pneumonia

1. Ineffective Airway Clearance

Nursing Diagnosis

Ineffective Airway Clearance

May be related to

Tracheal bronchial inflammation, edema formation, increased sputum production

Pleuritic pain
Decreased energy, fatigue
Possibly evidenced by

Changes in rate, depth of respirations

Abnormal breath sounds, use of accessory muscles
Dyspnea, cyanosis
Cough, effective or ineffective; with/without sputum production
Desired Outcomes

Identify/demonstrate behaviors to achieve airway clearance.

Display patent airway with breath sounds clearing; absence of dyspnea, cyanosis.
Nursing Interventions

Rationale
Tachypnea, shallow respirations, and

Assess the rate and depth of respirations

asymmetric chest movement are frequently

and chest movement.

present because of discomfort of moving

chest wall and/or fluid in lung.
Decreased airflow occurs in areas with

Auscultate lung fields, noting areas of

decreased or absent airflow and
adventitious breath sounds: crackles,
wheezes.

consolidated fluid. Bronchial breath sounds

can also occur in these consolidated areas.
Crackles, rhonchi, and wheezes are heard on
inspiration and/or expiration in response to
fluid accumulation, thick secretions, and
airway spams and obstruction.

Elevate head of bed, change position

Doing so would lower the diaphragm and

frequently.

promote chest expansion, aeration of lung

segments, mobilization and expectoration of

Nursing Interventions

Rationale
secretions.
Deep breathing exercises facilitates

Teach and assist patient with proper deepbreathing exercises. Demonstrate proper
splinting of chest and effective coughing
while in upright position. Encourage him
to do so often.

maximum expansion of the lungs and

smaller airways. Coughing is a reflex and a
natural self-cleaning mechanism that assists
the cilia to maintain patent airways.
Splinting reduces chest discomfort and an
upright position favors deeper and more
forceful cough effort.

Suction as indicated: frequent coughing,

adventitious breath sounds, desaturation
related to airway secretions.

Stimulates cough or mechanically clears

airway in patient who is unable to do so
because of ineffective cough or decreased
level of consciousness.

Force fluids to at least 3000 mL/day

(unless contraindicated, as in heart

Fluids, especially warm liquids, aid in

failure). Offer warm, rather than cold,

mobilization and expectoration of secretions.

fluids.
Nebulizers and other respiratory therapy
Assist and monitor effects of nebulizer

facilitates liquefaction and expectoration of

treatment and other respiratory

secretions. Postural drainage may not be as

physiotherapy: incentive spirometer, IPPB, effective in interstitial pneumonias or those

percussion, postural drainage. Perform

causing alveolar exudate or destruction.

treatments between meals and limit fluids

Coordination of treatments and oral intake

when appropriate.

reduces likelihood of vomiting with

coughing, expectorations.
Aids in reduction of bronchospasm and

Administer medications as indicated:

mucolytics, expectorants, bronchodilators,
analgesics.

mobilization of secretions. Analgesics are

given to improve cough effort by reducing
discomfort, but should be used cautiously
because they can decrease cough
effort and depress respirations.
Room humidification has been found to

Provide supplemental fluids: IV.

provide minimal benefit and is thought to

increase the risk of transmitting infection.

Monitor serial chest x-rays, ABGs, pulse

Followers progress and effects of the disease

oximetry readings.

process, therapeutic regimen, and may

Nursing Interventions

Rationale
facilitate necessary alterations in therapy.

Assist with bronchoscopy and/or

thoracentesis, if indicated.

Urge all bedridden and postoperative

patients to perform deep breathing and
coughing exercises frequently.

Occasionally needed to remove mucous

plugs, drain purulent secretions, and/or
prevent atelectasis.

To promote full aeration and drainage of

secretions.

2. Impaired Gas Exchange

Nursing Diagnosis

Impaired Gas Exchange

May be related to

Alveolar-capillary membrane changes (inflammatory effects)

Altered oxygen-carrying capacity of blood/release at cellular level (fever, shifting oxyhemoglobin
curve)

Altered delivery of oxygen (hypoventilation)

Possibly evidenced by

Dyspnea, cyanosis
Tachycardia
Restlessness/changes in mentation
Hypoxia
Desired Outcomes

Demonstrate improved ventilation and oxygenation of tissues by ABGs within patients acceptable
range and absence of symptoms of respiratory distress.

Participate in actions to maximize oxygenation.

Nursing Interventions

Rationale
Manifestations of respiratory distress are

Assess respiratory rate, depth, and ease.

dependent on/and indicative of the degree

of lung involvement and underlying general
health status.

Observe color of skin, mucous

Cyanosis of nail beds may represent

membranes, and nailbeds, noting

vasoconstriction or the bodys response to

presence of peripheral cyanosis (nail beds) fever/chills; however, cyanosis of earlobes,

Nursing Interventions

Rationale
mucous membranes, and skin around the

or central cyanosis (circumoral).

mouth (warm membranes) is indicative of

systemic hypoxemia.
Restlessness, irritation, confusion, and

Assess mental status.

somnolence may reflect hypoxemia and

decreased cerebral oxygenation.
Tachycardia is usually present as a result of

Monitor heart rate and rhythm.

fever and/or dehydration but may represent

a response to hypoxemia.

Monitor body temperature, as indicated.

Assist with comfort measures to reduce

High fever (common in bacterial pneumonia

fever and chills: addition or removal of

and influenza) greatly increases metabolic

bedcovers, comfortable room

demands and oxygen consumption and

temperature, tepid or cool water sponge

alters cellular oxygenation.

bath.
Maintain bedrest. Encourage use of

Prevents over exhaustion and reduces

relaxation techniques and diversional

oxygen demands to facilitate resolution of

activities.

infection.

Elevate head and encourage frequent

These measures promote maximum chest

position changes, deep breathing, and

expansion, mobilize secretions and improve

effective coughing.

ventilation.
Anxiety is a manifestation of psychological
concerns and physiological responses to

Assess anxiety level and encourage

verbalization of feelings and concerns.

hypoxia. Providing reassurance and

enhancing sense of security can reduce the
psychological component, thereby
decreasing oxygen demand and adverse
physiological responses.

Observe for deterioration in condition,

noting hypotension, copious amounts of
bloody sputum, pallor, cyanosis, change in
LOC, severe dyspnea, and restlessness.

Monitor ABGs, pulse oximetry.

Shock and pulmonary edema are the most

common causes of death in pneumonia and
require immediate medical intervention.

Follows progress of disease process and

facilitates alterations in pulmonary therapy.

Nursing Interventions

Rationale
The purpose of oxygen therapy is to
maintain PaO2 above 60 mmHg. Oxygen is

Administer oxygen therapy by appropriate

administered by the method that provides

means: nasal prongs, mask, Venturi

appropriate delivery within the patients

mask.

tolerance. Note: Patients with underlying

chronic lung diseases should be given
oxygen cautiously.

