Nursing care plan pneumonia

I. Pathophysiology

a. Inflammation of the lung parenchyma associated with
alveolar edema and congestion that impairs gas exchange
b. Common pathogens
i. Viruses
1. Common causative organisms include respiratory
syncytial virus (RSV) and influenza
2. Accounts for approximately half of all cases of
community-acquired pneumonia (CAP)
ii. Bacteria
1. Divided into typical and atypical types
2. Gram-positive Streptococcus pneumoniae,
Haemophilus, and Staphylococcus most common
bacterial causes
iii. Fungus
1. Most common causes Histoplasma capsulatum and
Coccidioides immitis
2. Pneumocystis carinii and cytomegalovirus (CMV)
often occur in immunocompromised persons
iv. Other
1. Agents include Mycoplasma, Mycobacterium tuberculosis,
Coxiella burnetii, Chlamydia, and Legionella

II. Classification

a. Site and causative agent
i. Lobar, single lobe; broncho, smaller lung areas in several
lobes; interstitial, tissues surrounding the alveoli and
bronchi
ii. Bacteria, viruses, and fungi
b. Distribution
i. CAP commonly caused by S. pneumoniae, Chlamydia
pneumoniae, Haemophilus influenzae, RSV, occasionally
atypical pathogens
ii. Nosocomial develops at least 48 hours after admission to
an institution or care center; hospital-acquired pneumonia
(HAP) and/or ventilator-associated pneumonia (VAP) is
often caused by Pseudomonas aeruginosa, Klebsiella
pneumoniae, Staphylococcus aureus, and both methicillinsensitive
and methicillin-resistant S. aureus (MRSA)

III. Etiology

a. Primary pneumonia is caused by the client’s inhalation or
aspiration of a pathogen (microaspiration).
b. Secondary pneumonia ensues from lung damage caused by
the spread of an infectious agent—bacterial, viral, or
fungal—from another site in the body or from various
chemical irritants (including gastric reflux and aspiration,
smoke inhalation) or radiation therapy.
c. Risk factors: comorbidities, such as heart or lung disease,
compromised immune system, diabetes mellitus, liver
or renal failure, malnutrition, smoking, over age 70,
previous antibiotic therapy, abdominal or thoracic surgical
procedures, endotracheal intubation with mechanical
ventilation
IV. Statistics (American Lung Association, 2007c; National
Center for Health Statistics [NCHS], 2007; National Heart,
Lung and Blood Institute [NHLBI], 2008a)
a. Morbidity: An estimated 6 million cases are reported
annually; hospital discharges attributed to pneumonia in
2005 were 651,000 males (44.9 per 10,000) and 717,000
females (47.7 per 10,000).
b. Mortality: Approximately 58,000 deaths per year; eighth
leading cause of death in the United States (pneumonia
and influenza combined, with pneumonia the leading
cause); accounts for approximately 10% of all inpatient
deaths.
c. Cost: Estimated annual cost is $8.4 billion for CAP
(Lutfiyya, 2006); in excess of $1 billion per year for HAPs;
up to $20,000 to $29,000 per episode of VAP, with length
of stay increased by as much as 14 days (Niederman, 2001;
Schleder, 2004).

Care Setting
Most clients are treated as outpatients in community settings;
however, persons at higher risk, such as those older
than 65 and persons with other chronic conditions such as
chronic obstructive pulmonary disease (COPD), diabetes,
cancer, and congestive heart failure, are treated in the hospital,
as are those already hospitalized for other reasons and
who have developed nosocomial pneumonia.

Related Concerns
Acquired immunodeficiency syndrome (AIDS)
Chronic obstructive pulmonary disease (COPD) and
asthma
Psychosocial aspects of care
Sepsis/septicemia
Surgical intervention

Nursing Priorities
1. Maintain or 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 or minimized.
3. Disease process, prognosis, and therapeutic regimen
understood.
4. Lifestyle changes identified and initiated to prevent
recurrence.
5. Plan in place to meet needs after discharge.

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