Pneumonia: Symptoms, Prevention And Treatment Options
Pneumonia is an acute infection of the lungs characterized by inflammation of the alveoli, which causes the sacs to fill with fluid or pus. Pneumonia has many causative factors such as bacteria, viruses, and fungi. If treatment is delayed or dismissed this disease can be fatal. This build up fluid in the lungs leads to decreased gas exchange due to poor ventilation. The fluid or pus will cause congestion in the tracheal region with thick secretions making it even harder for the patient to breath.
Symptoms of pneumonia include onset of cough with purulent sputum, fever, pleuritic chest pain, and dyspnea. The physical assessment of this patient may reveal tachypnea, rales, and diminished breath sounds. Antibiotics and other medications such as bronchodilators are used for primary treatment in pneumonia. Chest physiotherapy is a very common adjuvant treatment due to its ability to break up secretions and airway obstructions, increase gas exchange and decrease the work of breathing. It has been proven to have made a significant improvement in these patients with positive changes in their chest x-rays to a more productive cough within two days.
Risk factors for pneumonia include age (under 2 or over 65), smoking, alcoholism, a weakened immune system, immunosuppressant drugs, hospitalization, being on a ventilator, and/or having a chronic condition. This patient is at a particular risk because he has cerebral palsy. Cerebral palsy can affect the muscles used to breath, causing the person to take more shallow breaths than normal. Cerebral palsy patients typically exercise much less and generally move around less than a normal person. This puts them at further risk for respiratory complications such as pneumonia.
Nursing Diagnosis and Care
The patient is a sixteen-year-old male with cerebral palsy who was admitted to the pediatric unit with left lower lobe pneumonia. The patient presented to Spartanburg Regional Medical Centers emergency department with his mother, on October 28, 2019. His mother stated that he had been experiencing a fever lasting four days, congestion, cough, and shortness of breath, and what seemed like he was “choking on mucous”. In order of priority and symptomology of pneumonia, the nursing diagnoses for this patient would be ineffective airway clearance, impaired gas exchange, and risk for pressure ulcers.
The priority nursing diagnoses would be ineffective airway clearance due to the thick sputum and retained secretions in the patient’s airways. This diagnosis would take priority because if one’s airway becomes obstructed and they are unable to clear it, proper ventilation cannot occur. Evidence supporting this diagnosis would be the patients diminished breath sounds with rales heard bilaterally during inspiration, an ineffective cough, and bilateral infiltrates visualized on chest x-ray on 9/30/2019. Interventions would be aimed at monitoring lung sounds, assessing vital signs, and respiratory status, and cough reflex, as well as the type and amount of secretions. Suctioning is an important intervention for this patient due to his inability to clear his own airway. Increasing fluid intake, collaborating with respiratory therapy for chest physiotherapy, and administering the ordered bronchodilator will help to loosen and clear out the chest and lungs. Additionally, keeping the head of the bed elevated to at least a semi-fowlers position is also an important intervention to further open airways.
The second nursing diagnosis in order of priority would be impaired gas exchange due to alveolar capillary changes and impaired ventilation. Evidence supporting this diagnosis includes an increase in both heart rate and respiratory rate as well as retained secretions and bilateral infiltrate as visualized on the chest x-ray on 9/30/2019. Interventions related to this diagnosis would be assessing overall respiratory efforts, auscultating lung sounds in all fields, listening specifically for any adventitious breath sounds, and assessing vital signs for heart rate, respiratory rate, blood pressure, pulse oximetry, and temperature. Furthermore, this patients pulse oximetry should be monitored continuously or as ordered. Keeping the patient’s head of bed elevated to at least a semi-fowlers position, suctioning the mouth, nose, and trachea using a younker as needed, administering ordered bronchodilators, and encouraging frequent position changes by turning this patient every two hours are all excellent interventions to promoting a clear and patent airway for proper gas exchange. Encouraging a calm and stress-free environment is also important due to helping decrease the demand for oxygen supply and demand. Lastly, monitoring the patient’s lab results such as a CBC and chest x-rays allow their progress to be monitored and changes in care be made based upon those results.
The third nursing diagnosis would be risk for pressure ulcers due to impaired mobility and cognitive function of the patient related to his diagnosis of cerebral palsy, totality of incontinence, and a Braden score of 16. Interventions for this specific diagnosis are all related towards preventing pressure ulcers in their entirety. Assessing the patient’s skin especially pressure areas over bony prominences on admission and a daily basis is crucial in preventing a pressure ulcer from forming or current breakdown progressing. Turning and repositioning the patient every two hours, using the proper equipment and staff, and using pressure reducing devices such as a foam wedge or boots, and keeping the patient free from moisture is key in preventing breakdown from occurring. Education directed towards the caregiver(s) also plays a major role for long term compliance in prevention. It would benefit the patient drastically to teach these parents multiple ways mentioned above to prevent this from becoming a problem. Having them verbalize these teachings to you will ensure adequate understanding. In addition, one other way to monitor for potential breakdown would be through the patient’s laboratory work such as hemoglobin, hematocrit, albumin, and total protein.
The prognosis for this patient the day of my clinical wasn’t progressing in a positive manner. I cared for him the morning after his admission and from what was visualized on his follow up x-ray on 9/30/19 from the previous chest x-ray on 9/28/19, the pneumonia had begun spreading mid to right lung as well as what already existed in the lower lobe of his left lung upon admission. Treatments that were already being sought out were antibiotic therapy, chest physiotherapy, breathing treatments, and other supplemental care strategies. The goal for this patient is to treat any and all existing infection, return him back to his baseline health, free from infection and respiratory distress, and discharge him back home to his normal everyday routine.
Conclusion
In conclusion pneumonia can be a very serious and even fatal infection if not treated properly and in a timely manner. With knowing this, it is crucial that caregivers be educated on prevention, the signs and symptoms of pneumonia, and when to seek medical attention in order to get proper treatment. It is then in the hands of the healthcare workers to initiate any and all supportive treatments to cure the infection early and return these patients back to baseline to live a happy, healthier life.
