BAIAE
Bronchial Asthma in acute exacerbation
CAP
Community Acquired Pneumonia
Inefective airway clearance rtd to increased increased sputum production as evidenced by cough. Risk or indection related todepressed todepressed immune system. generic Name: Lagundi Indication: It is used or the relie o cough due to common colds and u. It also used in the treatment o bronchospasm in acute bronchial asthma chronic bronchitis ! other bronchopulmonary disorder. disorder. It is also prescribe prescribed d or the relie o rever reversible sible mild to moderate bronchospasm "prophylactic#maintenance "prophylacti c#maintenance medication$ in adults ! children w# obstructive airway disease.
ASCOF Lagundi Lagundi - medicine medicine for cough cough and asthma: asthma: a pure pure Filipino Filipino product As interest in phytomedicines continues continues to grow, grow, both patients and physicians alike are searching for new products that are as reliable as traditional alternatives, based on their quality, safety, and efficacy. n the Philippines, the leading proponent of phytomedicines is backed by a company with !" years of experience in the field of pharmaceuticals, the Pascual #aboratories, nc. who introduced to the country an organic and all$natural cough and asthma remedy, A%C&' #agundi, #agundi, derived derived from the lagundi lagundi plant ( Vitex negundo #.) and now available in syrup, tablet, and capsule forms. Raw Material
#agundi ( Vitex negundo #.) leaves is the main component of the A%C&' #agundi cough and asthma medicine. t is a large native shrub that grows in the Philippines. #agundi has been traditionally used as herbal medicine by Philippine folks. 'ilipino mothers would boil freshly$picked freshly$picked green leaves and strain them to produce produce an herbal tea, which
is then given to an ailing member of the family. *he efficacy of #agundi has also been verified by the Philippine +epartment of ealth and other Philippine based scientists which concentrated on its use to ease respiratory complaints. #agundi is generally used for the treatment of coughs, asthma symptoms, and other respiratory problems. t is also known for its analgesic effect that helps alleviate pain and discomfort. &ther traditional benefits that are derived from the use of #agundi are as follows-
• • • • •
relief of asthma pharyngitis recommended relief of rheumatism, dyspepsia, boils, diarrhea treatment of cough, colds, fever and flu and other bronchopulmonary disorders alleviate symptoms of chicken pox removal of worms, and boils History, Manufacturing and Marketing +uring /orld /ar , the country was devastated and, as a result, many 'ilipinos fell ill and were badly in need of medicine. t was sometime in 012! that the husband$and$wife team of sosceles sosceles and #eonora Pascual, Pascual, who both graduated graduated from the 3niversity of the Philippines with degrees in Chemistry, put up Pascual #aboratories in a single$room facility facility in their their home on Balut, Balut, *ondo. *ogether gether,, they develo developed ped product products s to treat treat tuberculosis and vitamin deficiency4two of the most pressing health concerns back then4in order to help thousands of people all over the country. 5ight years later, they produced antibiotics, as well as cardiovascular medicines. At about the same time, Pascuallab changed changed from a single proprietorship to a corporation, corporation, and strategic partnerships were formed with foreign$based principals. n the 0167s the manufacturing plant moved from *ondo to Bulacan and its head office was established in 5dsa, where the marketing and distribution of products were devolved to Pharex. *hrough the years, the effectiveness of #agundi was proven through intensive studies in mode modern rn medi medici cine ne led led by the the +epa +epart rtme ment nt of %cie %cienc nce e and and *echno chnolo logy gy (+&% (+&%*) *).. 8ecogni9ing the efficacy of #agundi as a natural remedy for cough and asthma, Pascual #aborat #aboratorie ories s (Pascua (Pascual#ab l#ab), ), in collabo collaborati ration on with with the :ationa :ationall ntegra ntegrated ted 8esearc 8esearch h Program Program of ;edicin ;edicinal al Plants Plants (:8P8 (:8P8&;P &;P)) introdu introduced ced A%C&' A%C&' #agund #agundii as the first first herbal medicine in the country in 011!. #icensed by the Philippine Council for ealth 8esearch and +evelopment (PC8+) and +&%*. *his became the company
established. A%C&' #agundi is currently the most successful phytomedicine (or plant$ based therapeutic product) in the Philippines.
*he initial production of A%C&' #agundi that began over a decade ago was done through a technology transfer from the +&%* and :8P8&;P. *his made it possible for Pascual#ab to manufacture quality medicine from organic lagundi leaves. A%C&' #agundi is currently the most successful phytomedicine (or plant$based therapeutic product) in the Philippines. %yrups, capsules, and tablets are available in drugstores nationwide. Product Description and Indication
•
•
A%C&' #agundi tablet and syrup is the only extensively researched and clinically proven natural medicine for cough and asthma in the Philippines. A%C&' #agundi is natural. ;ade from 077> #agundi leaves which were nurtured organically in a quality$ certified farm untainted by synthetic chemical fertili9ers and pesticides. A%C&' #agundi is safe.
•
:o side effects were reported in the clinical trials for the syrup.
•
:o known contraindications.
•
:o risk of overdose.
