Pneumonia: Respiratory- Activity-Exercise Pattern

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1. A provider will most likely order a continuous pulse oximeter for a patient with pneumonia, because hypoxemia is a serious complication that needs to be monitored

2. Pathophysiology

2.1. Causes

2.1.1. Viruses Influenza virus Respiratory syncytial virus (RSV)

2.1.2. Bacteria (most common) Streptococcus pneumoniae Haemophilus influenzae Chlamydia pneumoniae Mycoplasma pneumoniae Legionella pneumophila

2.1.3. Fungi (more rare) Coccidioidomycosis Histoplasmosis Blastomycosis

2.2. Progression

2.2.1. Pathogen enters respiratory tract through aspiration Pathogen gets past the body's upper respiratory defense system and into the lungs Macrophages in the alveoli activate B and T immune cells, causing them to release TNF-a and IL-1, which triggers an inflammatory response throughout the lungs and bronchi

2.3. Signs and Symptoms

2.3.1. Fever

2.3.2. Chills

2.3.3. Cough (productive or dry)

2.3.4. Malaise

2.3.5. Pain

2.3.6. Shortness of breath

2.3.7. hemoptysis

2.4. Possible Complications

2.4.1. Bacteremia: bacteria can enter the bloodstream from the areas of infection and possibly cause septic shock if not treated immediately

2.4.2. Hypoxia and hypoxemia: shortness of breath can cause cyanosis and hypoxemia, which leads to a lack of oxygen perfusion to tissues

2.4.3. Pleural effusion: buildup of fluid around the lungs that can become infected and require drainage.

2.4.4. Lung abscess: pus can form a cavity in the lung, which can require surgical or otherwise invasive procedures.

3. Assessment

3.1. Auscultation of the lungs

3.1.1. Listening for adventitious sounds such as crackles that can be signs of fluid in the lungs

3.2. Percussion over lung fields

3.2.1. Areas of consolidation will have a "dull" sound when percussed

3.3. Oxygen saturation

3.3.1. Checking O2 saturation when checking vitals can determine whether a patient is having hypoxia as a result of their pneumonia

3.4. Temperature

3.4.1. In the acute stages of illness, pneumonia can cause fever

3.5. Vital signs

3.5.1. Patients with pneumonia often present with an increased heart rate

4. Diagnostic tests

4.1. Chest X-ray

4.1.1. A chest x-ray is often ordered so the provider can look for signs of consolidation in the lungs and helps the provider locate the infected area.

4.2. White blood cell count

4.2.1. A white blood cell count will likely to be ordered to confirm there is an infection and determine its extent

4.3. Sputum Culture

4.3.1. If a patient is having a productive cough, the provider will order a sputum culture to identify the pathogen causing the infection

4.4. Pulse Oximetry

5. Nursing Diagnosis

5.1. Activity intolerance as evidenced by tachycardia and hypoxemia due to respiratory difficulties.

5.1.1. regularly monitor vital signs and pulse oximetry when patient exerts themselves (standing, walking)

5.1.2. Provide support and supervision during exertion to ensure safety

5.1.3. encourage patient to rest and provide comfort measures such as pillows and distractions to prevent overexertion.

5.2. Impaired gas exchange as evidenced by cyanosis and abnormal breathing pattern due to fluid in the alveoli.

5.2.1. Monitor pulse oximetry frequently

5.2.2. position patient in bed where they are best able to breathe

5.2.3. Provide relaxation tools such as music and calm lighting so that anxiety does not aggravate shortness of breath

5.3. Ineffective airway clearance as evidenced by adventitious breath sounds due to exudate in the alveoli and excessive mucous.

5.3.1. Monitor breath sounds and respirations regularly

5.3.2. Evaluate patient's ability to cough and clear airway independently

5.3.3. Elevate the head of the bed and frequently change positions to allow gravity to keep secretions and mucous out of the airway

5.4. Risk for shock due to infection and hypoxia.

5.4.1. regularly assess vital signs to promote early intervention

5.4.2. encourage proper nutrition and fluid intake to promote immune function

5.4.3. Educate patient about importance of taking the full course of prescribed medication.

6. Works Cited

6.1. Huether, S. E., McCance, K. L., Brashers, V. L., & Rote, N. S. (2017). Understanding Pathophysiology (6th ed.). St. Louis, MO: Elsevier.

6.2. Pneumonia. (2018, March 13). Retrieved December 6, 2018, from Pneumonia - Diagnosis and treatment - Mayo Clinic

6.3. Yoost, B., & Crawford, L. (2016). Fundamentals of Nursing: Active Learning for Collaborative Practice. St. Louis, MO: Elsevier.