What is pneumonia? Pneumonia is an infection of one or both lungs which is usually caused by bacteria, viruses, or fungi.

Prior to the discovery of antibiotics, one-third of all people who developed pneumonia subsequently died from the infection. Currently, over 3 million people develop pneumonia each year in the United States. Over a half a million of these people are admitted to a hospital for treatment. Although most of these people recover, approximately 5% will die from pneumonia. Pneumonia is the sixth leading cause of death in the United States. Pneumonia is an infection of the lungs that is caused by bacteria, viruses, fungi, or parasites. It is characterized primarily byinflammation of the alveoli in the lungs or by alveoli that are filled with fluid (alveoli are microscopic sacs in the lungs that absorb oxygen). At times a very serious condition, pneumonia can make a person very sick or even cause death. Although the disease can occur in young and healthy people, it is most dangerous for older adults, babies, and people with other diseases or impaired immune systems. In the United States, more than 3 million people develop pneumonia each year, and about 17% of these receive treatment in a hospital. Most people with pneumonia recover, but about 5% will succumb to the condition.

What are the symptoms of pneumonia? Symptoms of pneumonia caused by bacteria usually come on more quickly than pneumonia caused by virus. Elderly persons and small children may actually have fewer or more mild symptoms than expected for such high risk groups. Most people with pneumonia begin with cold and flu symptoms and then develop a high fever, chills, and cough with sputum. Although symptoms may vary greatly depending on other underlying conditions, common symptoms include: Cough Rusty or green mucus (sputum) coughed up from lungs Fever Fast breathing and shortness of breath Shaking chills Chest pain that usually worsens when taking a deep breath (pleuritic pain) Fast heartbeat Fatigue and feeling very weak Nausea and vomiting Diarrhea Sweating Headache Muscle pain Confusion or delirium Dusky or purplish skin color (cyanosis) from poorly oxygenated blood

Pneumonia - Topic Overview What is pneumonia? Pneumonia is a lung infection that can make you very sick. You may cough, run a fever, and have a hard time breathing. For most people,pneumonia can be treated at home. It often clears up in 2 to 3 weeks. But older adults, babies, and people with other diseases can become very ill. They may need to be in the hospital. You can get pneumonia in your daily life, such as at school or work. This is called community-associated pneumonia. You can also get it when you are in a hospital or nursing home. This is called healthcareassociated pneumonia. It may be more severe because you already are ill. This topic focuses on pneumonia you get in your daily life. What causes pneumonia? Germs called bacteria or viruses usually cause pneumonia. Pneumonia usually starts when you breathe the germs into your lungs. You may be more likely to get the disease after having a cold or the flu. These illnesses make it hard for your lungs to fight infection, so it is easier to get pneumonia. Having a long-term, or chronic, disease like asthma, heart disease, cancer, or diabetes also makes you more likely to get pneumonia. What are the symptoms? Symptoms of pneumonia caused by bacteria usually come on quickly. They may include: Cough. You will likely cough up mucus (sputum) from your lungs. Mucus may be rusty or green or tinged with blood. Fever. Fast breathing and feeling short of breath. Shaking and "teeth-chattering" chills. You may have this only one time or many times. Chest pain that often feels worse when you cough or breathe in. Fast heartbeat. Feeling very tired or feeling very weak. Nausea and vomiting. Diarrhea. When you have mild symptoms, your doctor may call this "walking pneumonia." Older adults may have different, fewer, or milder symptoms. They may not have a fever. Or they may have a cough but not bring up mucus. The main sign of pneumonia in older adults may be a change in how well they think. Confusion ordelirium is common. Or, if they already have a lung disease, that disease may get worse. Symptoms caused by viruses are the same as those caused by bacteria. But they may come on slowly and often are not as obvious or as bad. How is pneumonia diagnosed? Your doctor will ask you about your symptoms and do a physical exam. He or she may order a chest Xray and a blood test. This is usually enough for your doctor to know if you have pneumonia. You may need more tests if you have bad symptoms, are an older adult, or have other health problems. In general, the sicker you are, the more tests you will have.

Treatment:

The approach to treating patients with pneumonia generally involves:

Deciding who can be treated at home and who needs to be in the hospital Deciding whether a patient needs antibiotics, and which antibiotics are appropriate Providing appropriate supportive care Deciding what follow-up and preventive care are needed

Whether patients are treated at home or admitted to the hospital, receiving their first dose of antibiotics quickly improves the outcome of the illness and the speed at which they get better.