• • •
A%C&' #agundi is clinically$proven effective. A%C&' #agundi relieves cough through a ?three way alis-ubo action?Bronchodilating effect ( lumuluwag ) ;ucolytic (natutunaw ) Anti$histaminic @ Cough 8elief ( gumiginhawa) And since it is natural, you wont experience the harmful side effects of common chemical cough and asthma drugs. t is used for the relief of cough due to common colds and flu. t also used in the treatment of bronchospasm in acute bronchial asthma, chronic bronchitis other bronchopulmonary disorder. t is also prescribed for the relief of reversible, mild to moderate bronchospasm (prophylactic@maintenance medication) in adults children w@ obstructive airway disease. Current Trust
*oday, the company is into backward integration through the planting, harvesting and processing of herbal medicines in its certified organic farm in :ueva 5ci=a. Pascual#ab is the only local pharmaceutical company in the country today with an advanced herbal research facility that is tasked to study and develop technology for phytomedicines, thereby opening up a world of possibilities in the future of healthcare. ?/ith our second$ generation technology, our production process is more efficient and more standardi9ed, ensuring that A%C&'
5:58C :A;5- P8A*8&P3;@A#B3*58&# (%A#B3*A;&#) %*&: $ :A#A*&: (ip$ruh$*8&/$pee$um@al$BD&3$ter$ohl) BRAND NAME(S): DuoNeb
;edication 3ses E ow *o 3se E %ide 5ffects E Precautions E +rug nteractions E &verdose E :otes E;issed +ose E %torage !"E"# *his medication is used to treat severe breathing trouble caused by ongoing lung diseases (chronic obstructive pulmonary disease$C&P+, which include chronic bronchitis and emphysema). t helps to relax the muscles around your airways so that they open up to make breathing easier. t helps to reduce shortness of breath, whee9ing, and coughing. *his medication is a combination of drugs, ipratropium and albuterol. Albuterol is also called salbutamol in some countries. pratropium is an anticholinergic bronchodilator and albuterol (salbutamol) is a beta$agonist bronchodilator. H$% T$ !"E# 8ead the Patient nformation #eaflet provided by your pharmacist before you start using this medication and each time you get a refill. *his medication is used with a special machine called a nebuli9er. Consult your healthcare professional for how to properly use the nebuli9er and read the manufacturers instructions. f you have any questions, consult your doctor or pharmacist.*his medication does not require any mixing before use. nhale this medication into your lungs using the nebuli9er and mouthpiece@face mask, usually 2 times a day or as directed by your doctor.Avoid getting any medication into your eyes. t may help to close your eyes during use. *his will reduce the risk of temporary blurred vision, other vision changes, eye pain, and worsening of narrow$angle glaucoma. f you do get some medication into your eyes, rinse them with water and call your doctor promptly if symptoms persist.5ach treatment should last about F$0F minutes. 8inse your mouth after treatment to prevent dry mouth and throat irritation. *o prevent infections, clean the nebuli9er according to the manufacturers directions.3se this medication exactly as prescribed. 8emember to use it at the same times each day. +o not increase your dose or use it more often than prescribed because serious side effects may occur. +osage is based on your medical condition and response to therapy.nform your doctor if your symptoms do not improve or if they worsen. Consult your doctor about what you should do in case this medication stops working well, or if you have worsening shortness of breath@cough, increased sputum, or worsening peak flow meter readings. "IDE E&&ECT"# :ausea, diarrhea, constipation, blurred vision, di99iness,headache, nervousness, dry mouth, dry@sore throat, or voice changes may occur. f any of these effects persist or worsen, notify your doctor or pharmacist promptly.8emember that your doctor has prescribed this medication because he or she has =udged that the benefit to you is greater than the risk of side effects. ;any people using this medication do not
have serious side effects.*ell your doctor immediately if any of these unlikely but serious side effects occur- muscle cramps, vision changes, eye pain, trouble urinating, fast@pounding@irregular heartbeat.%eek immediate medical attention if any of these rare but very serious side effects occur- chest pain.8arely, this medication has caused severe (possibly fatal), sudden worsening of breathing problems (paradoxical bronchospasm). %eek immediate medical attention if you experience increased whee9ing@trouble breathing.A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. %ymptoms of a serious allergic reaction may include- rash, itching@swelling (especially of the face@tongue@throat), severe di99iness, trouble breathing.*his is not a complete list of possible side effects. f you notice other effects not listed above, contact your doctor or pharmacist.n the 3% $Call your doctor for medical advice about side effects. Dou may report side effects to '+A at 0$G77$'+A$07GG.n Canada $ Call your doctor for medical advice about side effects. Dou may report side effects to ealth Canada at 0$G!!$"2$"2F. PRECA!TI$'"# Before taking ipratropium@albuterol (salbutamol), tell your doctor or pharmacist if you are allergic to itH or to atropine or other belladonna$type drugsH or if you have any other allergies.Before using this medication, tell your doctor or pharmacist your medical history, especially of- heart problems (e.g., irregular heartbeat, heart failure), high blood pressure, sei9ures, overactive thyroid ( hyperthyroidism), low potassiumblood levels, diabetes, problems urinating, enlarged prostate, glaucoma (narrow$angle type).*his drug may make you di99y or cause blurred vision. +o not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. #imit alcoholic beverages.Before having surgery, tell your doctor or dentist that you are using this medication.*his medication should be used only when clearly needed during pregnancy. +iscuss the risks and benefits with your doctor.t is not known whether this drug passes into breast milk. Because of the potential risk to the infant, breast$feeding while using this drug is not recommended. Consult your doctor before breast$feeding. DR!( I'TERACTI$'"# Dour healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for it. +o not start, stop or change the dosage of any medicine before checking with them first.Avoid taking ;A& inhibitors (e.g., fura9olidone, isocarboxa9id, line9olid, moclobemide, phenel9ine, procarba9ine, rasagiline, selegiline, tranylcypromine) within weeks before, during, and after treatment with this medication. n some cases a serious, possibly fatal drug interaction may occur.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription@herbal products you may use, especially of- anticholinergic drugs (e.g., atropine, scopolamine), certain antihistamines (e.g., diphenhydramine, mecli9ine), antispasmodic drugs (e.g., dicyclomine, hyoscyamine), certain anti$Parkinsons drugs (e.g., ben9tropine, trihexyphenidyl), some beta$blockers (such as propranolol), bladder control drugs (e.g., oxybutynin, tolterodine),pramlintide, stimulant$like drugs (e.g., ephedrine,
epinephrine), tricyclicantidepressants (e.g., amitriptyline, nortriptyline), certain ?water pills? (diuretics that cause potassium loss from the body such as furosemide,hydrochlorothia9ide ).Check the labels on all your medicines (e.g., cough$ and$cold products, diet aids) because they may contain ingredients that could increase your heart rate or blood pressure. Ask your pharmacist about the safe use of those products.*his document does not contain all possible interactions. *herefore, before using this product, tell your doctor or pharmacist of all the products you use. Ieep a list of all your medications with you, and share the list with your doctor and pharmacist. $)ERD$"E# f overdose is suspected, contact your local poison control center or emergency room immediately. 3% residents can call the 3% national poison hotline at 0$ G77$$0. Canadian residents should call their local poison control center directly. %ymptoms of overdose may include- very fast or irregular heartbeat, unusual di99iness, sei9ures, chest pain. '$TE"# +o not share this medication with others.#aboratory and@or medical tests (e.g., lung function tests) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details. MI""ED D$"E# f you miss a dose, use it as soon as you remember. f it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. +o not double the dose to catch up. "T$RA(E# %tore 3.%. product between "!$G! degrees ' ($"7 degrees C) in the foil pouch or carton away from light and moisture. +o not store in the bathroom.%tore Canadian product at room temperature between F1$66 degrees ' (0F$F degrees C) away from light and moisture. +o not store in the bathroom.Ieep all medicines away from children and pets.+o not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.;5+CA# A#58*- Dour condition can cause complications in a medical emergency. 'or enrollment information call ;edicAlert at 0$G77$GF2$00!! (3%A) or 0$G77$!!G$0F76 (Canada).
