Pneumonia is an infection of the lungs involving alveoli that are in contact with bronchioles or complete lobes.

The disease is identified by the causative agents that may be bacterial, viral, fungal, or protozoan and may be termed lobar or bronchopneumonia. Nursing Diagnosis: Ineffective airway clearance related to decreased energy and fatigue resulting in decreased coughing and accumulation of secretions; tracheobronchial secretions related to inflammation resulting in increased mucus accumulation. Ineffective breathing pattern related to pain caused by positioning and coughing; decreased energy and fatigue caused by inflammatory process; decreased lung expansion caused by pain and fatigue resulting in hypoventilation. Expected Outcomes: Adequate ventilation evidenced by respiratory rate, depth and ease within baseline limits. Intervention and Rationale: I. Assess for: 1. Respiratory status including rate, depth, ease, shallow or irregular breathing, dyspnea, use of accessory muscles, and diminished breath sounds, rhonchi or crackles on auscultation - provides data baseline. 2. Quality of cough and ability to raise secretions including consistency and characteristics of sputum - removal of secretions prevents obstruction of airways and stasis leading to further infection and consolidation of lungs; clearing airways facilitates breathing. 3. Position of comfort in semi or high fowlers and change position q2h facilitates breathng and allows for full expansion of lungs. 4. Encourage coughing if sounds is moist; if dry and hacking, increase fluid intake and administer cough suppresant - reduces continual irritation to throat and liquefies secretions. 5. Coughing and deep breathing exercise; use incentive spirometer 5-10 breaths if tolerated - coughing clears airway by propelling secretions to mouth deep breathing promotes ventilation and prolongs expiratory phase. 6. Assist with coughing by splinting chest; humidified air with cool mist loosens secretions and improves ventilation, moistens mucous membranes 7. Postural drainage and percussion PRN - mobilizes secretion. 8. Oral care after expectoration and provide tissues and bag for disposal promotes comfort and prevents transmission of organisms to others.

II. Monitor, record, describe: Respiratory rate, quality and breath sounds q2-q4 - indicates airway resistance, air movement, severity of disease.

1. ABGs, oximeter reading - decreased oxygen levels result in hypoxemia.

III. Administer:

1. Oxygen therapy via cannula - maintain optimal oxygen level.

2. Antitussives/expectorants (terpin hydrate, guaifenesin) - acts on bronchial cells to increase fluid production and promote expectoration; guaifenesin reduces surface tension of secretions; both relieve non-productive cough 3. Mucolytic (acetylcysteine) - decrease viscosity of mucus for easier removal. 4. Antibiotic (ampicillin, cephalexin) - acts by binding to cell wall organisms preventing synthesis and destroying pathogens. 5. Suction secretions if cough ineffective - removal if unable to bring up secretions 6.

Breath Pattern ineffectiveness because of pulmonary infection

Characteristics : Cough (both productive and non productive), shortness of breath, Tachypnea, breath sounds are limited, retraction, fever, diaporesis, ronchii, cyanosis, leukocytosis.

Goal :

Effective breathing pattern characterized by : Voice of lung breath clean and the same on both sides The temperature of the body within the limits of 36.5 to 37.2 OC The rate of breathing in the normal range There is no coughing, cyanosis, retraction and diaporesis Intervention : Perform assessments every 4 hours of respiratory rate, temperature, and signs of airway effectiveness. Rational: Evaluation and reassessment of the actions that will be / have been granted. Perform scheduled Phisioterapi chest Rational: Removing the secretion of the airway, preventing obstruction Give Oxygen Rational: Increased lung tissue oxygen supply Give antibiotics and antipyretics, assess the effectiveness and side effects (rash, diarrhea) Rational: Eradication of the bacteria as a factor of disturbance causa Make checks thoracic photo Rational: The evaluation of the effectiveness of the circulation of oxygen, evaluated the condition of lung tissue Perform a gradual suction Rational: Helping airway clearance Record the results of the pulse oximeter when installed, every 2 - 4 hours Rational: Periodically Evaluate the success of therapy / health team action.

ineffective Airway Clearance may be related to excessive, thickened mucous secretions, possibly evidenced by presence of rhonchi, tachypnea, and ineffective cough.