Signs and Symptoms

Symptoms vary depending on the age of the child and the cause of the pneumonia, but common ones include:

fever chills cough nasal congestion unusually rapid breathing (in some cases, this is the only symptom) breathing with grunting or wheezing sounds labored breathing that makes the rib muscles retract (when muscles under the ribcage or between ribs draw inward with each breath) and causes nasal flaring vomiting chest pain abdominal pain decreased activity loss of appetite (in older kids) or poor feeding (in infants), which may lead to dehydration in extreme cases, bluish or gray color of the lips and fingernails

Risk factors
By Mayo Clinic staff Factors associated with an increased risk of pneumonia include:

Age. If you're age 65 or older, particularly if you have other conditions that make you more prone to developing pneumonia, you're at increased risk of pneumonia. Very young children, whose immune systems aren't fully developed, also are at increased risk of pneumonia.

Certain diseases. These include immune deficiency diseases such as HIV/AIDS and chronic illnesses such as heart disease, emphysema and other lung diseases. You're also at increased risk if your immune system has been weakened by chemotherapy or long-term use of immunosuppressant drugs.

Smoking. Smoking damages your body's natural defenses against the bacteria and viruses that cause pneumonia.

Having chronic obstructive pulmonary disease (COPD) and using inhaled corticosteroids for more than 24 weeks. Research indicates that this greatly increases your risk of developing possibly serious pneumonia.

Exposure to certain chemicals or pollutants. Your risk of developing some uncommon types of pneumonia may be increased if you work in agriculture, in construction or around certain industrial chemicals or animals. Exposure to air pollution or toxic fumes can also contribute to lung inflammation, which makes it harder for the lungs to clear themselves.

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Nursing Interventions: Pneumonia Maintain a patent airway and adequate oxygenation. Obtain sputum specimens as needed. Use suction if the patient cant produce a specimen. Provide a high calorie, high protein diet of soft foods. To prevent aspiration during nasogastric tube feedings, check the position of tube, and administer feedings slowly. To control the spread of infection, dispose secretions properly. Provide a quiet, calm environment, with frequent rest periods. Monitor the patients ABG levels, especially if hes hypoxic. Assess the patients respiratory status. Auscultate breath sounds at least every 4 hours. Monitor fluid and intake output. Evaluate the effectiveness of administered medications. Explain all procedures to the patient and family.

V. Medical Management Antibiotics are prescribed based on Gram stain results and antibiotic guidelines (resistance patterns, risk factors, etiology must be considered). Combination therapy may also be used. Classifications: Antibiotics (Aminoglycosides: gentamycin, tobramycin, amoxicillin, erythromycin, penicillin, tetracycline) Indications: Prevent or treat infections caused by pathogenic microorganisms Selected Interventions:

 Before administering the first dose, assess the client for allergies and determine whether culture has been obtained. After multiple doses, assess the client for superinfection (thrush, yeast infection, diarrhea); notify the health care provider if superinfection occurs. Assess the insertion site for phlebitis if antibiotics are being administered I.V. To assess the effectiveness of antibiotic therapy, monitor the white blood cell count. Monitor peaks and troughs for aminoglycosides.
Causes of Pneumonia
The most common causes of pneumonia are infections caused by:

bacteria - the most common cause of pneumonia in adults viruses - often responsible for pneumonia in children mycoplasma - organisms that have characteristics of bacteria and viruses that cause milder infections opportunistic organisms - a threat to people with vulnerable immune systems (e.g., Pneumocystis carinii pneumonia in people who have AIDS)

Zantac, Zantac EFFERdose, Zantac GELdose, Zantac-75 Action: Potent anti-ulcer drug that competitively and reversibly inhibits histamine action at H2-receptor sites on parietal cells, thus blocking gastric acid secretion. Indirectly reduces pepsin secretion but appears to have minimal effect on fasting and postprandial serum gastrin concentrations or secretion of gastric intrinsic factor or mucus Classifications: GASTROINTESTINAL AGENT; ANTISECRETORY (H2-RECEPTOR ANTAGONIST) Indication: Short-term treatment of active duodenal ulcer; maintenance therapy for duodenal ulcer patient after healing of acute ulcer; treatment of gastroesophageal reflux disease; short-term treatment of active, benign gastric ulcer; treatment of pathologic GI hypersecretory conditions (e.g., Zollinger-Ellison syndrome, systemic mastocytosis, and postoperative hypersecretion); heartburn.

GENERIC NAME: Ranitidine BRAND NAME: Zantac CLASSIFICATION Therapeutic: Anti-ulcer agents Pharmacologic: Histamine H2 antagonists

DOSAGE 20 mg IV q8h MECHANISM OF ACTION Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori. INDICATION Treatment and prevention of heartburn, acid indigestion, and sour stomach. CONTRA INDICATIONS Contraindicated in: Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Use Cautiously in: Renal impair- ment Geriatric patients (more susceptible to adverse CNS reactions) Pregnancy or Lactation SIDE EFFECTS/ ADVERSE EFFECTS CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis

NURSING IMPLICATIONS/RESPONSIBILITIES Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray black.