(eneric 'a*e# Albuterol Brand 'a*e# %albutamol, Proventil, Jentolin, Accuneb, airet, :ovo$%albutamol, Proventil 'A, en$salbutamol, Jentodisk, Jentolin 'A, Jolmax, Jo%pira 58 Classification# Bronchodilator (therapeutic)H adrenergics (pharmacologic) Indications 0. *o control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (C&P+)
. Kuick relief for bronchospasm ". 'or the prevention of exercise$induced bronchospasm 2. #ong$term control agent for patients with chronic or persistent bronchospasm Mecanis* of Action t relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles. *he relief from nasal congestion and bronchospasm is made possible by the following mechanism that takes place when %albutamol is administered. 0. 'irst, it binds to the beta$adrenergic receptors in the airway of the smooth muscle which then leads to the activation of the adenyl cyclase and increased levels of cyclic$ "
Route and Dosage P& (Adults and Children more than 0 years)- $2 mg "$2 times a day or 2$G mg of extended dose tablets twice a day. P& (eriatric Patients)- initial dose should not exceed mg "$2 times a day and may be increased carefully up to " mg@day P& (Children !$0 years old)- mg "$2 times a day or 2 mg as extended$release tablets twice a dayH may be carefully increased as needed but not to exceed 2 mg@day P& (Children $! years old)- 7.0 mg@kg " times a day nhalation (Adults and children more than 2 years of age)- inhalations every 2$! hours nhalation (Children $0 years old)- 7.0$7.0F mg@kg@dose "$2 times a day 'ursing Inter+entions 0. Assess lung sounds, P8 and BP before drug administration and during peak of medication. . &bserve fore paradoxical spasm and withhold medication and notify physician if condition occurs. ". Administer P& medications with meals to minimi9e gastric irritation. 2. 5xtended$release tablet should be swallowed$whole. t should not be crushed or chewed. F. f administering medication through inhalation, allow at least 0 minute between inhalation of aerosol medication. !. Advise the patient to rinse mouth with water after each inhalation to minimi9e dry mouth. 6. nform the patient that Albuterol may cause an unusual or bad taste.
+83 %*3+D + 8 3 : A ; 5 A C * & : @ C # A % % ' C A * & : : + C A * & : C & : * 8 A : + C A * & : : 3 8 % : 8 5 % P & : % B # * D *rade name - %albutamol:ebeneric name- Albuterol%ulfate+osage- 0 *ab'requency- q2 hoursn low doses, acts relativelyselectively at beta Ladrenergic receptors tocause bronchodilation andvasodilationH at higherdoses, beta selectivity islost, and the drug acts atbeta receptors to causetypical sympathomimeticcardiac effect.Antasthmatic M 8elief and prevention of brochospasm in patientswith reversibleobstructive airwaydisease. M nhalation- treatment of acute attacks of brochospasm. M Prevention of exercise$induced brochospasm. M 3nlabeled use- ad=unct intreating serioushyperkalemia in dialysispatientsH seems to lowerpotassium concentrationwhen inhaled by patientson hemodialysis. M Contraindicated withhypersensitivity toalbuterolHtachyarrhythmias,tachycardia cause bydigitalis intoxication.
M 3se cautiously withdiabetes mellitusHhyperthyroidism, historyof sei9ure disorders. M &bserve 07 rights ingiving medications. M 3se minimal doses forminimal periodsH drugtolerance can occur withprolonged used. M ;aintain a L adrenergicblocker ( cardioselectivebeta L blocker, such asatenolol, should be usewith respiratorydistress ) on standby incase cardiac arrhythmiasoccur.
Subjective: Inuubo ako atnahihirapanakongmakahinga.Masnakakahingaako ng maayoskapag ganitongmay Oxygen.Kapag wala, anghirap talagahuminga at sakamatanda na rinako. Objective: RestlessnessNasal flaringCrakles hearduponausultation onboth lung filedOxygen !ianasal annulaImpaired gasexhangerelated toinflammatoryproess in thelungparenhymaand al!eoli asmanifested byrestlessness.Community"a#uired pneumonia $C%&' isa disease inwhih indi!idualswho ha!e notreently beenhospitali(edde!elopan infetion of the lungs $pneumonia'.C%& is a ommonillness and anaffet people of all ages. C%&often ausesproblems likediffiulty inbreathing,fe!er, hestpains, and aough. C%&ours beausethe areas of thelung whihabsorb oxygen$al!eoli' from theatmospherebeome filledwith fluid andannot work Goal: %fter ) hours of nursinginter!ention, thelient will be able toestablish a normaland effeti!erespiratory pattern. Objectives:Independent *. %fter + minutesof inter!ention, thelient would be ableto ha!e normalbreath respirationand breath soundswithin - minutes.-. %fter + minutesof nursinginter!ention, thelient would be ableto ha!e easierbreathing. Independent *.Monitorrespiration andbreath sounds-. &lae the lient inhigh fowlersposition.ahypnea, stridor,rakles orwhee(es areindiati!e torepiratory distressand/oraumulation of fluid $Nurse0s &oket 1uide by 2oengeset al pp.3)' &ositioning thelient in highfowler0s positionpromote lungexpansion. $4undamentals of Nursing by Ko(ier
%fter ) hours of nursinginter!ention, thelient was able toestablish a normaland effeti!erespiratorypattern. '!R"I'( DIA('$"I" neffective Airway Clearance related to presence of %ecretions secondary to Co**unity ac-uired pneu*onia
Pneumonia (NCP)Nursing Care Plan-Risk for Infection %osted on &pril '( )*') by RNspeak in Nursing +are %lan with ( +omments
.
Pneumoni a i so n eoft h emo s tc o mmo nme di c a lp r o bl e ms
enc ount er edi ncl i ni c al pr ac t i c eandl eadi ngf at al i nf ec t i ousdi s eas ewor l dwi de.I nt hePhi l i ppi nesl as t2011bas edona n umb ero fh ea l t hi n su r a nc ec l a i msbyPh i l h ea l t hr e v ea l e da so neo ft h et o pc as esac qu i r e dd i s ea sei nt h ec ou nt r y . I t ’ sal s or ank edast heei ghtl eadi ngc aus eofdeat hi nt heUSc ons i s t ent l yac c ou nt sf ort heo v er whel mi ngmaj or i t y pneumoni a. d ea t hi n20 06 ,we r ei n55 , 4 77pe op l edi e do f
i sc au se db yanu mb ero fi n f e ct i o usag en t si n cl u di n gv i r u se s,b ac t e r i a ,a ndf u ng i .Th emo s tc ommo n Pneumoni a b ac t e r i a lp at h og en ,St r ep t o co cc usp ne umo ni a e,i si d en t i fi edast h el e ad i n gc au seofc ommu ni t y a cq ui r e dp ne umo ni a a mo ngc hi l d r e na ndad ul t s .
