This guide has a nursing care plan for pneumonia and nursing diagnosis, nursing interventions, and nursing assessment for pneumonia. Nursing interventions for pneumonia and aspiration pneumonia care plan goals for patients with pneumonia include measures to assist in effective coughing, maintain a patent airway, decrease viscosity and tenaciousness of secretions, and assist in suctioning.
What is Pneumonia?
Pneumonia is a bacterial or viral infection that causes the inflammation of the tiny alveoli in the lungs, causing pain and difficulties with breathing. The alveoli are the air sacs that are moistened to help in absorbing the oxygen during inspiration. It can be classified into two groups: community-related pneumonia which is acquired when the person is in the hospital or nursing home, and healthcare-related pneumonia, developed while the person is at home or in the community setting. The infection can pass in 2-3 weeks. However, for babies, people with other diseases, or older adults, such as those over 65 years old, the disease can become aggressive. This evaluation is important because it focuses on understanding the illness and its dynamics, which is essential, considering pneumonia is a life-threatening disease. Understanding the underlying anatomic features of its progression is necessary, which creates the need to develop a pneumonia care plan that includes the details and the intervention required in the course of this infection.
Disease Pathophysiology
One becomes predisposed to pneumonia when they are involved with the risk factors. Some of such factors include other lung diseases, like COPD (chronic obstructive pulmonary disease), cystic fibrosis, and asthma. Others include heart failure, diabetes, a weak immune system, inability to cough properly — for example, after a stroke, or a habit of smoking. Tobacco smoke, either secondary or primary, increases the patient’s susceptibility to contracting the respiratory infection, which includes but is not limited to pneumonia. The smoke and chemicals affect the air sacs, filling them with a purulent material or pus, which produces the thick, dark, and rusty sputum. The discharge causes breathing difficulties and fever, which prompts the patient to cough in an effort to get rid of the sputum. Cough along with fever is a life-threatening condition, especially among old patients.
Signs/ Symptoms
The severity of the symptoms varies depending on the progression stage, the age of the individual, the bacteria or virus causing the infection, and the overall health of the patient. Some of the symptoms of pneumonia include difficulties in breathing and nasal congestion. The patient may also experience a sore throat, which may cause the need to cough and lead to a large amount of sputum. As the disease advances, the patient can experience high fever, chills, and a persistent cough. In case the pleura — the outer lung membrane, is also involved in the process of inflammation, acute chest pain may occur. The infection spreads to other tissues if left untreated and it becomes more resistant to treatment. Increased inability to breathe well may reduce the amount of oxygen in the blood, causing the skin color to turn purplish or bluish. Other symptoms could be a headache, fatigue, ache, and body weakness. More symptoms of pneumonia that can be experienced include anorexia, shortness of breath, and cough which produces pus, as well as chills and fever, as mentioned above.
Progression Trajectory
The most common type of pneumonia is the community-acquired one. Quite often, patients fall sick when they are outside the hospital or in the community setting. Community-acquired pneumonia (CAP) is common among the aged, who are above the age of 65. The impact of the disease on these individuals is far greater than for the other groups. However, the study by Gattarello published in the journal of Current Infectious Disease Reports depicted that CAP among the elderly continues to be the leading cause of death as the annual incidence is four times higher than the younger population. Elderly persons have twice higher chances of dying from the illness compared to the general population; hence, there is a need for understanding microbiology, pathophysiology, as well as treatment and prevention of the affliction. Affecting about 450 million people annually globally, the disease is a common infection. It occurs in all parts of the world and kills across all age groups. It affects around 7% of the world population annually translating into around 4 million deaths. Diagnostic Testing: Various tests are required, especially, in the case where pneumonia is suspected. Exemplary symptoms such as inflamed alveoli and thick dark pus can be used as preliminary indicators. The diagnostic tests will include a physical exam which is the first step of the care plan for a patient with pneumonia. It’s done using a stethoscope to check for crackling sounds or abnormal bubbling. Then, a sputum test is done. Accordingly, a sample of fluid should be taken from the man’s lungs to pinpoint the cause of the illness. The sputum sample taken is used to prepare a culture so that the bacterial strain is established and identified. A second diagnostic test is blood culturing to detect the bacterial whose strain could be in the blood and which is responsible for the infection. A third test is the chest X-ray, which helps a practitioner to determine the location or extent of the disease. X-ray tests will also give a picturesque view of the portion