Pneumonia is an acute infection of lungs of an infectious-inflammatory nature, in which all the structural elements of the lung tissue are involved. The clinic of pneumonia is characterized by fever, weakness, sweating, chest pain, shortness of breath, and cough with phlegm. The urgency of the issue of the incidence of acute pneumonia, as well as high percentage of complications and lethality persist despite the introduction of new antimicrobial drugs. The problem of providing care is considered one of the most important criteria in the treatment of the inflammatory process. Therefore, pneumonia is an infection of lungs that occurs as a result of the multiplication of pathogens, it has different symptoms in accordance to its type and requires the development of nursing care plan to ensure proper treatment and prevention measures.
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Pathophysiology
From a pathophysiological point of view, pneumonia is the result of the multiplication of pathogens and the response of the host. It should be noted that the reproduction of microorganisms does not always lead to the development of pneumonia. Thus, patients, who are on artificial ventilation, often excrete pathogens in clinically significant concentrations, but pneumonia is absent. Hence, this condition is called colonization. Although the role of colonization of the upper respiratory tract in the development of pneumonia is incomprehensible, the entry of a large number of pathogens or a particularly virulent pathogen against the background of the loss of these protective mechanisms can result in severe infection.
Pneumonia can be caused by various pathogens. The reason for the occurrence of an inflammatory reaction in the respiratory parts of the lungs can be both a decrease in the effectiveness of protective mechanisms of the macroorganism and a massive dose of microorganisms along with their increased virulence (Singh, 2012, p. 7). Pneumonia develops when the virulence pathogen surpasses the immune defense. Thus, this can happen when an imperfect immune response is formed due to concomitant diseases (congestive heart failure, diabetes mellitus, renal failure), anatomical disorders (endobronchial obstruction, bronchiectasis), acute immune dysfunction (sepsis, acute lung damage) (Singh, 2012, p. 7). The massiveness of bacteria that have entered the body (aspiration of the contents of the stomach) is of great importance. Smoking and alcohol abusers are especially vulnerable to contracting pneumonia. Alcohol and nicotine damps impair the bronchial mucosa and suppress the protective agents of the bronchopulmonary system creating a favorable environment for the introduction and reproduction of the infection.
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Sign and Symptoms
The symptoms of pneumonia differ in accordance to its type. Croupous pneumonia is characterized by an acute onset with fever, chills, chest pain, dyspnea, and weakness. With a severe degree of croupous pneumonia, hyperemia of the skin and cyanosis of the nasolabial triangle are determined. Herpetic eruptions are visible on lips, cheeks, chin, and wings of the nose (Mayo Clinic Staff, n.d.). The patient’s condition is serious. Breathing is shallow, rapid, with swelling of the wings of the nose. Crepitation and wet small bubbling rales are auscultatory listening. Pulse is frequent, often arrhythmic. Blood pressure is lowered. Cardiac tone is deaf.
Focal pneumonia is identified by a gradual, barely noticeable onset, more commonly after a previous acute respiratory viral infection or acute tracheobronchitis. Body temperature is febrile with daily fluctuations. Cough is accompanied by the discharge of mucopurulent sputum (Mayo Clinic Staff, n.d.). Sweating, weakness, pain in the chest on inspiration followed by coughing and acrocyanosis are marked. With focal discharge pneumonia, the patient’s condition deteriorates. Moreover, there are pronounced dyspnoea and cyanosis.
The peculiarities of pneumonia are determined by the degree of severity, the properties of the pathogen and the presence of complications. The latter include the development of inflammatory and reactive processes in the bronchopulmonary system and other organs. Complications of pneumonia can be pulmonary and extrapulmonary. Pulmonary complications in pneumonia may encompass obstructive syndrome, abscess, gangrene of the lung, acute respiratory failure, as well as parapneumonic exudative pleurisy (Mayo Clinic Staff, n.d.). Among extrapulmonary complications of pneumonia, there are acute cardiopulmonary insufficiency, endocarditis, myocarditis, meningitis and meningoencephalitis, glomerulonephritis, infectious-toxic shock, anemia, psychosis, etc.
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Treatment
The main thing in the treatment of pneumonia is antibacterial therapy. Prescription antibiotics should be given as early as possible, without waiting for the definition of the pathogen. The choice of an antibiotic is made by a doctor (Mattila et. al., 2014, p. 189). No self-medication is allowed. In case of out-of-hospital pneumonia, penicillins, macrolides, cephalosporins are often prescribed. With regard to the unknown pathogen, combined antibiotic therapy of few drugs is required (Dhar, 2012, p. 27). The course of pneumonia treatment may last from 7-10 to 14 days. Nevertheless, there is the possibility of changing the antibiotic.
Pneumonia is treated with the use of detoxification therapy, immunostimulation, the appointment of antipyretic, expectorant and mucolytic, antihistamines. After the cessation of fever and intoxication, the regime is expanded and prescribed for physiotherapy (electrophoresis with calcium chloride, potassium iodide, hyaluronidase, UHF, massage, inhalation) and exercise therapy to stimulate the resolution of the inflammatory focus (Mayo Clinic Staff, n.d.). Treatment of pneumonia is provided until the patient’s absolute recovery, which is determined by the normalization of the condition and well-being, along with radiologic, physical and laboratory indicators (Mattila et. al., 2014, p. 190). With frequent repeated cases of pneumonia of the same localization, the question of surgical intervention is solved.