3. Risk for Deficient Fluid Volume

Nursing Diagnosis

Risk for Deficient Fluid Volume

Risk factors may include

Excessive fluid loss (fever, profuse diaphoresis, mouth breathing/hyperventilation, vomiting)

Decreased oral intake
Desired Outcomes

Demonstrate fluid balance evidenced by individually appropriate parameters, e.g., moist mucous
membranes, good skin turgor, prompt capillary refill, stable vital signs.
Nursing Interventions

Rationale
Elevated temperature and prolonged fever

Assess vital sign changes: increasing

increases metabolic rate and fluid loss

temperature, prolonged fever, orthostatic

through evaporation. Orthostatic BP changes

hypotension, tachycardia.

and increasing tachycardia may indicate

systemic fluid deficit.
Indirect indicators of adequacy of fluid

Assess skin turgor, moisture of mucous

volume, although oral mucous membranes

membranes.

may be dry because of mouth breathing and

supplemental oxygen.

Investigate reports of nausea and

Presence of these symptoms reduces oral

vomiting.

intake.

Monitor intake and output (I&O), noting

color, character of urine. Calculate fluid

Provides information about adequacy of fluid

balance. Be aware of insensible losses.

volume and replacement needs.

Weigh as indicated.

Nursing Interventions

Force fluids to at least 3000 mL/day or as

individually appropriate.

Administer medications as indicated:

antipyretics, antiemetics.

Provide supplemental IV fluids as

necessary.

Rationale
Meets basic fluid needs, reducing risk of
dehydration and to mobilize secretions and
promote expectoration.

To reduce fluid losses.

In presence of reduced intake and/or

excessive loss, use of parenteral route may
correct deficiency.

4. Imbalanced Nutrition
Nursing Diagnosis

Risk for Imbalanced Nutrition Less Than Body Requirements

Risk factors may include

Increased metabolic needs secondary to fever and infectious process

Anorexia associated with bacterial toxins, the odor and taste of sputum, and certain aerosol
treatments

Abdominal distension/gas associated with swallowing air during dyspneic episodes

Desired Outcomes

Demonstrate increased appetite.

Maintain/regain desired body weight.
Nursing Interventions
Identify factors that are contributing to
nausea or vomiting: copious sputum,
aerosol treatments, severe dyspnea, pain.

Rationale

Choice of interventions depends on the

underlying cause of the problem.

Provide covered container for sputum and

remove at frequent intervals. Assist and

Eliminates noxious sights, tastes, smells

encourage oral hygiene after emesis, after from the patient environment and can
aerosol and postural drainage treatments,

reduce nausea.

and before meals.

Schedule respiratory treatments at least 1 Reduces effects of nausea associated with
hr before meals.

these treatments.

Maintain adequate nutrition to offset

To replenish lost nutrients.

Nursing Interventions

Rationale

hypermetabolic state secondary to

infection. Ask the dietary department to
provide a high-calorie, high-protein diet
consisting of soft, easy-to-eat foods.

Consider limiting use of milk products

Milk products may increase sputum

production.
To prevent aspiration. Note: Dont give large

Elevate the patients head and neck, and

volumes at one time; this could cause

check for tubes position during NG tube

vomiting. Keep the patients head elevated

feedings.

for at least 30 minutes after feeding. Check

for residual formula regular intervals.
Bowel sounds may be diminished if the
infectious process is severe. Abdominal

Auscultate for bowel sounds. Observe for

distension may occur as a result of air

abdominal distension.

swallowing or reflect the influence of

bacterial toxins on the gastrointestinal (GI)
tract.

Provide small, frequent meals, including

dry foods (toast, crackers) and/or foods
that are appealing to patient.

These measures may enhance intake even

though appetite may be slow to return.

Presence of chronic conditions (COPD or

Evaluate general nutritional state, obtain
baseline weight.

alcoholism) or financial limitations can

contribute to malnutrition, lowered
resistance to infection, and/or delayed
response to therapy.

5. Acute Pain
Nursing Diagnosis

Acute Pain
May be related to

Inflammation of lung parenchyma

Cellular reactions to circulating toxins
Persistent coughing
Possibly evidenced by

 Reports of pleuritic chest pain, headache, muscle/joint pain

Guarding of affected area
Distraction behaviors, restlessness
Desired Outcomes

Verbalize relief/control of pain.

Demonstrate relaxed manner, resting/sleeping and engaging in activity appropriately.
Nursing Interventions

Assess pain characteristics: sharp,

constant, stabbing. Investigate changes in
character, location, or intensity of pain.

Rationale
Chest pain, usually present to some degree
with pneumonia, may also herald the onset
of complications of pneumonia, such as
pericarditis and endocarditis.
Changes in heart rate or BP may indicate

Monitor vital signs.

that patient is experiencing pain, especially

when other reasons for changes in vital
signs have been ruled out.
Non-analgesic measures administered with a

Provide comfort measures: back rubs,

gentle touch can lessen discomfort and

position changes, quite music, massage.

augment therapeutic effects of analgesics.

Encourage use of relaxation and/or

Patient involvement in pain control

breathing exercises.

measures promotes independence and

enhances sense of well-being.
Mouth breathing and oxygen therapy can

Offer frequent oral hygiene.

irritate and dry out mucous membranes,

potentiating general discomfort.

Instruct and assist patient in chest

splinting techniques during coughing
episodes.

Administer analgesics and antitussives as

indicated.

6. Activity Intolerance
Nursing Diagnosis

Activity intolerance
May be related to

Aids in control of chest discomfort while

enhancing effectiveness of cough effort.

These medications may be used to suppress

non productive cough or reduce excess
mucus, thereby enhancing general comfort.

 Imbalance between oxygen supply and demand

General weakness
Exhaustion associated with interruption in usual sleep pattern because of discomfort, excessive
coughing, and dyspnea
Possibly evidenced by

Verbal reports of weakness, fatigue, exhaustion

Exertional dyspnea, tachypnea
Tachycardia in response to activity
Development/worsening of pallor/cyanosis
Desired Outcomes

Report/demonstrate a measurable increase in tolerance to activity with absence of dyspnea and

excessive fatigue, and vital signs within patients acceptable range.
Nursing Interventions

Rationale

Determine patients response to activity.

Note reports of dyspnea, increased

Establishes patients capabilities and needs

weakness and fatigue, changes in vital

and facilitates choice of interventions.

signs during and after activities.

Provide a quiet environment and limit
visitors during acute phase as indicated.

Reduces stress and excess stimulation,

Encourage use of stress management and

promoting rest

diversional activities as appropriate.

Bedrest is maintained during acute phase to
Explain importance of rest in treatment
plan and necessity for balancing activities
with rest.

decrease metabolic demands, thus

conserving energy for healing. Activity
restrictions thereafter are determined by
individual patient response to activity and
resolution of respiratory insufficiency.
Patient may be comfortable with head of bed

Assist patient to assume comfortable

elevated, sleeping in a chair, or leaning

position for rest and sleep.

forward on overbed table with pillow

support.