or the parts of the lungs affected. Treatment Options: The variety of therapy options for pneumonia exists. The most common is the use of antibiotics. However, special care is given to children and older patients. The treatment of the infection is the goal of the care providers who make every effort to prevent complications during the treatment process. As stated earlier, the treatment regimen is determined by the patient’s age, the severity of pneumonia, and the overall health conditions. The drug prescription is done after a proper diagnostic test is run to identify the pathogen. Amoxycillin, e.g. Amoxil, is often recommended to be taken by ingestion against the causative bacteria, known as Streptococcus pneumoniae. Amoxycillin is in the same family as penicillin. In case the patient has a negative reaction to Amoxycillin, other antibiotics, such as clarithromycin, e.g. Klacid, and or doxycycline, e.g. Doxy-100, can be recommended. Upon prescription, the patient is put under watch to note any changes — improvement or exacerbation. In case of no improvement, further prescriptions can be implemented. A second treatment option involved using Ceftriaxone, which is an effective antibacterial antibiotic. It is effective against pneumococcal meningitis and it affects the bacteriolysis of pneumococcus, thereby destroying its cell wall products which are inflammatory. These factors tend to aggravate the meningeal swelling and pain, so it is important to deal with them, which was established by the study of Farkas. Moreover, cough medicine can also be used as a temporary way of managing the symptoms during the proper treatment. Individuals with pneumonia often develop a cough which unblocks the content in their lung pores. Therefore, patients require cough medicine to soothe the discomfort caused by coughing.
Disorder and Normal Development
The signs and symptoms of pneumonia make the disease different from the normal development. For instance, if the patient engages in harmful habits like smoking, the symptoms may increase. However, people need to understand how lifestyle contributes to the problem of pneumonia. Moreover, the study carried out by Stupka et al in 2009 entitled “Community-acquired pneumonia in elderly patients” depicted that smoking damages the lungs and make it difficult for the body to defend itself against diseases and germs. The outcome was published in the journal of the Aging Health volume 5. The diagnostic test in some unique pneumonia cases tends to indicate decreased breath sounds, meaning a previous difficulty in breathing, which is not normal in development. Further, these patients tend to develop bilateral expiratory wheezing caused by the inability of the lungs to exhale, which is an abnormal respiratory sound. Notably, an understanding of the various lung sounds, conducted through auscultation, is necessary to determine the underlying pathophysiology. The wheezing sound confirms the presence of pneumonia. As well, the wheezes indicate airway obstruction, which is abnormal.
Physical and Psychological Demands
Evidently, pneumonia drains the physical and psychological strength of the patient. The weakened immune system that develops in the process of the disease can open the organism to many other infections, including mental health problems, hypertension, especially due to psychological stress, diabetes, and osteoarthritis, among others. The older patients are most easily affected. It means that at any given point, the patient will be taking a medical prescription for more than one infection, which is cumbersome. This is how the patient gets physically and psychologically worn out — they take drugs for two illnesses at once, even though the initial problem was different. Besides, the disorder stresses the patient’s family, especially, when the patient experiences excruciating pain. The stress also occurs because the patient’s financial resources are drained. In this situation, the healing process becomes complicated, as it is difficult to provide the appropriate care. Also, the debilitating effect might reduce the life span of the patient and can even affect their functionality. Pneumonia results in cognitive impairments of patients, which is the reason they claim to be unfamiliar with medications. The brain problems often require nursing home admissions to relieve the patient’s family from the burden of caring for them, leaving it to care providers in the healthcare setting.
Key Concepts to Be Shared with the Patient and Family
A nurse practitioner should discuss precautionary measures with the patient and the family to avoid the spread of the disease. Needless to say, pneumonia patients have a cough and produce sputum, which can be irritating. Certain measures should be taken by the patient and their family when handling this. First, the patient and the family should be informed about respiratory hygiene and etiquette to avoid disease spread. Indeed, they should be educated on how respiratory infections are transmitted and the ways in which they can be prevented. A second concept is hand hygiene, which should be stressed to both the patient and the family. The patient should wash hands after coughing and use tissues during it, disposing of them properly afterward, since pneumonia is a contagious disease. The patient should also have many handkerchiefs which must be kept clean at all times. These concepts can prevent the infection from spreading, enabling the care providers to achieve optimal disorder management and outcomes.
