)
CBC: Leukocytosis usually present, although a low white blood
RESPIRATION cell (WBC) count may be present in viral infection,
May report: History of recurrent/chronic URIs, tuberculosis or immunosuppressed conditions such as AIDS, and
COPD, cigarette smoking overwhelming bacterial pneumonia. Erythrocyte
Progressive dyspnea sedimentation rate (ESR) is elevated.
Cough: Dry hacking (initially) progressing to productive cough
May exhibit: Tachypnea; shallow grunting respirations, use of Serologic studies, e.g., viral or Legionella titers, cold
accessory muscles, nasal flaring agglutinins: Assist in differential diagnosis of specific
Sputum: Scanty or copious; pink, rusty, or purulent (green, organism.
yellow, or white)
Percussion: Dull over consolidated areas Pulmonary function studies: Volumes may be decreased
Fremitus: Tactile and vocal, gradually increases with (congestion and alveolar collapse); airway pressure may be
consolidation increased and compliance decreased. Shunting is present
Pleural friction rub (hypoxemia).
Breath sounds: Diminished or absent over involved area, or
bronchial breath sounds over area(s) of consolidation; coarse Electrolytes: Sodium and chloride levels may be low.
inspiratory crackles
Color: Pallor or cyanosis of lips/nailbeds Bilirubin: May be increased.

SAFETY Percutaneous aspiration/open biopsy of lung tissues: May

May report: Recurrent chills reveal typical intranuclear and cytoplasmic inclusions
History of altered immune system: i.e., systemic lupus
erythematosus (SLE), AIDS, steroid or chemotherapy use, (CMV), characteristic giant cells (rubeola).
NURSING PRIORITIES 1. Ventilation and oxygenation adequate for individual needs.
1. Maintain/improve respiratory function. 2. Complications prevented/minimized.
2. Prevent complications. 3. Disease process/prognosis and therapeutic regimen
3. Support recuperative process. understood.
4. Provide information about disease process/prognosis and 4. Lifestyle changes identified/initiated to prevent recurrence.
treatment. 5. Plan in place to meet needs after discharge.

DISCHARGE GOALS