Assist with self-care activities as

necessary. Provide for progressive

Minimizes exhaustion and helps balance

increase in activities during recovery

oxygen supply and demand.

phase. and demand.

7. Risk for Infection

Nursing Diagnosis

Risk for [Spread] of Infection

Risk factors may include

Inadequate primary defenses (decreased ciliary action, stasis of respiratory secretions)

Inadequate secondary defenses (presence of existing infection, immunosuppression), chronic
disease, malnutrition
Desired Outcomes

Achieve timely resolution of current infection without complications.

Identify interventions to prevent/reduce risk/spread of/secondary infection.
Nursing Interventions

Monitor vital signs closely, especially

during initiation of therapy.

Rationale
During this period of time, potentially fatal
complications (hypotension, shock) may
develop.
Although patient may find expectoration

Instruct patient concerning the disposition

offensive and attempt to limit or avoid it, it

of secretions: raising and expectorating

is essential that sputum be disposed of in a

versus swallowing; and reporting changes

safe manner. Changes in characteristics of

in color, amount, odor of secretions.

sputum reflect resolution of pneumonia or

development of secondary infection.

Demonstrate and encourage good

Effective means of reducing spread or

handwashing technique.

acquisition of infection.

Change position frequently and provide

Promotes expectoration, clearing of

good pulmonary toilet.

infection.

Limit visitors as indicated.

Reduces likelihood of exposure to other

infectious pathogens.
Dependent on type of infection, response to

Institute isolation precautions as

individually appropriate.

antibiotics, patients general health, and

development of complications, isolation
techniques may be desired to prevent
spread from other infectious processes.

Nursing Interventions
Encourage adequate rest balanced with
moderate activity. Promote adequate
nutritional intake.

Rationale

Facilitates healing process and enhances

natural resistance.

Monitor effectiveness of antimicrobial

Signs of improvement in condition should

therapy.

occur within 2448 hr. Note any changes.

Investigate sudden change in condition,

such as increasing chest pain, extra heart
sounds, altered sensorium, recurring
fever, changes in sputum characteristics.

Delayed recovery or increase in severity of

symptoms suggests resistance to antibiotics
or secondary infection.

Fiberoptic bronchoscopy (FOB) may be done

Prepare and assist with diagnostic studies

in patients who do not respond rapidly

as indicated.

(within 13 days) to antimicrobial therapy to

clarify diagnosis and therapy needs.

8. Deficient Knowledge
Nursing Diagnosis

Deficient Knowledge regarding condition, treatment, self-care, and discharge needs

May be related to

Lack of exposure
Misinterpretation of information
Altered recall
Possibly evidenced by

Requests for information; statement of misconception

Failure to improve/recurrence
Desired Outcomes

Verbalize understanding of condition, disease process, and prognosis.

Verbalize understanding of therapeutic regimen.
Initiate necessary lifestyle changes.
Participate in treatment program.
Nursing Interventions

Rationale

Review normal lung function, pathology of

Promotes understanding of current situation

condition.

and importance of cooperating with

Nursing Interventions

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treatment regimen.
Information can enhance coping and help
reduce anxiety and excessive concern.

Discuss debilitating aspects of disease,

Respiratory symptoms may be slow to

length of convalescence, and recovery

resolve, and fatigue and weakness can

expectations. Identify self-care and

persist for an extended period. These factors

homemaker needs.

may be associated with depression and the

need for various forms of support and
assistance.

Provide information in written and verbal

form.

Fatigue and depression can affect ability to

assimilate information and follow therapeutic
regimen.

Reinforce importance of continuing

During initial 68 wk after discharge, patient

effective coughing and deep-breathing

is at greatest risk for recurrence of

exercises.

pneumonia.
Early discontinuation of antibiotics may

Emphasize necessity for continuing

result in failure to completely resolve

antibiotic therapy for prescribed period.

infectious process and may cause recurrence

or rebound pneumonia.
Smoking destroys tracheobronchial ciliary

Review importance of cessation of

smoking.

action, irritates bronchial mucosa, and

inhibits alveolar macrophages,
compromising bodys natural defense
against infection.

Outline steps to enhance general health

and well-being: balanced rest and activity,
well-rounded diet, avoidance of crowds
during cold/flu season and persons with

Increases natural defense, limits exposure

to pathogens.

URIs.
Stress importance of continuing medical
follow-up and obtaining vaccinations as
appropriate.

May prevent recurrence of pneumonia

and/or related complications.

Identify signs and symptoms requiring

Prompt evaluation and timely intervention

notification of health care

may prevent complications.

provider: increasing dyspnea, chest pain,

Nursing Interventions

Rationale

prolonged fatigue, weight loss, fever,

chills, persistence of productive cough,
changes in mentation.
This may results in upper airway
Instruct patient to avoid using antibiotics
indiscriminately during minor viral
infections.

colonization with antibiotic resistant

bacteria. If the patient then develops
pneumonia, the organisms producing the
pneumonia may require treatment with
more toxic antibiotics.

Encourage pneumovax and annual flu

shots for high-risk patients.

To help prevent occurrence of the disease.

Other Possible Nursing Care Plans

Impaired dentitionmay be related to dietary habits, poor oral hygiene, chronic vomiting, possibly
evidenced by erosion of tooth enamel, multiple caries, abraded teeth.

Impaired oral mucous membranemay be related to malnutrition or vitamin deficiency, poor oral
hygiene, chronic vomiting, possibly evidenced by sore, inflamed buccal mucosa, swollen salivary
glands, ulcerations, and reports of sore mouth and/or throat.

Predisposing and Precipitating Factors

Modifiable and Non-modifiable Factors

Poor Diet is a modifiable factor in which this is crucial in the strengthening of the immune system of the
client. Without the sufficient intake of vitamins and minerals that are present in the diet, the defense
mechanism of the body is weakened; making it susceptible to infection and invasion of possible
microorganisms that are present in the environment. This can be attributed to the possibility that these
microorganisms are dwelling in the environment itself.
Place of residence is underdeveloped is another modifiable factor since crowdedness of the people living in
a particular geographical area would facilitate direct contact mode of transmission of possible
microorganisms or through droplet infection, as well. This will make the client susceptible for acquiring a
disease from someone proximal to him; therefore, a disease may or may not develop depending on the
distance of the client from an infected person and the virulence of the disease.
Age is a non-modifiable factor in which the clients immunity against possible diseases is not that developed
in comparison to adults.
Sex is a non-modifiable factor in which the occurrence of the said disease in prevalent in males more it is in
females.