Two causes of Pneumonia
Pr i mar ypneumoni a i sc aus edb yt hepat i ent ’ si nhal i ngoras pi r at i ngapat hogen.
Secondar ypneumoni a e ns u esf r o ml u ngd ama gec a us e db yt h es p r e ado fb ac t e r i af r o ma ni n f e c t i o n
el s ewher ei nt hebody .Li k el ycaus esi nc l udev ar i ousi nf ec t i ousagent s ,c hemi c al i r r i t ant s( i nc l udi nggas t r i c r efl ux / as pi r at i on,s mok ei nhal at i on) ,andr adi at i ont her apy .Thi spl anofc ar edeal swi t hbac t er i al andv i r al Pn eu mo cy s t i sc a r i n i i ,Ha emo ph i l u si n flu en za e, p n eu mo ni a s ,e . g . ,p ne umo c o c c al p ne umo ni a , myc opl asma,and Gr a mn e ga t i v emi c r o be s . Nur s i ngPr i or i t i es
Mai nt ai n/ i mpr o ver es pi r at or yf unc t i on.
Pr e v entc ompl i c at i ons .
Su pp or tr e cu pe r a t i v ep r o ce ss .
Pr o v i d ei n f o r ma t i o na bo utd i s ea sep r o ce ss / p r o g no si san dt r e at me nt .
Di schar geGoal s
Ven t i l at i ona ndo xy gen at i onadequat ef ori ndi v i du al needs .
Co mp l i c at i o nspr e v en t e d/ mi n i mi z ed .
Di s ea sep r o ce ss / pr o gn os i sa ndt h er a pe ut i cr e gi me nun de r s t o od .
Li f es t y l ec hangesi dent i fi ed/ i ni t i at edt opr e ventr ec ur r enc e.
Pl a ni np l a cet ome etn ee dsaf t e rd i s c ha r g e.
Nursing Diagnosis:Risk for Infection Ri s kf a ct or sma yi nc l ude
I nadequat epr i mar ydef ens es( dec r e as edci l i ar yac t i on,s t as i sofr es pi r at or ys ec r e t i ons )
I n ad eq ua t es ec on da r ydef e ns es( p r e s en ceo fe x i s t i n gi n f e ct i o n,i mmu no su pp r e s s i o n) ,c hr o ni cd i s ea se , mal nut r i t i on
Possi bl yevi dencedby
[ No ta pp l i c ab l e ;p r e se nc eo fs i g nsan ds y mp t o mses t a bl i s he sa na ct u al d i a gn os i s . ] Desi r edout comes
Ac hi ev et i mel yr es ol ut i onofc ur r enti nf ec t i onwi t houtc ompl i c at i ons .
Kn owl e dg e:I n f e ct i o nCo nt r o l
I dent i f yi nt er v ent i onst opr ev ent / r educ er i s k/ s pr eadof / s ec ondar yi nf ec t i on. Nursing actions
Rationale
,onitor vital signs closely especially during initiation o therapy.
-uring this period o time potentially atal complications "hypotension#shock$ may develop.
Instruct patient concerning the disposition o secretions "e.g. raising and epectorating versus swallowing$ and reporting changes in color amount odor o secretions.
<hough patient may /nd epectoration ofensive and attempt to limit or avoid it it is essential that sputum be disposed o in a sae manner. +hanges in characteristics o sputum reect resolution o pneumonia or development o secondary inection.
-emonstrate#encourage good handwashing techni0ue.
1fective means o reducing spread or ac0uisition o inection.
+hange position re0uently and provide good pulmonary toilet.
%romotes epectoration clearing o inection.
Limit visitors as indicated.
Reduces likelihood o eposure to other inectious pathogens.
Institute isolation precautions as individually appropriate.
-ependent on type o inection response to antibiotics patient2s general health and development o complications isolation
techni0ues may be desired to prevent spread#protect patient rom other inectious processes.
1ncourage ade0uate rest balanced with moderate activity. %romote ade0uate nutritional intake.
3acilitates healing process and enhances natural resistance.
,onitor efectiveness o antimicrobial therapy.
4igns o improvement in condition should occur within )5657 hr.
Investigate sudden changes#deterioration in condition such as increasing chest pain etra heart sounds altered sensorium recurring ever changes in sputum characteristics.
-elayed recovery or increase in severity o symptoms suggests resistance to antibiotics or secondary inection. +omplications afecting any#all organ systems include lung abscess#empyema bacteremia pericarditis#endocarditis meningitis#encephalitis and superinections.
&dminister antimicrobials as indicated by results o sputum#blood cultures: e.g. penicillins: erythromycin "18,ycin$ tetracycline "&chromycin$ doycycline hyclate "9ibramycin$ amikacin "&mikin$ cephalosporins: cetriaone "Rocephin$ amantadine "4ymmetrel$ sparoacin ";agam$ macrolide derivatives e.g a
=hese drugs are used to combat most o the microbial pneumonias. +ombinations o antiviral and antiungal agents may be used when the pneumonia is a result o mied organisms. Note:9ancomycin and third8 generation cephalosporins are the treatment o choice or penicillin8resistant streptococcal pneumonia
Defi ni t i on Cont ent s[ hi de] • • • • •
o o o o o
1Defi ni t i on 2Nur s i ngPr i or i t i es 3Di s c ha r g eGo al s 4Di agnos t i cSt udi es 5Nu r s i n gCa r ep l a ns 5. 1I neff ec t i v eAi r wa yCl ear anc e 5 . 2I mp ai r e dGa sEx c h a ng e 5. 3Ri s kf orDefi ci entFl ui dVol ume 5. 4I mbal anc edNut r i t i on 5. 5Ac ut ePai n
o o o
5. 6Ac t i v i t yI nt ol er anc e 5. 7Ri s kf orI nf ec t i on 5. 8De fic i e ntKn owl e dg e
Pneumoni a i sani n fl amma t i o no ft h el un gp ar e nc h y ma ,a s so ci a t e dwi t hal v e ol a re de maan d c on ge s t i o nt h ati mp ai rg asex c h an ge .
