Pneumonia is one of the most common medical problems encountered in clinical practice and leading fatal infectious disease worldwide. In the Philippines last 2011 based on a number of health insurance claims by Philhealth revealed as one of the top cases acquired disease in the country.
It’s also ranked as the eight leading cause of death in the US consistently accounts for the overwhelming majority death in 2006, were in 55,477 people died of pneumonia.
Pneumonia is caused by a number of infectious agents including viruses, bacteria, and fungi. The most common bacterial pathogen, Streptococcus pneumoniae, is identified as the leading cause of community-acquired pneumonia among children and adults.
Two causes of Pneumonia
- 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.
- Maintain/improve respiratory function.
- Prevent complications.
- Support recuperative process.
- Provide information about disease process/prognosis and treatment.
- Ventilation and oxygenation adequate for individual needs.
- Complications prevented/minimized.
- Disease process/prognosis and therapeutic regimen understood.
- Lifestyle changes identified/initiated to prevent recurrence.
- Plan in place to meet needs after discharge.
Nursing Diagnosis:Risk for Infection
Risk factors may include
- Inadequate primary defenses (decreased ciliary action, stasis of respiratory secretions)
- Inadequate secondary defenses (presence of existing infection, immunosuppression), chronic disease, malnutrition
Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]
- Achieve timely resolution of current infection without complications.
- Knowledge: Infection Control
- Identify interventions to prevent/reduce risk/spread of/secondary infection.
|Monitor vital signs closely, especially during initiation of therapy.||During this period of time, potentially fatal complications (hypotension/shock) may develop.|
|Instruct patient concerning the disposition of secretions (e.g., raising and expectorating versus swallowing) and reporting changes in color, amount, odor of secretions.||Although patient may find expectoration offensive and attempt to limit or avoid it, it is essential that sputum be disposed of in a safe manner. Changes in characteristics of sputum reflect resolution of pneumonia or development of secondary infection.|
|Demonstrate/encourage good handwashing technique.||Effective means of reducing spread or acquisition of infection.|
|Change position frequently and provide good pulmonary toilet.||Promotes expectoration, clearing of infection.|
|Limit visitors as indicated.||Reduces likelihood of exposure to other infectious pathogens.|
|Institute isolation precautions as individually appropriate.||Dependent on type of infection, response to antibiotics, patient’s general health, and development of complications, isolation techniques may be desired to prevent spread/protect patient from other infectious processes.|
|Encourage adequate rest balanced with moderate activity. Promote adequate nutritional intake.||Facilitates healing process and enhances natural resistance.|
|Monitor effectiveness of antimicrobial therapy.||Signs of improvement in condition should occur within 24–48 hr.|
|Investigate sudden changes/deterioration in condition, such as increasing chest pain, extra heart sounds, altered sensorium, recurring fever, changes in sputum characteristics.||Delayed recovery or increase in severity of symptoms suggests resistance to antibiotics or secondary infection. Complications affecting any/all organ systems include lung abscess/empyema, bacteremia, pericarditis/endocarditis, meningitis/encephalitis, and superinfections.|
|Administer antimicrobials as indicated by results of sputum/blood cultures: e.g., penicillins: erythromycin (E-Mycin), tetracycline (Achromycin), doxycycline hyclate (Vibramycin), amikacin (Amikin); cephalosporins: ceftriaxone (Rocephin); amantadine (Symmetrel); sparfloxacin (Zagam); macrolide derivatives, e.g, azithromycin (Zithromax).||These drugs are used to combat most of the microbial pneumonias. Combinations of antiviral and antifungal agents may be used when the pneumonia is a result of mixed organisms. Note: Vancomycin and third-generation cephalosporins are the treatment of choice for penicillin-resistant streptococcal pneumonia.|