Signs and Symptoms

Cough an important way to keep your throat and airways clear. However, excessive coughing may mean you
have an underlying disease or disorder. Some coughs are dry, while others are considered productive; a
reflex which is said to be a natural defense mechanism because of its action of expulsing bacteria out of the
tracheobronchial tree.
Dyspnea is the difficult or labored breathing; shortness of breath. It is a sign of serious disease of the
airway, lungs, or heart.
Chills refer to feeling cold after an exposure to a cold environment. The word can also refer to an episode of
shivering, accompanied by paleness and feeling cold
Fever isnt an illness itself, but its usually a sign that something out of the ordinary is going on in your
body. Fevers arent necessarily bad. In fact, fevers seem to play a key role in helping your body fight off a
number of infections.
Vomiting is seldom related to food intake, is usually the result of irritation of the vagal centers in the
medulla
Chest pain or angina, uncomfortable pressure, squeezing or fullness in substernum, radiation to arms and
hands is described as numbness, tingling, or aching
Cyanosis refers to a blue or purple hue to the skin. It is most easily observed on the lips, tongue and
fingernails. Cyanosis indicates there may be decreased oxygen in the bloodstream. It may suggest a
problem with the lungs, but most often is a result of mixing blue and red blood due to defects of the heart or

great vessels. Cyanosis is a finding based on observation, not a laboratory test. Cyanosis is usually caused
by either serious lung or heart disease, or circulation problems.
Loss of Appetite is a result of decrease in the brain impulses that stimulates the function of the taste buds.
It is because of the vascular changes in the cephalic area. Since the alveoli where filled with fluids and
exudates, gas exchange was not accomplished well; so what happened was, there was diminished Oxygen in
the body, as it was manifested by the presence of cyanosis. Hypoxemia had erupted resulting to low oxygen
in the brain and muscles which eventually lead to the vascular changes.
Abdominal pain: the patient experiences pain on his/hers stomach
Decreased activity: decrease in activity patter
Loss of appetite (in older children) or poor feeding (in infants)
In extreme cases, bluish or gray color of the lips and fingernails
Headache is the outcome when there is low oxygen in the brain. There are vascular changes in the cephalic
area.
Body Malaise had resulted out of low oxygen content in the muscles. Since the cells in the body require
sufficient amount in oxygen, it cannot work properly if its level is decrease resulting to malaise.

Preventive Measures
Get vaccinated. A vaccine known as pneumococcal conjugate vaccine can help protect young children
against pneumonia. Its recommended for all children younger than age 2 and for children 2 years and older
who are at particular risk of pneumococcal disease, such as those with an immune system deficiency, cancer,
cardiovascular disease or sickle cell anemia. Side effects of the pneumococcal vaccine are generally minor
and include mild soreness or swelling at the injection site.
Wash hands. Hands are in almost constant contact with germs that can cause pneumonia. These germs
enter your body when you touch your eyes or rub the inside of your nose. Washing your hands thoroughly
and often can help reduce your risk. When washing isnt possible, use an alcohol-based hand sanitizer, which
can be more effective than soap and water in destroying the bacteria and viruses that cause disease. Whats
more, most hand sanitizers contain ingredients that keep your skin moist. Carry one in your purse or in your
pocket.
Dont smoke. Smoking damages your lungs natural defenses against respiratory infections.
Proper rest and a diet. Foods rich in fruits, vegetables and whole grains along with moderate exercise can
help keep the immune system strong.

Protect others from infection. Try to stay away from anyone with a compromised immune system. When that
isnt possible, help protect others by wearing a face mask and always coughing into a tissue.

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus
(purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of
organisms, including bacteria, viruses and fungi, can cause pneumonia.
Pneumonia can range in seriousness from mild to life-threatening It is most serious for infants and young
children, people older than age 65, and people with health problems or weakened immune systems.

Causes
Many germs can cause pneumonia. The most common are bacteria and viruses in the air we breathe. Your
body usually prevents these germs from infecting your lungs. But sometimes these germs can overpower your
immune system, even if your health is generally good.
Pneumonia is classified according to the types of germs that cause it and where you got the infection.

Community-acquired pneumonia
Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other
health care facilities. It may be caused by:

Bacteria. The most common cause of bacterial pneumonia in the U.S. is Streptococcus pneumoniae.
This type of pneumonia can occur on its own or after you've had a cold or the flu. It may affect one part
(lobe) of the lung, a condition called lobar pneumonia.
Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia. It typically produces
milder symptoms than do other types of pneumonia. Walking pneumonia, a term used to describe
pneumonia that isn't severe enough to require bed rest, may be caused by M. pneumoniae.

Viruses. Some of the viruses that cause colds and the flu can cause pneumonia. Viruses are the most
common cause of pneumonia in children younger than 5 years. Viral pneumonia is usually mild. But in some
cases it can become very serious.

Fungi. This type of pneumonia is most common in people with chronic health problems or weakened
immune systems, and in people who have inhaled large doses of the organisms. The fungi that cause it can
be found in soil or bird droppings.

Hospital-acquired pneumonia
Some people catch pneumonia during a hospital stay for another illness. This type of pneumonia can be
serious because the bacteria causing it may be more resistant to antibiotics. People who are on breathing
machines (ventilators), often used in intensive care units, are at higher risk of this type of pneumonia.

Health care-acquired pneumonia

Health care-acquired pneumonia is a bacterial infection that occurs in people who are living in long-term care
facilities or have been treated in outpatient clinics, including kidney dialysis centers. Like hospital-acquired
pneumonia, health care-acquired pneumonia can be caused by bacteria that are more resistant to antibiotics.

Aspiration pneumonia
Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs. Aspiration is more
likely if something disturbs your normal gag reflex, such as a brain injury or swallowing problem, or excessive
use of alcohol or drugs.

Symptoms
The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of
germ causing the infection, and your age and overall health. Mild signs and symptoms often are similar to those
of a cold or flu, but they last longer.
Signs and symptoms of pneumonia may include:

Fever, sweating and shaking chills

Cough, which may produce phlegm

Chest pain when you breathe or cough

Shortness of breath

Fatigue

Nausea, vomiting or diarrhea

Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and cough,
appear restless or tired and without energy, or have difficulty breathing and eating.
People older than age 65 and people in poor health or with a weakened immune system may have a lower than
normal body temperature. Older people who have pneumonia sometimes have sudden changes in mental
awareness.

When to see a doctor

See your doctor if you have difficulty breathing, chest pain, persistent fever of 102 F (39 C) or higher, or
persistent cough, especially if you're coughing up pus.
It's especially important that people in these high-risk groups see a doctor:

Children younger than age 2 with signs and symptoms

Adults older than age 65

People with an underlying health condition or weakened immune system

People receiving chemotherapy or taking medication that suppresses the immune system

For some older adults and people with heart failure or chronic lung problems, pneumonia can quickly become a
life-threatening condition.

