Question

Question: Conduct an academic search of literature and identify current best practice associated with one nursing intervention for a patient with community acquired pneumonia.

Answer 1

Community acquired pneumonia remains a significant cause of morbidity and in-hospital mortality, and readmission rates are rising for older persons (> 65 years). Optimized treatment and nursing care will benefit patients and the health economy. Hence, there is a need to describe gaps between current clinical practice and recommendations in evidence-based guidelines for diagnostic procedures, medical treatment and nursing interventions for older patients with CAP.Initial outpatient therapy should include a macrolide or doxycycline. For outpatients with comorbidities or who have used antibiotics within the previous three months, a respiratory fluoroquinolone (levofloxacin, gemifloxacin, or moxifloxacin), or an oral beta-lactam antibiotic plus a macrolide should be used.

Of all the members of the health care team, nurses therefore play a critically important role in ensuring patient safety by monitoring patients for clinical deterioration, detecting errors and near misses, understanding care processes and weaknesses inherent in some systems.With treatment, most people improve within 2 weeks. Older adults or very sick people may need longer treatment. Those who may be more likely to have complicated pneumonia include.

Diagnosis is suggested by a history of cough, dyspnea, pleuritic pain, or acute functional or cognitive decline, with abnormal vital signs (e.g., fever, tachycardia) and lung examination findings. Diagnosis should be confirmed by chest radiography or ultrasonography.

Nursing Quality Improvement Project Ideas and Guide on Improved Nursing Care

• Improving healthcare-related communication about individual patients during shift changes of nurses or other healthcare professionals.
• Improving nursing teamwork.
• Improving patient safety by improving the nursing workload.

Severe CAP is defined as a pneumonia requiring supportive therapy within a critical care environment, that is associated with a higher mortality rate. Severe CAP is frequently a multisystem disease and patients will often present with multiple organ failure.

Nursing diagnosis common to pneumonia nursing care plans

1. Impaired Gas Exchange
2. Ineffective Breathing Pattern
3. Risk for Infection
4. Acute Pain
5. Activity Intolerance
6. Hyperthermia
7. Risk for Deficient Fluid Volume
8. Risk for Imbalanced Nutrition: Less Than Body Requirements
9. Deficient Knowledge
10. Deficient Fluid Volume

• Ineffective Airway Clearance

Related Factors

The following are the common related factors for the nursing diagnosis Ineffective Airway Clearance related to pneumonia:

• Tracheal bronchial inflammation, edema formation, increased sputum production
• Pleuritic pain
• Decreased energy, fatigue
• Aspiration

Defining Characteristics

Here are the common assessment cues that could serve as defining characteristics or “as evidenced by” for ineffective airway clearance secondary to pneumonia.

• Changes in rate, depth of respirations
• Abnormal breath sounds (rhonchi, bronchial lung sounds, egophony)
• Use of accessory muscles
• Dyspnea, tachypnea
• Cough, effective or ineffective; with/without sputum production
• Cyanosis
• Decreased breath sounds over affected lung areas
• Ineffective cough
• Purulent sputum
• Hypoxemia
• Infiltrates seen on chest x-ray film

Desired Outcomes

Below are the common expected outcomes for ineffective airway clearance secondary to pneumonia:

• Patient will identify/demonstrate behaviors to achieve airway clearance.
• Patient will display/maintain patent airway with breath sounds clearing; absence of dyspnea, cyanosis, as evidenced by keeping a patent airway and effectively clearing secretions.

1. Assess the rate, rhythm, and depth of respiration, chest movement, and use of accessory muscles.
2. Assess cough effectiveness and productivity
3. Auscultate lung fields, noting areas of decreased or absent airflow and adventitious breath sounds: crackles, wheezes.
4. Observe the sputum color, viscosity, and odor. Report changes.
5. Assess the patient’s hydration status
6. Elevate head of bed, change position frequently.
7. Teach and assist patient with proper deep-breathing exercises. Demonstrate proper splinting of chest and effective coughing while in upright position. Encourage him to do so often.
8. Administer medications as indicated:

• mucolytics
• expectorants
• bronchodilators
• analgesics