Nur s i ngPr i or i t i es 1.
Mai nt ai n/ i mpr over espi r at or yf unct i on.
2.
Pr ev ent c ompl i c at i on s .
3.
Supp or tr ec upe r at i v epr oc es s .
4 .
Pr o v i d ei n f o r ma t i o nab ou td i s e a s epr o c e s s ,p r o gn o s i sa n dt r e a t me nt .
Di s c h ar geGoal s 1 .
Ve nt i l a t i o nan do x y g en at i o nad eq ua t ef o ri n di v i d ua ln e ed s .
2.
Compl i ca t i onspr ev ent ed/ mi ni mi zed .
3.
Di seasepr oces s/ pr ognosi sandt her apeut i cr egi menunder st ood.
4 .
Li f e s t y l ec ha ng esi d en t i fi ed / i n i t i a t edt opr e v en tr e c ur r e nc e.
5.
Pl ani npl acet omeetneedsaf t erdi sc har ge.
Di agnos t i cSt udi es •
Che stx r a y : I dent i fi esst r uc t ur al di s t r i but i on( e. g. ,l obar ,br onc hi al ) ;mayal s or ev eal mul t i pl e abs ces ses / i nfi l t r at es ,empy ema( s t aphy l oc oc cus ) ; s cat t er edorl oc al i z edi nfi l t r at i on( b ac t er i al ) ;or di ff us e/ e xt ens i v enodul ari nfi l t r at es( mor eof t env i r al ) .I nmy c opl as mal pneumoni a,c hes tx r a y ma yb ec l e ar .
•
Fi ber opt i cbr onchoscopy: Maybebot hdi agnos t i c( q ual i t at i v ec ul t ur es )a ndt her apeut i c( r ee x pa ns i o no fl u ngs eg me nt ) .
•
ABGs/ pul seoxi met r y: Abn or ma l i t i e sma yb ep r e se nt ,d ep en di n go ne x t e nto fl u ng i n v ol v ementandunder l y i ngl ungdi s eas e.
•
Gr a ms t a i n/ c ul t ur e s: Sput um c ol l e ct i on;needl eas pi r a t i ono femp y ema ,pl eur al ,and t r ans t r ac heal ort r ans t hor ac i cfl ui ds ;l ungbi ops i esandbl oodc ul t ur esma ybedonet or ec ov er c a us a t i v eo r g an i s m.Mo r et h ano net y p eo fo r g an i s m ma ybep r e s en t ;c o mmo nb ac t e r i ai n c l u de Di pl o c oc c uspn eu mo ni a e,St a ph y l o co c cu sa ur e us ,a he mo l y t i cs t r ep t o co c cu s ,Ha emop hi l u s i nfl uenz ae;c y t omeg al o v i r us( CMV) .No t e:Spu t um c ul t ur esma yno ti den t i f yal l o ffend i ng or g ani s ms .Bl o odc ul t u r e sma ys ho wt r a ns i e ntb ac t e r e mi a .
•
Le uk o c yt o si sus ua l l ypr e sen t ,a l t h ou ghal o w wh i t ebl o odc e l l ( WBC)c ou ntma ybe CBC: pr es enti nv i r al i nf ec t i on,i mmuno suppr es s edc ond i t i onss uc hasAI DS,andov er whel mi ng bac t er i al pneumoni a.Er y t hr oc yt esedi ment at i onr at e( ESR)i sel e vat ed.
•
Ser ol ogi cst udi es,e. g. ,vi r alorLegi onel l at i t er s,col daggl ut i ni ns: As s i s ti ndi ffer ent i al di a gno si sofs pec i fi cor gani s m.
•
Pul monar yf unct i onst udi es: Vo l u me sma yb ed ec r e as e d( c o ng es t i o na ndal v e ol a r c ol l a ps e) ;a i r wa yp r e ss ur ema yb ei n cr ea se da ndc omp l i a nc ed ec r e as ed .Sh un t i ngi spr e se nt ( h y po x emi a ) .
•
El ect r ol yt es : So di u ma ndc h l o r i d el e v el sma ybel o w.
•
Ma yb ei n c r e as e d . Bi l i r ubi n:
•
Pe r c ut a ne ousas pi r a t i on/ ope nbi ops yofl ungt i s sue s: Ma yr ev eal t y pi c al i nt r anuc l ear andc yt opl as mi ci nc l us i ons( CMV) ,c har ac t er i s t i cgi antc el l s( r ubeol a) .
Nur s i ngCar epl ans Be l o wa r e8Nu r s i n gCa r ePl a ns( NCP)f o rPn eu mo n i a .
I neffec t i v eAi r wa yCl ear anc e r wa yCl ear anc e,i neffec t i v e Nur si ngDi agnosi s:Ai
Ma yber e l a t e dt o •
T r a c he al b r o nc hi a li n fla mma t i on ,e demaf or ma t i o n,i n cr e as e ds p ut u mp r o du ct i on
•
Pl eur i t i cpai n
•
Dec r ea sedener gy , f at i gue
Possi bl yevi dencedby •
Changesi nr at e,dept hofr es pi r at i ons
•
Ab no r ma lb r e at hs ou nd s ,u s eo fa c c es s o r ymu s c l e s
•
Dy s p ne a,c y a no s i s
•
Cough,effec t i v eori neffec t i v e;wi t h/ wi t houts put um pr oduc t i on
Desi r edOut comes •
I dent i f y / demons t r at ebeha vi or st oac hi ev eai r wa yc l ear anc e.
•
Di s pl a ypat en tai r wa ywi t hb r eat hs ou nd sc l e ar i n g;abs enc eofdy s pne a,c y anos i s .
'ursing Inter+entions
Rationale
Assess rate@depth of respirations and chest
*achypnea, shallow respirations, and asymmetric chest
movement.
movement are frequently present because of discomfort of moving chest wall and@or fluid in lung.
Auscultate lung fields, noting areas of
+ecreased airflow occurs in areas consolidated with
decreased@absent airflow and adventitious breath
fluid. Bronchial breath sounds (normal over bronchus)
sounds, e.g., crackles, whee9es.
can also occur in consolidated areas. Crackles, rhonchi, and whee9es are heard on inspiration and@or expiration in response to fluid accumulation, thick secretions, and airway spasm@obstruction.
5levate head of bed, change position frequently.
#owers diaphragm, promoting chest expansion, aeration of lung segments, mobili9ation and expectoration of secretions.