Risk factors
Pneumonia can affect anyone. But the two age groups at highest risk are:

Children who are 2 years old or younger developing

People who are age 65 or older

Other risk factors include:

Chronic disease. You're more likely to get pneumonia if you have asthma, chronic obstructive
pulmonary disease or heart disease.
Weakened or suppressed immune system. People who have HIV/AIDS, who've had an organ
transplant, or who receive chemotherapy or long-term steroids are at risk.

Smoking. Smoking damages your body's natural defenses against the bacteria and viruses that cause
pneumonia.

Being hospitalized. You're at greater risk of pneumonia if you're in a hospital intensive care unit,
especially if you're on a machine that helps you breathe (a ventilator).

Complications
Pneumonia can be treated successfully with medication.However, some people, especially those in high-risk
groups, may experience complications, including:

Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can
spread the infection to other organs, potentially causing organ failure.
Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated
with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed into the abscess is
needed to remove the pus.

Fluid accumulation around your lungs (pleural effusion).Pneumonia may cause fluid to build up in
the thin space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes
infected, you may need to have it drained through a chest tube or removed with surgery.

Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you
may have trouble breathing in enough oxygen. You may need to be hospitalized and use a breathing
machine (ventilator) while your lung heals.

Tests and diagnosis

Your doctor will start by asking about your medical history and doing a physical exam, including listening to your
lungs with a stethoscope to check for abnormal bubbling or crackling sounds that indicate the presence of
secretions.
If pneumonia is suspected, your doctor may recommend the following tests:

Chest X-ray. This helps your doctor diagnose pneumonia and determine the extent and location of the
infection. However, it can't tell your doctor what kind of germ is causing the pneumonia.
Blood tests. Blood tests are used to confirm infection and to try to identify the type of organism
causing the infection. However, precise identification isn't always possible.

Pulse oximetry. This measures the oxygen level in your blood. Pneumonia can prevent your lungs
from moving enough oxygen into your bloodstream.

Sputum test. A sample of fluid from yourlungs (sputum) is taken after a deep cough and analyzed to
help pinpoint the cause of the infection.

Your doctor might order additional tests if you're older than age 65, are in the hospital, or have serious
symptoms or health conditions. These may include:

Pleural fluid culture. A fluid sample is taken by putting a needle between your ribs from the pleural
area and analyzed to help determine the type of infection.
CT scan. If your pneumonia isn't clearing as quickly as expected, your doctor may recommend a chest
CT scan to obtain a more detailed image of your lungs.

Treatments and drugs

Treatment for pneumonia involves curing the infection and preventing complications. People who have
community-acquired pneumonia usually can be treated at home with medication. Although most symptoms
ease in a few days or weeks, the feeling of tiredness can persist for a month or more.
Specific treatments depend on the type and severity of your pneumonia, your age and your overall health. The
options include:

Antibiotics. These medicines are used to treat bacterial pneumonia. It may take time to identify the
type of bacteria causing your pneumonia and to choose the best antibiotic to treat it. If your symptoms don't
improve, your doctor may recommend a different antibiotic.
Fever reducers. These include drugs such as aspirin, ibuprofen (Advil, Motrin IB, others) and
acetaminophen (Tylenol, others).
Cough medicine. This medicine may be used to calm your cough so that you can rest. Because
coughing helps loosen and move fluid from your lungs, it's a good idea not to eliminate your cough
completely.

Hospitalization
You may need to be hospitalized if:

You are older than age 65

You become confused about time, people or places

Your nausea and vomiting prevent you from keeping down oral antibiotics

Your blood pressure drops

Your breathing is rapid

You need breathing assistance

Your temperature is below normal

Your heart rate is below 50 or higher than 100

You may be admitted to the intensive care unit if you need to be placed on a breathing machine (ventilator) or if
your symptoms are severe.
Children may be hospitalized if they:

Are younger than age 2 months

Are excessively sleepy

Have trouble breathing

Have low blood oxygen levels

Appear dehydrated

Have a lower than normal temperature

Lifestyle and home remedies

These tips can help you recover more quickly and decrease your risk of complications:

Get plenty of rest. Don't go back to school or work until after your temperature returns to normal and
you stop coughing up mucus. Even when you start to feel better, be careful not to overdo it. Because
pneumonia can recur, it's better not to jump back into your routine until you are fully recovered. Ask your
doctor if you're not sure.
Stay hydrated. Drink plenty of fluids, especially water, to help loosen mucus in your lungs.
Take your medicine as prescribed. Take the entire course of any medications your doctor prescribed
for you. If you stop medication too soon, your lungs may continue to harbor bacteria that can multiply and
cause your pneumonia to recur.

Prevention
To help prevent pneumonia:

Get vaccinated. Vaccines are available to prevent some types of pneumonia and the flu. Talk with
your doctor about getting these shots.
Make sure children get vaccinated. Doctors recommend a different pneumonia vaccine for children
younger than age 2 and for children ages 2 to 5 years who are at particular risk of pneumococcal disease.
Children who attend a group child care center should also get the vaccine. Doctors also recommend flu
shots for children older than 6 months.

Practice good hygiene. To protect yourself against respiratory infections that sometimes lead to
pneumonia, wash your hands regularly or use an alcohol-based hand sanitizer.

Don't smoke. Smoking damages your lungs' natural defenses against respiratory infections.

Keep your immune system strong. Get enough sleep, exercise regularly and eat a healthy diet.

Cancer of the larynx

Symptoms
Signs and symptoms of throat cancer may include:

A cough
Changes in your voice, such as hoarseness

Difficulty swallowing

Ear pain

A lump or sore that doesn't heal

A sore throat

Weight loss

Causes
By Mayo Clinic Staff

Throat cancer occurs when cells in your throat develop genetic mutations. These mutations cause cells to grow
uncontrollably and continue living after healthy cells would normally die. The accumulating cells can form a
tumor in your throat.
It's not clear what causes the mutation that causes throat cancer. But doctors have identified factors that may
increase your risk.

Types of throat cancer

Throat cancer is a general term that applies to cancer that develops in the throat (pharyngeal cancer) or in the
voice box (laryngeal cancer). The throat and the voice box are closely connected, with the voice box located
just below the throat.
Though most throat cancers involve the same types of cells, specific terms are used to differentiate the part of
the throat where cancer originated.

Nasopharyngeal cancer begins in the nasopharynx the part of your throat just behind your nose.
Oropharyngeal cancer begins in the oropharynx the part of your throat right behind your mouth
that includes your tonsils.

Hypopharyngeal cancer (laryngopharyngeal cancer)begins in the hypopharynx (laryngopharynx)

the lower part of your throat, just above your esophagus and windpipe.

Glottic cancer begins in the vocal cords.

Supraglottic cancer begins in the upper portion of the larynx and includes cancer that affects the
epiglottis, which is a piece of cartilage that blocks food from going into your windpipe.
Subglottic cancer begins in the lower portion of your voice box, below your vocal cords.

