Lesson 5

PNEUMONIA

CONTENTS

I. Introduction
II. Assessment
a. Risk Factors / Predisposing Conditions
b. Etiology
c. Clinical Manifestations
d. Diagnostic Examination/ Laboratory Tests
III. Treatment
IV. Nursing Intervention/Goals
V. Self Test / Self Directed Learning / Critical Thinking Drill
VI. References/Further Readings

I. Introduction
 Pneumonia is an acute inflammatory process caused by a microbial agent; it involves the lung
parenchyma, including the small airways and alveoli.

II. Assessment
A. Risk Factors / Predisposing conditions
1. Chronic upper respiratory tract infections
2. Surgery
3. Immobility
4. Smoking
5. Decreased immunity disease and/or age)
6. Aspiration of foreign material or gastric contents
7. Nosocomial infection / healthcare related
B. Etiology
1. Viral: parainfluenza, RSV
2. Bacterial: Streptococcus, staphylococcus, mycoplasma
3. Fungal (increased risk in immunocompromised clients)
C. Clinical Manifestations
1. Fever, chills
 2. Tachycardia
3. Tachypnea, dyspnea
4. Productive cough: thick, yellow, purulent
5. Pleuritic chest pain
6. Body malaise
7. Respiratory distress (hypoxia)
8. Diminished breath sounds, wheezing, crackles, tactile fremitus
9. Feeding difficulty in infants
10. Anorexia
11. Decreasing level of consciousness in elderly

D. Diagnostic Exam
1. Culture of organism from sputum
2. Chest X-ray
3. Complete blood count for increased leukocytes
4. ABGs, pulse oximetry

III. Treatment
A. Antibiotic (according to organism identified through culture and sensitivity result)
B. Respiratory (airborne/droplet) precautions: most microbes causing this disease are transmitted
via these respiratory medium
C. Inhalation therapy
D. Cool O2 mist (mist tents are effective for newborn patients)
a. Postural drainage
b. Bronchodilator medications
E. Other medications
a. Expectorant/Mucolytic
b. Antipyretic (in case of fever)
F. Hydration (through oral or IV fluid management)

IV. Nursing Intervention

Goal No 1: To decrease infection and remove secretions to facilitate O2 and CO2 exchange.
1. Antibiotics administrations ordered
 2. Have client turn, cough, and deep breathe
3. Liquefy secretions
a. Adequate hydration
b. Cool mist inhalation
c. Hydration management
4. Evaluate breath sounds and changes in sputum
5. Position for comfort or place in semi-Fowler’s position
6. Manage hypoxia (O2 administration, positioning, hydration)

V. Self Test / Critical Thinking Drill

SELF DIRECTED LEARNING

Research Assignment

1. Read about Pulmonary Diagnostic Exams that may be used for respiratory assessment, including
diseases like pneumonia. Know their implications, usage and benefits.
a. Chest X-ray
________________________________________________________________________________
________________________________________________________________________________
b. Bronchoscopy
________________________________________________________________________________
_______________________________________________________________________________
c. Pulmonary Angiography
________________________________________________________________________________
________________________________________________________________________________
d. Pulmonary Function Test (PFT)
________________________________________________________________________________
________________________________________________________________________________
e. Arterial Blood Gas (ABG)
________________________________________________________________________________
________________________________________________________________________________
2. Read about Bronchodilators. Provide 3 types of
common bronchodilators and give 2 nursing
implications for each.
a. _______________________________________
1. ____________________________________
______________________________________
2. ____________________________________
______________________________________
b. ______________________________________
1. ___________________________________
_____________________________________
2. ___________________________________
_____________________________________
c. ______________________________________
1. ___________________________________
_____________________________________
2. ___________________________________
_____________________________________
CRITICAL THINKING DRILL
Case Study: Pneumonia
Theresa, a 20 year old college student, lives in a
small dormitory with 30 other students. Four
weeks into the next semester, she was diagnosed
as having bacterial pneumonia and was admitted
to the hospital.
1. What intervention can the nurse provide to
decrease the viscosity of the secretion?
_______________________________________
_______________________________________
2. The nurse assessing Theresa during the
admission process. What manifestations of
bacterial pneumonia does the nurse expect to
find?
_______________________________________
_______________________________________
3. The nurse is assessing vital signs and lung
sounds every 4 hours. What complications
should the nurse monitor for?
_______________________________________
_______________________________________