Assist patient with frequent deep$breathing
+eep breathing facilitates maximum expansion of the
exercises. +emonstrate@help patient learn to perform
lungs@smaller airways. Coughing is a natural self$
activity, e.g., splinting chest and effective coughing
cleaning mechanism, assisting the cilia to maintain
while in upright position.
patent airways. %plinting reduces chest discomfort, and an upright position favors deeper, more forceful cough effort.
%uction as indicated (e.g., frequent or sustained
%timulates cough or mechanically clears airway in
cough, adventitious breath sounds, desaturation
patient who is unable to do so because of ineffective
related to airway secretions).
cough or decreased level of consciousness.
'orce fluids to at least "777 m#@day (unless
'luids (especially warm liquids) aid in mobili9ation and
contraindicated, as in heart failure). &ffer warm,
expectoration of secretions.
rather than cold, fluids.
Assist with@monitor effects of nebuli9er treatments
'acilitates liquefaction and removal of secretions.
and other respiratory physiotherapy, e.g., incentive
Postural drainage may not be effective in interstitial
spirometer, PPB, percussion, postural drainage.
pneumonias or those causing alveolar
Perform treatments between meals and limit fluids
exudate@destruction. Coordination of
when appropriate.
treatments@schedules and oral intake reduces likelihood of vomiting with coughing, expectorations.
Administer medications as indicated- mucolytics,
Aids in reduction of bronchospasm and mobili9ation of
expectorants, bronchodilators, analgesics.
secretions. Analgesics are given to improve cough effort by reducing discomfort, but should be used cautiously because they can decrease cough effort@depress respirations.
Provide supplemental fluids, e.g., J, humidified
'luids are required to replace losses (including
oxygen, and room humidification.
insensible) and aid in mobili9ation of secretions. :ote%ome studies indicate that room humidification has been found to provide minimal benefit and is thought to increase the risk of transmitting infection.
;onitor serial chest x$rays, ABs, pulse oximetry
'ollows progress and effects of disease
readings.
process@therapeutic regimen, and facilitates necessary alterations in therap y.
Assist with bronchoscopy@thoracentesis, if indicated.
&ccasionally needed to remove mucous plugs, drain purulent secretions, and@or prevent atelectasis.
I mpai r edGasEx change Nur si ngDi agnosi s:Ga sEx c h a ng e,i mp ai r e d
Ma yber e l a t e dt o •
Al v e ol a r c a pi l l a r yme mbr a nec ha ng es( i n fla mmat o r yeff ec t s )
•
Al t er edox ygenc ar r y i ngc apac i t yofbl ood/ r el eas eatc el l ul arl ev el ( f ev er ,s hi f t i ng o x y he mo gl o bi nc u r v e )
•
Al t er eddel i v er yofox ygen( h ypo vent i l at i on)
Possi bl yevi dencedby •
Dy s p ne a,c y a no s i s
•
T ac hy c ar di a
•
Re s t l e s sne s s/ c ha ng esi nme nt a t i o n
•
Hy p o x i a
Desi r edOut comes
•
Demo ns t r at ei mpr o v edv ent i l at i o nan do xy gen at i onoft i s s ue sb yABGswi t hi np at i en t ’ s a cc ep t a bl er a ng ea nda bs e nc eo fs y mp t o msofr e sp i r a t o r ydi s t r e ss .
•
Par t i c i pat ei nac t i onst omax i mi z eo xy genat i on. 'ursing Inter+entions
Rationale
Assess respiratory rate, depth, and ease.
;anifestations of respiratory distress are dependent on@and indicative of the degree of lung involvement and underlying general health status.
&bserve color of skin, mucous membranes,
Cyanosis of nailbeds may represent vasoconstriction or the
and nailbeds, noting presence of peripheral
body
cyanosis (nailbeds) or central cyanosis
mucous membranes, and skin around the mouth (Nwarm
(circumoral).
membranesO) is indicative of systemic hypoxemia.
Assess mental status.
8estlessness, irritation, confusion, and somnolence may reflect hypoxemia@ decreased cerebral oxygenation.
;onitor heart rate@rhythm.
*achycardia is usually present as a result of fever@dehydration but may represent a response to hypoxemia.
;onitor body temperature, as indicated. Assist
igh fever (common in bacterial pneumonia and influen9a)
with comfort measures to reduce fever and
greatly increases metabolic demands and oxygen
chills, e.g., addition@removal of bedcovers,
consumption and alters cellular oxygenation.
comfortable room temperature, tepid or cool water sponge bath.
;aintain bedrest. 5ncourage use of relaxation
Prevents overexhaustion and reduces oxygen
techniques and diversional activities.
consumption@demands to facilitate resolution of infection.
5levate head and encourage frequent position
*hese measures promote maximal inspiration, enhance
changes, deep breathing, and effective
expectoration of secretions to improve ventilation.
coughing.
Assess level of anxiety. 5ncourage
Anxiety is a manifestation of psychological concerns and
verbali9ation of concerns@feelings. Answer
physiological responses to hypoxia. Providing reassurance
questions honestly. Jisit frequently, arrange for
and enhancing sense of security can reduce the psychological
%&@visitors to stay with patient as indicated.
component, thereby decreasing oxygen demand and adverse physiological responses.
&bserve for deterioration in condition, noting
%hock and pulmonary edema are the most common causes of
hypotension, copious amounts of pink@bloody
death in pneumonia and require immediate medical
sputum, pallor, cyanosis, change in level of
intervention.
consciousness, severe dyspnea, restlessness.
; onitor ABs, pulse oximetry.
'ollows progress of disease process and facilitates alterations in pulmonary therap y.
Administer oxygen therapy by appropriate
*he purpose of oxygen therapy is to maintain Pao above !7
means, e.g., nasal prongs, mask, Jenturi mask.
mm g. &xygen is administered by the method that provides appropriate delivery within the patient
Ri s kf orDefi c i entFl ui dVol ume s kf orDefi c i en tFl ui dVol ume Nur si ngDi agnosi s:Ri
Ri s kf a ct or sma yi nc l ude •
Ex ces si v efl ui dl os s( f ev er ,pr of us edi aphor es i s ,mout hbr eat hi ng/ h yper v ent i l at i on,v omi t i ng)
•
Dec r ea sedor al i nt a ke
Desi r edOut comes •
Demons t r at eflui dbal anc ee vi denc edbyi ndi v i dual l yappr opr i at epar amet er s ,e. g. ,moi s t muc ousmembr anes ,goods ki nt ur gor ,pr omptc api l l ar yr efi l l ,s t abl ev i t al s i gns . 'ursing Inter+entions
Rationale
Assess vital sign changes, e.g., increased
5levated temperature@prolonged fever increases metabolic
temperature@prolonged fever, tachycardia,
rate and fluid loss through evaporation. &rthostatic BP
orthostatic hypotension.
changes and increasing tachycardia may indicate systemic fluid deficit.