Risk factors
By Mayo Clinic Staff

Factors that can increase your risk of throat cancer include:

Tobacco use, including smoking and chewing tobacco

Excessive alcohol use

A virus called human papillomavirus (HPV)

A diet lacking in fruits and vegetables

Tests and diagnosis

In order to diagnose throat cancer, your doctor may recommend:

Using a scope to get a closer look at your throat.Your doctor may use a special lighted scope
(endoscope) to get a close look at your throat during a procedure called endoscopy. A tiny camera at the
end of the endoscope transmits images to a video screen that your doctor watches for signs of
abnormalities in your throat. Another type of scope (laryngoscope) can be inserted in your voice box. It uses
a magnifying lens to help your doctor examine your vocal cords. This procedure is called laryngoscopy.
Removing a tissue sample for testing. If abnormalities are found during endoscopy or laryngoscopy,
your doctor can pass surgical instruments through the scope to collect a tissue sample (biopsy). The
sample is sent to a laboratory for testing.
Imaging tests. Imaging tests, including X-ray, computerized tomography (CT), magnetic resonance
imaging (MRI) and positron emission tomography (PET), may help your doctor determine the extent of your
cancer beyond the surface of your throat or voice box.

Staging
Once throat cancer is diagnosed, the next step is to determine the extent, or stage, of the cancer. Knowing the
stage helps determine your treatment options.
The stage of throat cancer is characterized with the Roman numerals I through IV. Each subtype of throat
cancer has its own criteria for each stage. In general, stage I throat cancer indicates a smaller tumor confined
to one area of the throat. Later stages indicate more advanced cancer, with stage IV being the most advanced.

Treatments and drugs

By Mayo Clinic Staff

Your treatment options are based on many factors, such as the location and stage of your throat cancer, the
type of cells involved, your overall health, and your personal preferences. Discuss the benefits and risks of each
of your options with your doctor. Together you can determine what treatments will be most appropriate for you.

Radiation therapy
Radiation therapy uses high-energy beams, such as X-rays, to deliver radiation to the cancer cells, causing
them to die. Radiation therapy can come from a large machine outside your body (external beam radiation). Or

radiation therapy can come from small radioactive seeds and wires that can be placed inside your body, near
your cancer (brachytherapy).
For early-stage throat cancers, radiation therapy may be the only treatment necessary. For more advanced
throat cancers, radiation therapy may be combined with chemotherapy or surgery. In very advanced throat
cancers, radiation therapy may be used to reduce signs and symptoms and make you more comfortable.

Surgery
The types of surgical procedures you may consider to treat your throat cancer depend on the location and
stage of your cancer. Options may include:

Surgery for early-stage throat cancer. Throat cancer that is confined to the surface of the throat or
the vocal cords may be treated surgically using endoscopy. Your doctor may insert a hollow endoscope into
your throat or voice box and then pass special surgical tools or a laser through the scope. Using these tools,
your doctor can scrape off, cut out or, in the case of the laser, vaporize very superficial cancers.
Surgery to remove all or part of the voice box (laryngectomy). For smaller tumors, your doctor
may remove the part of your voice box that is affected by cancer, leaving as much of the voice box as
possible. Your doctor may be able to preserve your ability to speak and breathe normally. For larger, moreextensive tumors, it may be necessary to remove your entire voice box. Your windpipe is then attached to a
hole (stoma) in your throat to allow you to breathe (tracheotomy). If your entire larynx is removed, you have
several options for restoring your speech. You can work with a speech pathologist to learn to speak without
your voice box.

Surgery to remove all or part of the throat (pharyngectomy). Smaller throat cancers may require
removing only part of your throat during surgery. Parts that are removed may be reconstructed in order to
allow you to swallow food normally. Surgery to remove your entire throat usually includes removal of your
voice box as well. Your doctor may be able to reconstruct your throat to allow you to swallow food.

Surgery to remove cancerous lymph nodes (neck dissection). If throat cancer has spread deep
within your neck, your doctor may recommend surgery to remove some or all of the lymph nodes to see if
they contain cancer cells.

Surgery carries a risk of bleeding and infection. Other possible complications, such as difficulty speaking or
swallowing, will depend on the specific procedure you undergo.

Chemotherapy
Chemotherapy uses chemicals to kill cancer cells. Chemotherapy is often used along with radiation therapy in
treating throat cancers. Certain chemotherapy drugs make cancer cells more sensitive to radiation therapy. But
combining chemotherapy and radiation therapy increases the side effects of both treatments. Discuss with your
doctor the side effects you're likely to experience and whether combined treatments will offer benefits that
outweigh those effects.

Targeted drug therapy

Targeted drugs treat throat cancer by taking advantage of specific defects in cancer cells that fuel the cells'
growth. Cetuximab (Erbitux) is one targeted therapy approved for treating throat cancer in certain situations.
Cetuximab stops the action of a protein that's found in many types of healthy cells, but is more prevalent in
certain types of throat cancer cells.

Other targeted drugs are being studied in clinical trials. Targeted drugs can be used in combination with
chemotherapy or radiation therapy.

Rehabilitation after treatment

Treatment for throat cancer often causes complications that may require working with specialists to regain the
ability to swallow, eat solid foods and talk. During and after throat cancer treatment, your doctor may have you
seek help for:

The care of a surgical opening in your throat (stoma) if you had a tracheotomy
Eating difficulties

Swallowing difficulties

Stiffness and pain in your neck

Speech problems

Your doctor can discuss the potential side effects and complications of your treatments with you.

Lifestyle and home remedies

Quit smoking
Throat cancers are closely linked to smoking. Not everyone with throat cancer smokes. But if you do smoke,
now is the time to stop because:

Smoking makes treatment less effective.

Smoking makes it harder for your body to heal after surgery.

Smoking increases your risk of getting another cancer in the future.

Stopping smoking can be very difficult. And it's that much harder when you're trying to cope with a stressful
situation, such as a cancer diagnosis. Your doctor can discuss all of your options, including medications,
nicotine replacement products and counseling.

Quit drinking alcohol

Alcohol, particularly when combined with smoking or chewing tobacco, greatly increases the risk of throat
cancer. If you drink alcohol, stop now. This may help reduce your risk of a second cancer. Stopping drinking
may also help you better tolerate your throat cancer treatments.

Alternative medicine
By Mayo Clinic Staff

No alternative treatments have proved helpful in treating throat cancer. However, some complementary and
alternative treatments may help you cope with your diagnosis and with the side effects of throat cancer
treatment. Talk to your doctor about your options.

