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Pneumonia – Prevention, Nursing management

Prevention

There are several ways to prevent infectious pneumonia.

  • Frequent Hand washing is main rule to prevent spreading infection.
  • Smoking cessation is important not only because it helps to limit lung damage, but also because cigarette smoke interferes with many of the body’s natural defenses against pneumonia.
  • Research shows that there are several ways to prevent pneumonia in newborn infants. Testing pregnant women for Group B Streptococcus and Chlamydia trachomatis, and then giving treatment if needed, reduces pneumonia in infants. Suctioning the mouth and throat of infants with meconium-stained amniotic fluid decreases the rate of aspiration pneumonia
  • Vaccination is important for preventing pneumonia in both children and adults. Vaccinations against Haemophilus influenzae and pneumoniae in the first year of life have greatly reduced the role these bacteria play in causing pneumonia in children. Vaccinating children against Streptococcus pneumoniae has also led to a decreased incidence of these infections in adults because many adults acquire infections from children. Hib vaccine is now widely used around the globe. The childhood pneumococcal vaccine is still as of 2009 predominantly used in high-income countries, though this is changing. In 2009, Rwanda became the first low-income country to introduce pneumococcal conjugate vaccine into their national immunization program.
  • vaccine against Streptococcus pneumoniae is also available for adults. In the U.S., it is currently recommended for all healthy individuals older than 65 and any adults with emphysema, congestiv heart failure, diabetes mellitus, cirrhosis of the liver, alcoholism, cerebrospinal fluid leaks, or those who do not have a spleen. A repeat vaccination may also be required after five or ten years The most important preventive tool is availability of poly valent pneumococcal vaccine in those with chronic lung disease, chronic liver disease, splenectomy and diabetes mellitus.
  • Influenza vaccines should be given yearly to the same individuals who receive vaccination against Streptococcus pneumoniae. In addition, health care workers, nursing home residents, and pregnant women should receive the vaccine. When an influenza outbreak is occurring, medications such as amantadine, rimantadine, zanamivir, and oseltamivircan help prevent influenza.

 

Nursing Management

  • Nursing assessment

The nurse should monitor the following

  • Changes in temperature and pulse
  • Amount, odor, and color of secretions
  • Frequency and severity of cough
  • Degree of tachypnea or shortness of breath
  • Changes in physical assessment findings (primarily assessed by inspecting and auscultating the chest)
  • Changes in the chest x-ray findings

In addition, it is important to assess the elderly patient for unusual behavior, altered mental status, dehydration, excessive fatigue and for signs of heart failure.

Nursing diagnosis

  • Ineffective airway clearance related to copious tracheobronchial secretions.
  • Activity intolerance related to impaired respiratory function
  • Risk for deficient fluid volume related to fever and dyspnea
  • Imbalanced nutrition: less than body requirements
  • Deficient knowledge about the treatment regimen and preventive health measures

Interventions

Improving airway patency

The nurse encourages hydration (2 to 3 L/day) because adequate hydration thins and loosens pulmonary secretions. Humidification may be used to loosen secretions and improve ventilation.

  • A high humidity facemask (using either compressed air or oxygen) delivers warm, humidified air to the tracheobronchial tree, helps to liquify secretions, and relieves tracheo-bronchial irritation.
  • Coughing can be initiated either voluntarily or by reflex.
  • Lung expansion maneuvers, such as deep breathing with an incentive spirometer,may induce a cough.
  • The nurse encourages the patient to perform an effective, directed cough, which includes correct positioning.
  • Chest physiotherapy (percussion and postural drainage) is important in loosening and mobilizing secretions.
  • The patient is placed in the proper position to drain the involved lung segments, and then the chest is percussed and vibrated either manually or with a mechanical percussor.

Promote Rest

  • The nurse encourages the debilitated patient to rest and avoid overexertion and possible exacerbation of symptoms.
  • The patient should assume a comfortable position to promote rest and breathing (eg, semi-Fowler’s) and should change positions frequently to enhance secretion clearance and ventilation/perfusion in the lungs.
  • It is important to instruct outpatients not to overexert themselves and to engage in only moderate activity during the initial phases of treatment.

Promoting Fluid Intake

  • The respiratory rate of a patient with pneumonia increases because of the increased workload imposed by labored breathing and fever.
  • An increased respiratory rate leads to an increase in insensible fluid loss during exhalation and can lead to dehydration. Therefore, it is important to encourage increased fluid intake (at least 2 L/day), unless contraindicated.

Maintaining Nutrition

  • Patients with shortness of breath and fatigue often have a decreased appetite and will take only fluids. Fluids with electrolytes may help provide fluid, calories, and electrolytes. Other nutritionally enriched drinks or shakes may be helpful.
  • In addition, fluids and nutrients may be administered intravenously if necessary.

Promoting The Patients Knowledge

  • The patient and family are instructed about the cause of pneumonia,management of symptoms of pneumonia, and the need for follow-up.
  • If hospitalized for treatment, the patient is instructed about the purpose and importance of management strategies that have been implemented
  • Explanations need to be given simply and in language that the patient can understand. If possible, written instructions and information should be provided.
  • Because of the severity of symptoms, the patient may require that instructions and explanations be repeated several times.

Prevention of VAP (Ventilator associated Pneumonia)

  1. hand washing and use of alcohol based hand rubs
  2. maintenance of oral hygiene
  3. oral suctoning in intubated patients
  4. head end elevation before tube feeding the patient
  5. early ambulation
  6. early extubation if possible
  7. use of non invasive methods of ventilation

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