Assess skin turgor, moisture of mucous
ndirect indicators of adequacy of fluid volume, although
membranes (lips, tongue).
oral mucous membranes may be dry because of mouth breathing and supplemental oxygen.
:ote reports of nausea@vomiting.
Presence of these symptoms reduces oral intake.
;onitor intake and output (&), noting color,
Provides information about adequacy of fluid volume and
character of urine. Calculate fluid balance. Be
replacement needs.
aware of insensible losses. /eigh as indicated.
'orce fluids to at least "777 m#@day or as
;eets basic fluid needs, reducing risk of deh ydration
individually appropriate.
Administer medications as indicated, e.g.,
3seful in reducing fluid losses.
antipyretics, antiemetics.
Provide supplemental J fluids as necessary.
n presence of reduced intake@excessive loss, use of parenteral route may correct@prevent deficiency.
Administer medications as indicated, e.g.,
3seful in reducing fluid losses.
antipyretics, antiemetics.
Provide supplemental J fluids as necessary.
n presence of reduced intake@excessive loss, use of parenteral route may correct@prevent deficiency.
I mbal anc edNut r i t i on Nur si ngDi agnosi s:Ri s kf o rI mb al a nc edNu t r i t i onLe s sTh anBo dyReq ui r e me nt s
Ri s kf a ct or sma yi nc l ude •
I nc r ea sedme t ab ol i cneedss ec ondar yt of e v erandi nf ec t i ouspr o ces s
•
Anor e xi aas soc i at edwi t hbac t er i al t o xi ns ,t heodorandt as t eofs put um,andc er t ai naer os ol t r eat ment s
•
Abdomi nal di s t ens i on/ gasas s oc i a t edwi t hs wal l o wi ngai rdur i ngdy s pnei cepi s od es
Desi r edOut comes •
Demo ns t r at ei nc r eas edappe t i t e .
•
Mai nt ai n / r eg ai ndes i r edbo dywe i gh t . 'ursing Inter+entions
Rationale
dentify factors that are contributing to
Choice of interventions depends on the underlying cause
nausea@vomiting, e.g., copious sputum, aerosol
of the problem.
treatments, severe dyspnea, pain.
Provide covered container for sputum and remove
5liminates noxious sights, tastes, smells from the patient
at frequent intervals. Assist with@encourage oral
environment and can reduce nausea.
hygiene after emesis, after aerosol and postural drainage treatments, and before meals.
%chedule respiratory treatments at least 0 hr
8educes effects of nausea associated with these
before meals.
treatments.
Auscultate for bowel sounds. &bserve@palpate for
Bowel sounds may be diminished@absent if the infectious
abdominal distension.
process is severe@prolonged. Abdominal distension may occur as a result of air swallowing or reflect the influence of bacterial toxins on the gastrointestinal () tract.
Provide small, frequent meals, including dry foods
*hese measures may enhance intake even though
(toast, crackers) and@or foods that are appealing to
appetite may be slow to return.
patient.
5valuate general nutritional state, obtain baseline
Presence of chronic conditions (e.g., C&P+ or alcoholism)
weight.
or financial limitations can contribute to malnutrition, lowered resistance to infection, and@or delayed response to therapy.
Ac ut ePai n n,ac ut e Nur si ngDi agnosi s:Pai
Ma yber e l a t e dt o •
I n fl amma t i o no fl u ngpa r e nc h y ma
•
Cel l ul arr eac t i onst oc i r c ul at i ngt ox i ns
•
Per s i s t entc oughi ng
Possi bl yevi dencedby •
Repor t sofpl eur i t i cches tpai n,headac he,mus cl e/ j oi ntpai n
•
Gu ar d i n go fa ffe ct e dar e a
•
Di s t r ac t i onbehav i or s ,r es t l es snes s
Desi r edOut comes •
Ver bal i z er el i ef / c ont r ol ofpai n.
•
Demons t r at er el ax edmanner ,r es t i ng/ s l eepi ngandengagi ngi nac t i v i t yappr opr i at el y . 'ursing Inter+entions
Rationale
+etermine pain characteristics, e.g., sharp,
Chest pain, usually present to some degree with pneumonia,
constant, stabbing. nvestigate changes in
may also herald the onset of complications of pneumonia, such
character@location@intensity of pain.
as pericarditis and endocarditis.
;onitor vital signs.
Changes in heart rate or BP may indicate that patient is experiencing pain, especially when other reasons for changes in vital signs have been ruled out.
Provide comfort measures, e.g., back rubs,
:onanalgesic measures administered with a gentle touch can
change of position, quiet music or
lessen discomfort and augment therapeutic effects of
conversation. 5ncourage use of
analgesics. Patient involvement in pain control measures
relaxation@breathing exercises.
promotes independence and enhances sense of well$being.
&ffer frequent oral hygiene.
;outh breathing and oxygen therapy can irritate and dry out mucous membranes, potentiating general discomfort.
nstruct and assist patient in chest splinting
Aids in control of chest discomfort while enhancing
techniques during coughing episodes.
effectiveness of cough effort.
Administer analgesics and antitussives as
*hese medications may be used to suppress
indicated.
nonproductive@paroxysmal cough or reduce excess mucus, thereby enhancing general comfort@rest.
Ac t i v i t yI nt ol er anc e Nur si ngDi agnosi s:Ac t i v i t yi nt ol er anc e
Ma yber e l a t e dt o •
I mbal ancebet weenoxy gensuppl yanddemand
•
Gener alweakness
•
Ex haus t i onas soc i at edwi t hi nt er r upt i oni nus ual s l eeppat t er nbec aus eofdi s comf or t , e x c e s s i v ec ou gh i n g,a ndd y s pn ea
Possi bl yevi dencedby •
Ver bal r epor t sofweak nes s,f at i gue,e xhaus t i on
•
Ex e r t i onal dy s pnea,t a ch ypnea
•
T ac hy car di ai nr es pons et oac t i v i t y
•
De v el opment / wor s eni ngofpal l or / c y an os i s
Desi r edOut comes •
Repor t / d emon st r at eame as ur abl ei nc r ea sei nt ol er anc et oac t i v i t ywi t hab senc eofd ys pnea andex ces si v ef at i gue,andv i t al s i gnswi t hi npat i ent ’ sac cept abl er ange. 'ursing Inter+entions
Rationale
5valuate patient
5stablishes patient
reports of dyspnea, increased
of interventions.
weakness@fatigue, and changes in vital signs during and after activities.