2. Ineffective Breathing Pattern Nursing Diagnosis: Ineffective breathing pattern related to presence of tracheobronchial secretions and nasal secretions Alteration on the clients O2:CO2 ratio due to decreased absorbed oxygen and poor gas exchage related to presence to exudates on the alveolar spaces causes the body to cope by increasing respiratory rate or by hyperventilation. The increase in respiratory rate is elicited to cause an increase in the tidal volume of air that in inspired in order to absorb more oxygen. The increase in respiratory rate may need the assistance of accessory muscle that would be evident by the rising and falling of the shoulders during inspiration and expiration. ASSESSMENT OBJECTIVES INTERVENTIONS RATIONALE EXPECTED OUTCOMES Increase in respiratory rate of 31 cpm Shortness of breath (orthopnea) Dyspnea Use of accessory muscles in breathing Altered chest excursion Nasal Flaring Increased anterior-posterior diameter SHORT TERMAfter 2-3 hours of nursing intervention, patient will be able to verbalize understanding and demonstrate proper deep breathing technique to facilitate proper oxygenation to alleviate hyperventilation LONG TERM After 2-3 days of nursing intervention, patient will be free of cyanosis and establish normal breathing pattern Establish rapport with patient Instruct patient to increase oral fluid intake to 8-10 glasses Instruct patient to do deep breathing exercise after demonstrating proper technique Keep environment allergen free (dust, feather pillows, smoke, pollen) Take and VS Suction naso, tracheal/oral PRN Educate proper hand washing Position the patient in semi fowlers position Encourage patient to eat nutritious foods such as green leafy vegetables and lean meat Review clients chest x-ray for severity of acute/ chronic conditions To gain patients trust and cooperation Increased mucus and sputum secretions can lead to dehydration; increased water intake can help dissolve secretions Deep breathing exercise increases oxygen intake and can help alleviate dyspnea Presence may trigger allergic response that may cause further increase in mucus secretion To get baseline data These may compromise airway. A distended abdomen can interfere with normal diaphragm expansion To increase feeling of comfort To enable the body to recuperate and repair To prevent infections such as nosocomial infections To prevent allergic reactions that can cause respiratory distres SHORT TERMClient shall verbalize understanding and demonstrate proper deep breathing technique to facilitate proper oxygenation to alleviate hyperventilation LONGTERM Patient shall be free of cyanosis and establish normal breathing pattern Navigation Ineffective Airway Clearance Ineffective Breathing Pattern Impaired Gas Exchange Risk for Infection Hyperthermia & Other Care Plans Share: Facebook58 Twitter1 Reddit Print & PDF Email Read more at Nurseslabs.com 5 Pneumonia Nursing Care Plans http://nurseslabs.com/pneumonia-nursing-careplans/2/

. Ineffective Airway Clearance NDx: Ineffective airway clearance related to presence of secretions secondary to pneumonia. The inflammation and increased secretions make it difficult to maintain a patent airway, which is cause by decrease ability to expel the excessive mucus produced that will lead to extensive obstruction of the airway. ASSESSMENT OBJECTIVES NURSING INTERVENTIONS RATIONALE EXPECTED OUTCOMES With unproductive cough With wheezes and crackles auscultated on left lower lungfield. Presence of clear watery discharge from her nose Restlessness Irritability Short Term: After 3-4 hours of nursing interventions, the patients respiration will improve and difficulty of breathing will be relieved. Long Term: After 3 4 days of nursing interventions, the patient will maintain a patent airway. Establish rapport to patient and SO Assess patients condition Monitor and record V/S Auscultate lung fields, noting areas of decreased/absent airflow and adventitious breath sounds Assist patient to change position every 30 minutes Elevate head of bed and align head in the middle Provide health teachings regarding effective coughing and deep breathing exercise. Encourage to increase fluid intake. Encourage steam inhalation Administer meds as ordered To gain the trust and cooperation To know and determine patients needs To establish base line data To identify areas of consolidation and determine possible bronchospasm or obstruction. To mobilize secretions To facilitate breathing To expel the mucous To liquefy secretions To moisten secretions and alleviate congestion To reduce bronchospasm and mobilize secretion Short Term: After 3-4 hours of nursing interventions, the patients respiration shall have improved and difficulty of breathing shall have been relieved. Long Term: After 3 4 days of nursing interventions, the patient will have been able to maintain a patent airway. Navigation Read more at Nurseslabs.com 5 Pneumonia Nursing Care Plans http://nurseslabs.com/pneumonia-nursing-careplans/