NCP Pneumonia

Pneumonia is an inflammation of the lung parenchyma, associated with alveolar edema and congestion that
impair gas exchange.
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.

CARE SETTING

Most patients are treated as outpatients; however, persons at

higher risk (e.g., with ongoing/chronic health problems) are
treated in the hospital, as are those already hospitalized for
other reasons.

RELATED CONCERNS

AIDS
Chronic obstructive pulmonary disease (COPD) and asthma
Psychosocial aspects of care
Sepsis/septicemia
Surgical intervention
Patient Assessment Database

ACTIVITY/REST

May report: Fatigue, weakness

Insomnia
May exhibit: Lethargy
Decreased tolerance to activity

CIRCULATION

May report: History of recent/chronic heart failure (HF)

May exhibit: Tachycardia
Flushed appearance or pallor

EGO INTEGRITY
May report: Multiple stressors, financial concerns
FOOD/FLUID
May report: Loss of appetite, nausea/vomiting
May exhibit: Distended abdomen
Hyperactive bowel sounds
Dry skin with poor turgor
Cachectic appearance (malnutrition)

PAIN/DISCOMFORT

May report: Headache

Chest pain (pleuritic), aggravated by cough; substernal chest
pain (influenza)
Myalgia, arthralgia
May exhibit: Splinting/guarding over affected area (patient
commonly lies on affected side to restrict movement)

RESPIRATION

May report: History of recurrent/chronic URIs, tuberculosis or

COPD, cigarette smoking
Progressive dyspnea
Cough: Dry hacking (initially) progressing to productive cough
May exhibit: Tachypnea; shallow grunting respirations, use of
accessory muscles, nasal flaring
Sputum: Scanty or copious; pink, rusty, or purulent (green,
yellow, or white)
Percussion: Dull over consolidated areas
Fremitus: Tactile and vocal, gradually increases with
consolidation
Pleural friction rub
Breath sounds: Diminished or absent over involved area, or
bronchial breath sounds over area(s) of consolidation; coarse
inspiratory crackles
Color: Pallor or cyanosis of lips/nailbeds

SAFETY

May report: Recurrent chills

History of altered immune system: i.e., systemic lupus
erythematosus (SLE), AIDS, steroid or chemotherapy use,

institutionalization, general debilitation

Fever (e.g., 1028F–1048F/398C–408C)
May exhibit: Diaphoresis
Shaking
Rash may be noted in cases of rubeola or varicella
TEACHING/LEARNING

May report: History of recent surgery; chronic alcohol use;

intravenous (IV) drug therapy or abuse; immunosuppressive
therapy

Discharge plan

DRG projected mean length of inpatient stay: 4.3–8.3 days

Assistance with self-care, homemaker tasks.
Oxygen may be needed, especially if recovery is prolonged or
other predisposing condition exists.
Refer to section at end of plan for postdischarge
considerations.

DIAGNOSTIC STUDIES

Chest x-ray: Identifies structural distribution (e.g., lobar,

bronchial); may also reveal multiple abscesses/infiltrates,
empyema (staphylococcus); scattered or localized infiltration
(bacterial); or diffuse/extensive nodular infiltrates (more often
viral). In mycoplasmal pneumonia, chest x-ray may be clear.

Fiberoptic bronchoscopy: May be both diagnostic (qualitative

cultures) and therapeutic (re-expansion of lung segment).

ABGs/pulse oximetry: Abnormalities may be present,

depending on extent of lung involvement and underlying lung
disease.

Gram stain/cultures: Sputum collection; needle aspiration of

empyema, pleural, and transtracheal or transthoracic fluids;
lung biopsies and blood cultures may be done to recover
causative organism. More than one type of organism may be
present; common bacteria include Diplococcus pneumoniae,
Staphylococcus aureus, ahemolytic streptococcus,
Haemophilus influenzae; cytomegalovirus (CMV). Note:
Sputum cultures may not identify all offending organisms.
Blood cultures may show transient bacteremia.

CBC: Leukocytosis usually present, although a low white blood

cell (WBC) count may be present in viral infection,
immunosuppressed conditions such as AIDS, and
overwhelming bacterial pneumonia. Erythrocyte
sedimentation rate (ESR) is elevated.
Serologic studies, e.g., viral or Legionella titers, cold agglutinins: Assist in differential diagnosis of specific
organism.

Pulmonary function studies: Volumes may be decreased

(congestion and alveolar collapse); airway pressure may be
increased and compliance decreased. Shunting is present
(hypoxemia).

Electrolytes: Sodium and chloride levels may be low.

Bilirubin: May be increased.

Percutaneous aspiration/open biopsy of lung tissues: May

reveal typical intranuclear and cytoplasmic inclusions

(CMV), characteristic giant cells (rubeola

NURSING PRIORITIES

1. Maintain/improve respiratory function.

2. Prevent complications.
3. Support recuperative process.
4. Provide information about disease process/prognosis and
treatment.

DISCHARGE GOALS

1. Ventilation and oxygenation adequate for individual needs.

2. Complications prevented/minimized.
3. Disease process/prognosis and therapeutic regimen
understood.
4. Lifestyle changes identified/initiated to prevent recurrence.
5. Plan in place to meet needs after discharge.