Activity Intolerance [specify level] may be related to imbalance between O2 supply and demand, possibly evidenced by reports of fatigue, dyspnea, and abnormal vital sign response to activity.

acute Pain may be related to localized inflammation, persistent cough, aching associated with fever, possibly evidenced by reports of discomfort, distraction behavior, and facial mask of pain.

impaired Gas Exchange may be related to inflammatory process, collection of secretions affecting O2 exchange across alveolar membrane, and hypoventilation, possibly evidenced by restlessness/changes in mentation, dyspnea, tachycardia, pallor, cyanosis, and ABGs/oximetry evidence of hypoxia.

risk for Infection [spread]: risk factors may include decreased ciliary action, stasis of secretions, presence of existing infection.

Anxiety

Hyperthermia

Imbalanced nutrition: Less than body requirements Impaired gas exchange Ineffective coping Risk for deficient fluid volume

Key outcomes Nursing care plans for Pneumonia

1.
2.

Patient will express feelings of comfort and relief of pain. Patient will identify measures to reduce anxiety.

3. 4. 5. 6. 7. 8. 9. 10.

Patient will identify measures to reduce anxiety. Patient will maintain a normal body temperature. The patient will consume a specific number of calories daily. The patient will maintain adequate ventilation and oxygenation. The patient will maintain a patent airway. The patient will use support systems to assist with coping. The patient will maintain adequate fluid balance. The patient will remain free from signs or symptoms of infection.

Research Article
Laboratory Investigation advance online publication 18 July 2011; doi: 10.1038/labinvest.2011.103

Neonatal chlamydial pneumonia induces altered respiratory structure and function lasting into adult life
Received 20 October 2010; Revised 23 May 2011; Accepted 23 May 2011

Abstract
Respiratory dysfunction in adults has been correlated with neonatalChlamydia trachomatis pneumonia in several studies, but a causal association has not been clearly demonstrated. In this study, we examined radial alveolar counts (RACs) by microscopy, and airway and parenchymal lung function using a small animal ventilator in juvenile (5 weeks age) and adult (8 weeks age) BALB/c mice challenged as neonates with Chlamydia muridarum (C. mur) on day 1 or day 7 after birth, representing saccular (human pre-term neonates) and alveolar (human term neonates) stages of lung development, respectively. Pups challenged with C. mur on either day 1 or 7 after birth demonstrated significantly enhanced airway hyperreactivity and lung compliance, both as juveniles (5 weeks age) and adults (8 weeks age), compared with mockchallenged mice. Moreover, mice challenged neonatally with Chlamydia displayed significantly reduced RACs, suggesting emphysematous changes. Antimicrobial treatment during the neonatal infection induced early bacterial clearance and partially ameliorated the Chlamydiainduced lung dysfunction as adults. These results suggest that neonatal chlamydial pneumonia, especially in pre-term neonates, is a cause of respiratory dysfunction continuing into adulthood, and that antimicrobial administration may be partially effective in preventing the adverse respiratory sequelae in adulthood. The results of our studies also emphasize the importance of prenatal screening and treatment of pregnant women for C. trachomatis in order to prevent the infection of neonates.

Effect of statin treatment on short term mortality after pneumonia episode: cohort study
Abstract
Objective To determine whether statins protect against all cause mortality after a diagnosis of pneumonia. Design Cohort study using propensity score based method to control for differences between people prescribed and not prescribed statins. Setting United Kingdom Health Improvement Network database, which contains electronic primary care medical records of more than six million patients. Participants Every patient starting a statin between 1995 and 2006 (129288) matched with up to five non-statin users (n=600241); 9073 patients had a recorded diagnosis of pneumonia, of whom 1398 were using a statin. Main outcome measure All cause mortality within six months of diagnosis of pneumonia. Results Among users and non-users of statins with comparable propensity scores, 95/942 users and 686/3615 non-users died on the day that pneumonia was diagnosed. In the following six month period, 109/847 statin users died compared with 578/2927 non-users, giving an adjusted hazard ratio of 0.67 (0.49 to 0.91). If these observed benefits translated into clinical practice, 15 patients would need to be treated with a statin for six months after pneumonia to prevent one death. Conclusions Compared with people who were not taking statins, the risk of dying in the six month period after pneumonia was substantially lower among people who were already established on long term statin treatment when the pneumonia occurred. Whether some or all of this protective effect would be obtained if statin treatment begins when a patient first develops pneumonia is not known. However, given that statins are cheap, safe, and well tolerated, a clinical trial in which people with pneumonia are randomised to a short period of statin treatment is warranted. Bibliography
http://www.bmj.com/content/342/bmj.d1642.abstract