Alternative treatments you may find helpful include:

Acupuncture
Massage therapy

Meditation

Relaxation techniques

Coping and support

By Mayo Clinic Staff

Being diagnosed with cancer can be devastating. Throat cancer affects a part of your body that is vital to
everyday activities, such as breathing, eating and talking. In addition to worrying about how these basic
activities may be affected, you may also be concerned about your treatments and chances for survival.
Though you may feel like your life your survival is out of your hands, you can take steps to feel more in
control and to cope with your throat cancer diagnosis. To cope, try to:

Learn enough about throat cancer to make treatment decisions. Write down a list of questions to
ask your doctor at your next appointment. Ask your doctor about further sources of information about your
cancer. Knowing more about your specific condition may help you feel more comfortable when making
treatment decisions.
Find someone to talk with. Seek out sources of support that can help you deal with the emotions
you're feeling. You may have a close friend or family member who is a good listener. Clergy members and
counselors are other options. Consider joining a support group for people with cancer. Contact your local
chapter of the American Cancer Society (ACS) or Support for People with Oral and Head and Neck Cancer.
The ACS's Cancer Survivors Network offers online message boards and chat rooms that you can use to
connect with others with throat cancer.

Take care of yourself during cancer treatment. Make keeping your body healthy during treatment a
priority. Avoid extra stress. Get enough sleep each night so that you wake feeling rested. Take a walk or find
time to exercise when you feel up to it. Make time for relaxing, such as listening to music or reading a book.

Go to all of your follow-up appointments. Your doctor will schedule follow-up exams every few
months during the first two years after treatment, and then less frequently after that. These exams allow
your doctor to monitor your recovery and check for a cancer recurrence. Follow-up exams can make you
nervous, since they may remind you of your initial diagnosis and treatment. You may fear that your cancer
has come back. Expect some anxiety around the time of each follow-up appointment. Plan ahead by finding
relaxing activities that can help redirect your mind away from your fears.

Prevention
There's no proven way to prevent throat cancer from occurring. But in order to reduce your risk of throat cancer,
you can:

Stop smoking or don't start smoking. If you smoke, quit. If you don't smoke, don't start. Stopping
smoking can be very difficult, so get some help. Your doctor can discuss the benefits and risks of the many
stop-smoking strategies, such as medication, nicotine replacement products and counseling.
Drink alcohol only in moderation, if at all. For women, this means one drink a day. For men,
moderate drinking means no more than two drinks a day.

Choose a healthy diet full of fruits and vegetables. The vitamins and antioxidants in fruits and
vegetables may reduce your risk of throat cancer. Eat a variety of colorful fruits and vegetables.

Protect yourself from HPV. Some throat cancers are thought to be caused by the sexually
transmitted infection human papillomavirus HPV. You can reduce your risk of HPV by limiting your number
of sexual partners and using a condom every time you have sex. Also consider the HPV vaccine, which is
available to boys, girls, and young women and men.

What are the risk factors for laryngeal and hypopharyngeal cancers?
A risk factor is anything that affects your chance of getting a disease like cancer. Different cancers have different risk factors. Some
risk factors, like smoking, can be changed. Others, like a persons age or family history, cant be changed.
But risk factors dont tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get the disease.
And many people who get the disease may have few or no known risk factors.
Laryngeal and hypopharyngeal cancers are often grouped with other cancers of the mouth and throat (known as head and neck
cancers). These cancers often have many of the same risk factors, some of which are included below.

Tobacco and alcohol use

Tobacco use is the most important risk factor for head and neck cancers (including cancers of the larynx and hypopharynx). The risk
for these cancers is much higher in smokers than in nonsmokers. Most people with these cancers have a history of smoking or other
tobacco exposure. The more you smoke, the greater the risk. Smoke from cigarettes, pipes, and cigars all increase your chance of
getting these cancers.
Some studies have also found that long-term exposure to secondhand smoke might increase the risk of these cancers, but more
research is needed to confirm this.
Moderate or heavy alcohol use (more than 1 drink a day) also increases the risk of these cancers, although not as much as
smoking.
People who use both tobacco and alcohol have the highest risk of all. Combining these 2 habits doesnt just add both risks together,
it actually multiplies them. People who smoke and drink are many times more likely to get head and neck cancer than are people
with neither habit.
If are thinking about quitting smoking and need help, call the American Cancer Society at 1-800-227-2345. A tobacco cessation and
coaching service can help increase your chances of quitting for good. More information is also available in the Stay Away from
Tobacco section of our website.

Poor nutrition
Poor nutrition may increase the risk of getting head and neck cancer. The exact reason for this is not known. Heavy drinkers often
have vitamin deficiencies, which may help explain the role of alcohol in increasing risk of these cancers.

Human papilloma virus infection

Human papilloma virus (HPV) is a group of over 150 related viruses. They are called papilloma viruses because some of them
cause a type of growth called a papilloma, more commonly known as a wart.

Infection with certain types of HPV can also cause some forms of cancer, including cancers of the penis, cervix, vulva, vagina, anus,
and throat. Other types of HPV cause warts in different parts of the body.
HPV can be passed from one person to another during skin-to-skin contact. One way HPV is spread is through sex, including
vaginal and anal intercourse and even oral sex.
HPV types are given numbers. The type linked to throat cancer (including cancer of the hypopharynx) is HPV16.
Most people with HPV infections of the mouth and throat have no symptoms, and only a very small percentage develop throat
cancer. HPV infection of the mouth and throat is more common in men than in women. The risk of this infection is linked to certain
sexual behaviors, such as open mouth kissing and (in some studies) oral-genital contact (oral sex). The risk also increases with the
number of sexual partners a person has and with. Smoking also increases the risk of oral HPV infection. At this time, there is no test
for HPV infection of the mouth and throat that is approved by the US Food and Drug Administration.
HPV infection of the throat seems to be a factor in some throat cancers, such as some cancers of the tonsils and some cancers of
the hypopharynx. HPV infection is very rarely a factor in laryngeal cancer.
Get more information in our document HPV and HPV Testing.

Genetic syndromes
People with syndromes caused by inherited defects (mutations) in certain genes have a very high risk of throat cancer, including
cancer of the hypopharynx.
Fanconi anemia: This condition can be caused by inherited defects in several genes. People with this syndrome often have blood
problems at an early age, which may lead to leukemia or aplastic anemia. They also have a very high risk of cancer of the mouth
and throat.
Dyskeratosis congenita: This genetic syndrome can cause aplastic anemia, skin rashes, and abnormal fingernails and toenails.
People with this syndrome have a very high risk of developing cancer of the mouth and throat when they are young.

Workplace exposures
Long and intense exposures to wood dust, paint fumes, and certain chemicals used in the metalworking, petroleum, plastics, and
textile industries can also increase the risk of laryngeal and hypopharyngeal cancers.
Asbestos is a mineral fiber that was often used as an insulating material in many products in the past. Exposure to asbestos is an
important risk factor for lung cancer and mesothelioma (cancer that starts in the lining of the chest or abdomen). Some studies have
also found a possible link between asbestos exposure and laryngeal cancer.

Gender
Cancers of the larynx and hypopharynx are about 4 times more common in men than women. This is likely because the main risk
factors smoking and heavy alcohol use are more common in men. But in recent years, as these habits have become more
common among women, their risks for these cancers have increased as well.

