Introduction to Nursing Interventions for Pneumonia

Pneumonia is an infection that inflames the air sacs in one or both lungs. A variety of organisms, such as bacteria, viruses (including Covid-19), and fungi, can cause pneumonia. In pneumonia, the alveoli in one or both lungs fill with pus and fluids (exudate), which interferes with gas exchange. This can often lead to respiratory failure if left untreated.

Pulmonary findings include a cough with or without sputum. Further inflammation can lead to fever, chills, cough, chest pain, fatigue, loss of appetite, and weight loss.

Pneumonia is typically treated by providing fever-reducing medicine and antibiotics. Nursing responsibilities include, providing prescribed oxygen therapy, antibiotics, and other respiratory support for clients with pneumonia.

Pathophysiology of Pneumonia

Anatomically the lungs are located in the chest cavity on either side of the heart. The right lung contains three (3) lobes, while the left lung contains two (2) lobes. Each lobe consists of air sacs called alveoli. Alveoli exchange oxygen and carbon dioxide with the blood. 

Pneumonia begins when the lungs become inflamed, usually preceded by an upper respiratory infection, aspiration of fluids or gastric contents, asthma, or allergies. This inflammation causes air sacs in the lungs to fill with fluid. 

The infection spreads through the lungs, causing inflammation.  When inflammation occurs, the body sends white blood cells to fight off the infection. The white blood cells release chemicals like interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF), which cause swelling in the lung tissue around the site of infection.

Causes of Pneumonia

Common causes of pneumonia include:

• Bacteria
• Fungi
• Aspiration of fluids or gastric contents
• Asthma,and/or allergies
• Upper respiratory infection

Pneumonia Risk Factors 

Risk factors for pneumonia include:

• Age
• Smoking
• Asthma
• COPD
• Immunocompromised state

Signs and Symptoms of Pneumonia

The main signs and symptoms of pneumonia include rapid breathing rate (over 30 breaths/minute), flushed face, and fast heartbeat (over 100 beats per minute). Others include:

• Fever (Over 100.4° F  / 38° C)
• Altered mental status or confusion
• Restlessness or agitation
• Productive cough (yellow sputum)
• Fine or coarse crackles
• Dyspnea (shortness of breath)
• Pleuritic chest pain (pleural friction rub) 
• Dry cough
• Wheezing

Nursing Assessment for Pneumonia

Nursing assessment includes:

1. A thorough client history: A complete history will enable the nurse to identify risk factors that may have contributed to the client’s developing pneumonia.
2. Physical assessment: Airway, breathing and circulation are key in identifying the client’s respiratory status. Assess for signs of pneumonia and respiratory distress which will require immediate intervention. Physical assessment consists of: auscultating lung sounds, obtaining vital signs (to include pulse oximetry), and skin assessment for the client’s overall respiratory health.
3. The health care provider (HCP) will prescribe lab tests (such as arterial blood gas (ABG) and cultures) to identify what type of infection is present in the client’s lungs (bacterial vs viral), and which antibiotic would be most effective at treating it.

Nursing Interventions for Pneumonia

Encourage clients to drink more fluids to prevent dehydration.

Assess clients’ hydration status and keep electrolytes normal through oral rehydration solutions (ORS) or intravenous therapy as needed.

Monitor their oxygen levels by measuring pulse oximetry at least every 2-4 hours. Also monitor for side effects, such as nausea or vomiting.

Administer medications as prescribed, such as antibiotics. Also, administer oxygen appropriately according to protocol or physician orders.

Avoid cough suppressants, so reinfection doesn’t occur.

Complications of Pneumonia

When pneumonia is left untreated for too long, it can lead to complications such as:

Fibrosis- scarring can occur when the walls of the alveoli thicken and become stiff

Bronchitis – A lung infection that causes inflammation in the bronchi.

Lung abscesses – A collection of pus in one or more lungs.

Empyema – An accumulation of pus in the space between the lungs and chest wall.]

Pleural Effusion  – Fluid that fills the pleural space (space between the lung itself & the chest wall). This prevents full lung expansion, resulting in decreased gas exchange.

Key signs of pleural effusion memory trick: 

1. During inhalation = Chest pain 
2. Dyspnea 
3. Diminished breath sounds 
4. Dull resonance on percussion

Conclusion to Nursing Interventions for Pneumonia

Inflammation brought on by pneumonia develops in the lungs’ air sacs, which could lead to fluid accumulation. More severe symptoms, such as fever, chills, coughing, chest pain, exhaustion, loss of appetite, and weight loss, might result from the infection spreading to other body areas.

If untreated, the enlarged tissue can cause breathing difficulties and even respiratory failure because it makes it harder for oxygen to enter the bloodstream. For certain people, particularly young children and the elderly, pneumonia can be dangerous and even fatal.

Antibiotics and medications for lowering fever are frequently used to treat pneumonia. Additionally, you will need to administer oxygen therapy and other forms of respiratory support.

Sources

https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204 

https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/symptoms-and-diagnosis 

https://www.hopkinsmedicine.org/health/conditions-and-diseases/pneumonia 

https://www.winchesterhospital.org/health-library/article?id=20036