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Interdisciplinary Team Personnel
Interventions against the disease may need an interdisciplinary team approach to improve the outcomes of the healing process and nursing care plan for pneumonia. It is apparent that the healthcare field does not encompass individuals who have knowledge of all nursing areas. As a result, interventional specialties, that is, persons with the potential to provide non-technical and technical skills or aid to the patient, are required. Such an issue also explains the need to have coordination between the nurse professionals while performing complex tasks. Based on the principle of evidence-based care, the study by Cregin et al. reports that while attending to a CAP case, Antimicrobial regimens were formulated, following the published standard guidelines. The microbial combination was recommended for the particular instances after determining the antimicrobial susceptibility of the patient and given the stage of the infection. The multidisciplinary team took six months to design and implement an intervention plan.
Furthermore, the professionals require leadership and communication skills to work well with the rest of the members. In the same manner, the patient needs individuals who have interrelated skills depending on the type of illness. The disease affects the cognitive and mental health of the patient apart from inducing psychological stress. The patient, therefore, needs a nurse or a counseling psychologist to monitor the actions, attitudes, and cognition of the patient. It requires patient’s coordination, which is a fast way to recovery. If the connection is achieved, the patient will agree to take the appropriate medications.
The interdisciplinary team personnel should involve a dietician so that the pneumonia patient would be encouraged to eat properly. Besides, they need to be informed of the necessity to quit smoking and drinking, if it is their habit. The right food should be consumed to help gain energy. The dietician should provide knowledge of practicing a healthy lifestyle by keeping a balanced diet, full of vegetables and fruits. Also, the team should encourage physical exercises for the patient to keep fit and to enhance their blood circulation. It will also help with chest problems. Therefore, the dietician should collaborate with the nurse practitioner to help the patient develop a healthy lifestyle.
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Facilitators and Barriers
Managing the condition is easy when the patient possesses a clear disease etiology and a history of past illnesses. Another facilitator could be strict adherence to the medical prescriptions of the doctor. There have been challenges in managing patient’s condition when the patient did not stick to the prescriptions and hospital appointments. The additional facilitator can be when the patient is under an appropriate care system. Arrangements can be made so that depending on the severity of the condition, the patient can be placed in nursing homes in order to be under constant surveillance. Furthermore, communal sensitization can also be a facilitator in this regard, because addressing such matter is of public health concern.
On the other hand, there are also several barriers in addressing this disease. Some of them include the fact that the disease affects the mental and cognitive health of the patients, especially in its advanced form in older patients. It impairs the proper diagnosis because the patient’s reasoning, communication, and response abilities may be compromised. For this reason, it is hard to ascertain the other parts of the patient’s body that might relate to the illness. The physical and psychological effects also contribute to the cognitive compromise. Another barrier is the financial resources needed to meet the clinical and medical interventions against the disease. Moreover, the habitual attributes of the patient can be an obstacle to a quick recovery. For instance, beer and smoking tobacco after diagnosis worsen the condition. The patient becomes more susceptible to other opportunistic infections (OI), and it complicates the situation.
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Strategies to Overcome Barriers
The barriers above need to be overcome to achieve optimal disorder management and outcomes. First, the review of the systems should be assessed to provide a set of interrelated responses. Patients should be interrogated about the feelings in the nose, chest, and throat to identify the extent of a cough or flu. On a different note, pneumonia patients should be asked to quit harmful habits such as smoking which increase their susceptibility to other infections. Such habits also prevent the lungs from absorbing more fluids, a condition that is likely to hinder optimal disorder management and outcomes. Pneumonia patients should receive treatment to ease the brain problems, a condition that will improve disease management as he will agree to consume the Pneumovax medications, which he ignores. The barrier accompanied by age can be overcome through close monitoring, identifying any recent illnesses which the patient experiences.
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