Age
Cancers of the larynx and hypopharynx usually develop over many years, so they are not common in young people. Over half of
patients with these cancers are 65 or older when the cancers are first found.

Race
Cancers of the larynx and hypopharynx are more common among African Americans and whites than among Asians and Latinos.

Gastroesophageal reflux disease

When acid from the stomach backs up into the esophagus it is called gastroesophageal reflux disease (GERD). GERD can cause
heartburn and increase the chance of cancer of the esophagus. Studies are being done to see if it increases the risk of laryngeal
and hypopharyngeal cancers.

Impaired Verbal Communication

Impaired Verbal Communication - Nursing Diagnosis for Stroke / CVA
Impaired Verbal Communication - NCP for Laryngeal Cancer
Laryngeal Cancer
Imbalanced Nutrition: less than body requirements - NCP for Laryngeal Cancer

Disturbed Body Image - NCP for Laryngeal Cancer

Treatment to recover any lost function is termed stroke rehabilitation, ideally in a stroke unit and involving health professions
such as speech and language therapy, physical therapy and occupational therapy.
Nursing Diagnosis for Stroke / CVA : Impaired Verbal Communication related to the decrease in cerebral blood circulation.
Goal: communication can function optimally.
Outcomes:

The creation of a communication where the client's needs can be met.

The client is able to respond to any communication verbal and gesture.

Interventions:
1.
2.

Assess the type / degree of dysfunction, such as patients do not seem to understand the word or have difficulty
speaking or understanding their own making.
Distinguish between aphasia by dysarthria.

3.

Notice errors in communication and provide feedback.

4.

Ask the patient to follow simple commands (like "open eyes," "point to the door") repeat the word / phrase that
simple.

5.

Show the object and ask the patient to name the object.

6.

Ask the patient to utter simple sounds. such as "you".

7.

Ask the patient to write the name and / or short sentences. If you can not write, ask the patient to read short
sentences.

8.

Place a notice in the nurses' station and patient room on the speech disorder. Give special bell when necessary.

9.

Provide alternative methods of communication, such as writing on the blackboard, drawing. Provide visual cues
(hand gestures, drawings, list of requirements, demonstrations).

10. Anticipate and meet the needs of patients.

11. Tell directly with the patient, speak slowly and calmly. Use open-ended questions with a "Yes / No" further develop
the more complex questions according to patient response.
12. Speak in a normal tone and avoid rapid conversation. Give the patient time to respond distance. Talk without
pressure on a response.
13. Encourage visitors / people nearby retain his efforts to communicate with patients, such as reading, discussion
about the things that happen to the family.
14. Talk about things that are known to the patient, such as work, family, and hobbies (pleasure).
15. Appreciate the ability of the patient before the disease; avoid "patronizing speech" at the patient or making things
against the pride of the patient.
16. Consult with / refer to a speech therapist.

Rationale :

1.

2.

Help define the area and the degree of cerebral damage that occurred and the patient's difficulties in some or all
stages of the communication process. Patients may have difficulty understanding spoken words (aphasia sensory /
damage to the area Wernick); pronounce words correctly (expressive aphasia / damage to Broca's speech area) or
suffered damage to both regions.
Interventions are chosen depending on the type of degradation. Aphasia is a disorder in use and interpret
language and symbols may involve components of sensory and / or motor skills, such as the inability to understand
the writing / speech or written word, making signs, talking. Someone with disantria can understand, read, and write
the language but have difficulty forming / pronounce words with respect to weakness and paralysis of the muscles
of the oral region.

3.

Patients may lose the ability to monitor speech out and do not realize that real communication is not spoken.
Feedback helps patients realize why caregivers do not understand / respond accordingly and provide an
opportunity to clarify the content / meaning contained in the words.

4.

Assessing the damage to the sensory (Sensory aphasia).

5.

Assessing the damage to motor (motor aphasia, such patients may recognize it but can not mention).

6.

Identify the presence of dysarthria appropriate motor component of speech (such as the tongue, lips, breath
control) that may affect articulation and may also not accompanied by motor aphasia.

7.

Assess the ability to write (agrafia) and correct deficiencies in reading (aleksia) are also part of aphasia sensory
and motor aphasia.

8.

Eliminate the anxiety of patients in connection with the inability to communicate and the fear that the patient's
needs will not be met immediately. The use of the bell is activated with minimal pressure will be beneficial when the
patient cannot use regular bell system.

9.

Provide communication about needs by state / underlying deficit.

10. Helpful in reducing frustration when dependent on others and cannot communicate meaning.

11. Lowering the confusion / anxiety during the communication process and respond to information more at any given
time. As the process of re-training to further develop communication more and more complex to stimulate memory
and can improve the association of ideas / words.
12. Patients do not need to damage hearing, and raised his voice can lead to angry patients / cause pain. Focusing
responses can result in frustration and may cause patients to come talk to "automatic," such as twisting the words,
talking rough / dirty.
13. Reduce the social isolation of patients and enhance the creation of effective communication.
14. Increasing meaningful conversation and provide opportunities for practical skills.
15. The ability of the patient to feel self-esteem, because patients often remain intellectual abilities well.
16. Assessment of individual speech and sensory, motor and cognitive functions to identify gaps / needs therapy.

Nursing Diagnosis : Disturbed Body Image related to loss of voice, face and neck anatomy changes.
characterized by: negative feelings about body image, a change in social engagement, anxiety, depression, lack of eye
contact.
Goal: Identify feelings and coping methods for negative perceptions of themselves.
Outcomes:
Shows the initial adaptation to changes in the body as evidence of the participation of self-care activities and positive
interactions with others.
Communicating with people nearby on the roles change has occurred.
Begin to develop a plan for lifestyle change.
Participate in an effort to carry out the rehabilitation team.
Interventions and Rationale:
1 Discuss the meaning of loss or change in the patient, identification of perception or expectation that the situation will come.
Rational: Tool in identifying or interpreting issues to focus attention and intervention constructively.
2 Note the non-verbal body language, behavior or the negative self talk. Assess self destruction or suicide behavior.
Rational: may indicate depression or despair, the need for further assessment or more intensive intervention.
3 Record the emotional reaction, sample loss, depression, anger.
Rationale: The patient may experience depression after surgery or shock reaction and deny. Acceptance of change can not
be imposed and the process takes time to improve loss.
4. Arrange the limits on maladaptive behavior; help the patient to identify positive behaviors that will improve.
Rational: refusal may result in a decrease in self-esteem and affect the acceptance of a new self-image.
5. Collaborative: to refer patients or those closest to the source of support, examples of the psychological therapist, social
worker, family counseling.
Rationale: a comprehensive approach is needed to help patients face the rehabilitation and health. Families need help in
understanding the process through which patients and assist them in their emotions. The goal is to enable them to resist the
tendency to reject or isolation of patients from social contact.