Provide a quiet environment and limit visitors
8educes stress and excess stimulation, promoting rest
during acute phase as indicated. 5ncourage use of stress management and diversional activities as appropriate.
5xplain importance of rest in treatment plan
Bedrest is maintained during acute phase to decrease
and necessity for balancing activities with rest.
metabolic demands, thus conserving energy for healing. Activity restrictions thereafter are determined by individual patient response to activity and resolution of respiratory insufficiency.
Assist patient to assume comfortable position
Patient may be comfortable with head of bed elevated,
for rest@sleep.
sleeping in a chair, or leaning forward on overbed table with pillow support.
Assist with self$care activities as necessary.
;inimi9es exhaustion and helps balance oxygen supply and
Provide for progressive increase in activities
demand.
during recovery phase. and demand.
Ri s kf orI nf ec t i on Nur si ngDi agnosi s: Ri s kf or[ Spr ead]ofI nf ec t i on
Ri s kf a ct or sma yi nc l ude •
I nadequat epr i mar ydef ens es( dec r eas edc i l i ar yac t i on,s t as i sofr es pi r at or ysec r e t i ons )
•
I nadequat es ec ondar ydef ens es( pr es en ceofe xi s t i ngi nf ec t i o n,i mmun os uppr es s i o n) , c hr oni cdi s eas e,mal nut r i t i on
Desi r edOut comes •
Ac hi ev et i mel yr es ol ut i onofc ur r enti nf ec t i onwi t houtc ompl i c at i ons .
•
I dent i f yi nt er v ent i onst opr ev ent / r educ er i s k/ s pr eadof / s ec ondar yi nf ec t i on. 'ursing Inter+entions
Rationale
;onitor vital signs closely, especially during
+uring this period of time, potentially fatal complications
initiation of therapy.
(hypotension@shock) may develop.
nstruct patient concerning the disposition of
Although patient may find expectoration offensive and attempt
secretions (e.g., raising and expectorating
to limit or avoid it, it is essential that sputum be disposed of in
versus swallowing) and reporting changes in
a safe manner. Changes in characteristics of sputum reflect
color, amount, odor of secretions.
resolution of pneumonia or development of secondary infection.
+emonstrate@encourage good handwashing
5ffective means of reducing spread or acquisition of infection.
technique.
Change position frequently and provide good
Promotes expectoration, clearing of infection.
pulmonary toilet.
#imit visitors as indicated.
8educes likelihood of exposure to other infectious pathogens.
nstitute isolation precautions as individually
+ependent on type of infection, response to antibiotics,
appropriate.
patient
5ncourage adequate rest balanced with
'acilitates healing process and enhances natural resistance.
moderate activity. Promote adequate nutritional intake.
;onitor effectiveness of antimicrobial therapy.
%igns of improvement in condition should occur within 2L2G hr.
nvestigate sudden changes@deterioration in
+elayed recovery or increase in severity of symptoms
condition, such as increasing chest pain, extra
suggests resistance to antibiotics or secondary infection.
heart sounds, altered sensorium, recurring
Complications affecting any@all organ systems include lung
fever, changes in sputum characteristics.
abscess@empyema, bacteremia, pericarditis@endocarditis, meningitis@encephalitis, and superinfections.
Prepare for@assist with diagnostic studies as
'iberoptic bronchoscopy ('&B) may be done in patients who
indicated.
do not respond rapidly (within 0L" days) to antimicrobial therapy to clarify diagnosis and therapy needs.
De fi c i e ntKn owl e dg e Nur si ngDi agnosi s:Defi c i entKnowl edger egar di ngc ondi t i on,t r eat ment ,s el f c ar e,anddi s char ge needs
Ma yber e l a t e dt o •
La c kofe x po su r e
•
Mi s i nt er pr et at i onofi nf or mat i on
•
Al t er edr ec al l
Possi bl yevi dencedby •
Reques t sf ori nf or mat i on;s t at ementofmi s c onc ept i on
•
Fai l ur et oi mpr o ve/ r ec ur r enc e
Desi r edOut comes
•
Ver bal i z eunder s t andi ngofc ondi t i on,di s eas epr oc es s ,andpr ognos i s .
•
Ver bal i z eunder s t an di ngoft h er apeu t i cr egi men.
•
I ni t i at enec es sar yl i f es t y l ec hanges .
•
Par t i c i pat ei nt r eat mentpr ogr am. 'ursing Inter+entions
Rationale
8eview normal lung function, pathology of
Promotes understanding of current situation and
condition.
importance of cooperating with treatment regimen.
+iscuss debilitating aspects of disease, length of
nformation can enhance coping and help reduce anxiety
convalescence, and recovery expectations. dentify
and excessive concern. 8espiratory symptoms may be
self$care and homemaker needs@resources.
slow to resolve, and fatigue and weakness can persist for an extended period. *hese factors may be associated with depression and the need for various forms of support and assistance.
Provide information in written and verbal form.
'atigue and depression can affect ability to assimilate information@follow medical regimen.
%tress importance of continuing effective
+uring initial !LG wk after discharge, patient is at greatest
coughing@deep$breathing exercises.
risk for recurrence of pneumonia.
5mphasi9e necessity for continuing antibiotic
5arly discontinuation of antibiotics may result in failure to
therapy for prescribed period.
completely resolve infectious process
8eview importance of cessation of smoking.
%moking destroys tracheobronchial ciliary action, irritates bronchial mucosa, and inhibits alveolar macrophages, compromising body
&utline steps to enhance general health and well$
ncreases natural defenses@immunity, limits exposure to
being, e.g., balanced rest and activity, well$rounded
pathogens.
diet, avoidance of crowds during cold@flu season and persons with 38s.
%tress importance of continuing medical follow$up
;ay prevent recurrence of pneumonia and@or related
and obtaining vaccinations@immuni9ations as
complications.
appropriate.
dentify signs@symptoms requiring notification of
Prompt evaluation and timely intervention may
healthcare provider, e.g., increasing dyspnea, chest pain, prolonged fatigue, weight loss, fever@chills, persistence of productive cough, changes in mentation.
prevent@minimi9e complications.
