Pneumonia Worksheet PDF

Breathing would be easy for this client -- with good gas exchange! All airways are open and there is no excessive mucus. Now let's look at the lungs with left lower lobe pneumonia. This client has infl**ammation** in the left lung base. This client has a bacterial infection in the lungs. The body'...

Breathing would be easy for this client -- with good gas exchange! All airways are open and there is no excessive mucus. Now let's look at the lungs with left lower lobe pneumonia. This client has infl**ammation** in the left lung base. This client has a bacterial infection in the lungs. The body's immune system reacts to the foreign bacteria -- setting off the body's **inflammatory response**. The lung tissue works overtime making mucus and filling up the affected area with fluid. The inflamed alveoli and airways fill up with purulent mucus. This client may have moderate to severe difficulty breathing. \#1. A hospital nurse is caring for a client with pneumonia. Which of the following would be MOST appropriate to help clear secretions from the lower airways? Turning and repositioning If the mucus thickens, it can form mucous plugs which can obstruct the client's airways and even cause the lungs to collapse. This is called atelectasis. \ This client would likely have significant dyspnea. If the mucus plugs the large airways it may cause collapse of an entire lobe or even the entire lung. The image (right) shows a fully inflated right lung and a severely collapsed left lung. A collapsed lung may be caused by several things. With pneumonia, the HCP (healthcare provider) would suspect that the left mainstem bronchus was obstructed with mucus. This client would likely have severe respiratory distress! \#3. A hospital nurse is caring for a client with pneumonia. Which of the following would be MOST appropriate to help clear secretions from the upper airways? How do you know that a client has pneumonia? Classic manifestations include frequent cough with purulent sputum; dyspnea and tachypnea; fatigue; tachycardia; fever -- often with chills; and crackles in the lung bases -- often accompanied by wheezing and coarser breath sounds if there is congestion in the larger airways. Clients who are NOT immunocompromised usually have a high white blood cell count. A client with p**neumonia** may also have sharp, stabbing chest pain if they have pleurisy. A c**hest** x-ray would confirm the diagnosis of pneumonia. Elderly clients may have a decreased inflammatory **response**, and may not have the classic manifestations of pneumonia. The first sign of pneumonia (or other illness) in the elderly may be altered **mental** **status**. They are at higher risk for pneumococcal sepsis. Many clients with pneumonia would receive treatment at home. Treatment plans for clients with breathing difficulty like pneumonia or bronchitis include: 1. High F**owlers** during periods of dyspnea 2. Plenty of **fluids** to keep secretions moist a. Goal = 2,000 -- 3,000 mL/day 3. Supplemental oxygen (if needed) to keep pulse ox \> 90% 4. Stay as mobile as possible b. If in bed, turn and reposition at least q 2 hours 5. Balance of rest and exercise 6. Appropriate antibiotic therapy 7. Treat any fevers as needed 8. Coughing and deep breathing several times/hour c. Teach effective (huff) c**oughing** d. Teach use of incentive sp**irometer** 9. Teach client how to use inhalers (if prescribed) If the client has inflammation of the pleura (**pleurisy**), they may have severe, stabbing chest **pain** with every breath. **[Clients who have pleurisy still need to cough and deep breathe to clear secretions.]** They should be taught to "splint" the affected area of the chest when they cough, sneeze or breathe deeply Look at the following case study: Herbert Scott is a 68-year-old client who comes to the clinic with C/O frequent productive cough and a temperature of 103.4˚F. The clinic nurse, Dorothea, auscultates Mr. Scott's chest and hears fine crackles in the right lung base. She notes that Mr. Scott has a weak cough and teaches him e**ffective** coughing. He spits out (ex**cretes**­) a large amount of thick, yellow sputum. The clinic provider orders a chest x-ray which shows right lower lobe pneumonia. Mr. Scott is given a prescription for azithromycin (Zithromax) -- a macrolide antibiotic that is usually effective for community-acquired pneumonia. \#4. Which of the following signs would indicate that the azithromycin was having a therapeutic action? (Select all that apply) \#5. Which of the following interventions would be MOST appropriate for Mr. Scott? How can you, the Future Nurses of America, tell if a client is doing well (or not)? First you would look at their general ap**pearance**. Are they having trouble breathing? Are they up walking around (usually a good sign!) or are they in the orthopneic position, struggling for each breath? Are they eating and drinking well, or are they exhausted and unable to take food or fluids? You would assess their vital signs -- especially their respirations and **pulse** oximetry. Are the respirations between 12-20? Are they labored? Is the pulse ox 95 -- **100**? You should assess the client's mental status (you must always know their b**aseline**). Restlessness and altered mental **status** may be the first sign of hypoxia -- especially in the elderly. And never forget to **listen** to your clients. If they tell you they're having trouble breathing they may need rapid intervention. Your head-toe assessment would focus heavily on **breathing** -- but you should always try to see your client as a whole person. Mental status, hydration and bowel function should never be omitted. You would look at the client's mobility, safety and ability to do self-care plus ADLs. Pneumonia may be caused by bacteria or many other things. If the cause is bacterial, the doctor will likely prescribe a**ntibiotics**. What lab value would you monitor to see if the antibiotics are working? **WBC** Certain clients are at higher risk for pneumonia -- especially in**fant**s and the el**derly**. Also, clients who are immuno**compromised** or who have respiratory problems (like COPD or ventilator-dependent clients) are very high **risk**. Any client who has **dysphagia** (difficulty sw**allowing**) is at high risk for asp**iration** pneumonia -- and should be on aspiration pre**cautions**. Pneumonia may last for several weeks. The recovery period may take a few months -- with decreased activity tolerance, frequent cough and generalized weakness. Clients should be taught to continue deep breathing and coughing frequently to maintain good lung expansion, oxygenation and prevent a relapse. \#6. What teaching would you do for a home health client who has pneumonia and is taking an antibiotic? **effective coughing, consistent antibiotic schedule, fluid intake / output, repositioning / turning schedule, signs to monitor for,**