The prevention measures of pneumonia development include exercising the body, maintaining immunity, eliminating the hypothermia factor, sanitizing chronic infectious foci of the nasopharynx, fighting dustiness, stopping smoking and alcohol abuse (Dhar, 2012, p. 28). In regards to the weakened recumbent patients in order to prevent pneumonia, it is advisable to perform respiratory and therapeutic exercises, massage, the appointment of antiaggregants (pentoxifylline, heparin) (Mayo Clinic Staff, n.d.). Often, pneumonia develops after a viral infection; therefore, annual vaccination against influenza is also considered a preventive measure.
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Care Plan and Nursing Process
Nursing care for pneumonia involves organizing events and monitoring a person who has experienced an inflammatory process. It consists of several stages in relation to severity of the disease. It is important to provide care for patients, who have fallen ill with croupous pneumonia, because it affects both lungs at once and progresses very quickly. The time of full recovery of the patient and the occurrence of complications depend entirely on the organization of care.
In order to offer quality nursing care, it is essential to have several stages of the procedure. Nursing care plan should include assessing, diagnosing, planning, implementing, and evaluating. The first stage of pre-medical correction of pneumonia is the collection of anamnesis and the analysis of the condition. The first aid for a patient with pneumonia requires creation of comfortable conditions. If necessary, the medical staff provides clean removable underwear and hygienic supplies. Initially, it is significant to pay attention to complaints (fever with chills, wet or dry cough, dyspnea, rusty sputum, chest pain etc.) (Belleza, 2016). In the outpatient card, signs of the inflammatory process can be detected.
The second stage of nursing care is diagnosing. A nurse can draw the doctor’s attention to the fact that diagnosis of the disease has changed. The medical attendant can first notice specific symptoms of one’s pathology. In the presence of a pathological process in the lung, the patient suffers from secondary symptoms such as decreased appetite, headache, dizziness, and increased heart rate. To make a correct diagnosis, a certain level of awareness of the physical, psychological and social activities of a person as well as basic knowledge of nursing are required.
Another stage of nursing care is planning. After the examination, diagnosis and identification of the primary problems of the patient, the nurse establishes the goals of care, the expected results and timeframe, as well as the methods that are necessary to achieve the set objectives. During planning, the aims and the plan of care are formulated for each priority problem. Thus, there are two types of goals, namely short-term and long-term ones. The former must be met in a short time (usually 1-2 weeks). Long-term goals are attained over a longer period of time, and are focused on preventing relapses of diseases, complications, rehabilitation, social adaptation and the acquisition of medical knowledge.
Nursing care process includes implementing of the care plan. Meanwhile, the secondary symptoms may lead to the correction of the plan for nursing intervention. In the presence of the above-described signs, the patient must be admitted to the hospital. Stage hospital care requires nursing intervention and dynamic assessment of the patient’s health status (Belleza, 2016). During the time of the hospital stay, the nurse must monitor the patient’s position in bed, intake of medications and the prescribed procedures. The outpatient care plan should focus on preventing complications of the process. The medical attendant should ensure bed rest until the general condition of the individual is improved. Moreover, the nurse has to organize a dairy and vegetable diet, control the patient’s intake of fluid, diluting and expectorants (Belleza, 2016). Therefore, the nurse provides symptomatic therapy that is recommended by a doctor.
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The final stage of the nursing care is the evaluation of the process effectiveness. Its purpose is to assess the patient’s response to nursing care and the quality of care, compare progress and results with planned care outcomes, evaluate the efficiency of planned nursing intervention, conduct the critical analysis of all stages of the nursing process and making the necessary amendments. The final assessment is also important in order to learn about the impact of different types of nursing intervention on the achievement of specific results and on the application of various stages of the nursing process as well as the use of the chosen model of nursing care.
If pneumonia occurs in a child, nursing care expands to family education. It should include teaching the right breathing. In addition, a medical attendant has to perform practical exercises with parents regarding the technique of vibrating massage (Belleza, 2016). A nurse should describe the home management of the junior after the treatment of pneumonia. Parents are to know how to make mustard wrap and follow the preventive procedures. Hence, a nurse should explain to parents how to properly feed a baby with pneumonia or to hold preventive conversations with adults.
Conclusion
Various pathogens can cause pneumonia that is an infection of lungs, which is characterized by different symptoms according to its type, and requires accurate nursing care plan. Pneumonia is inflammation of the lower respiratory tract of various etiologies accompanied by the intra-alveolar exudation as well as typical clinical and roentgenological features. The symptoms of pneumonia depend on severity of the process, the nature of the pathogen and the general condition of the human body. Treatment includes antibacterial therapy, detoxification therapy, and immunostimulation. Prevention of pneumonia is reached thorough healthy lifestyle and vaccination. Nursing care that encompasses assessing, diagnosing, planning, implementing and evaluating is of particular importance in the process of pneumonia treatment.
