STUDY GUIDE
PNEUMONIA
Respiratory NursingSOS
LEGAL DISCLAIMER: This study guide is intended for educational purposes only. This is not medical advice and errors
may occur. Never treat a patient or make a nursing or medical decision based solely on the information provided in
this study guide. Never practice nursing or medicine unless you have a proper license to do so.
PNEUMONIA
STUDY GUIDE
DEFINITION
Infection and inflammation of the lungs.
PATHOPHYSIOLOGY
STEP 1: Invasion of a Pathogen or Other Irritant
This can be a bacteria, a virus or fungi, or it can be caused by an invasion of
chemicals or something else that causes irritation of the lungs.
STEP 2: The Inflammatory Response is Triggered
The blood vessels dilate and the blood vessel walls actually separate and become
leaky (which is called capillary leak).
STEP 3: Capillary Leak
The blood vessel walls separate so the white blood cells can move from the blood
and into the tissues to fight off the pathogen.
STEP 4: Edema & Exudate Build Up Inside the Lungs
With all that capillary leak, a lot of fluid moves from the blood vessels, into the lungs,
along with the white blood cells fighting to get rid of those pathogens. This causes a
lot of exudate or debri build up inside the lungs (all of those dead pathogens and
white blood cells).
STEP 5: Reduced Gas Exchange
But with all this fluid and debri build up inside the lungs, gas exchange in the lungs
is reduced. Respiratory acidosis is possible because of all of that carbon dioxide
build up in the body, which causes the blood to become acidic.
STEP 6: Atelectasis
This is where the alveoli collapse. When atelectasis occurs, it further impairs the
lungs ability to do gas exchange.
STEP 7: Sepsis
Sepsis is possible if the pathogen moves into the blood stream.
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Respiratory NursingSOS
SIGNS & SYMPTOMS
These are all related to the inflammatory process due to the
infection, causing decreased gas exchange and lack of oxygen.
The signs and symptoms of pneumonia fall into 2 major categories: lack of oxygen
and infection.
Lack of Oxygen Signs & Symptoms:
Increased Respiratory Rate
The respiratory rate increases to compensate for the lack of oxygen in the blood.
Increased Heart Rate
The heart rate increases to compensate for the lack of oxygen in the blood.
Decreased Oxygen Saturation
Gas exchange will decrease because gas exchange is decreased, the lungs can't get
oxygen in or out as effectively.
Mental Status Changes
Confusion, disorientation, or other neurological changes can occur because the
brain isn't getting the oxygen it needs.
Labored Breathing & Accessory Muscle Use
You might see their shoulders go up and down, or their nostrils flare as they
breathe, or it just looks like they're having a difficult time breathing. Their body isn't
getting the oxygen it needs, so all of those muscles are trying to help the lungs
expand more to get more air.
Infection Signs & Symptoms:
Increased Temperature
The body temperature elevates to try to kill the pathogen.
Adventitious Breath Sounds
All of the debri and fluid in the lungs can cause the airways to narrow, leading to
crackles or wheezes or other adventitious breath sounds.
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PNEUMONIA
STUDY GUIDE
Productive Cough
mucous and sputum can come up during coughing, as the body is trying to get rid of
the fluid, exudate and debri from the lungs.
Pleuritic Pain
All of the coughing, and build up in the lungs can cause pain in the chest.
NURSING ASSESSMENT
Full Respiratory Assessment
You will need to do a full respiratory assessment, and especially look for: signs of a
lack of oxygen, such as: an increased respiratory rate (otherwise known as
tachypnea), increased heart rate, decreased oxygen saturation, mental status
changes, and labored breathing or accessory muscle use.
Assess for Infection
Check for an increased temperature, wheezes/crackles or other adventitious breath
sounds, a productive cough, and pain in the chest while breathing or coughing (this
is called pleuritic pain).
IV Site
Make sure they have an IV in place and that it is open (patent) and ready to go in an
emergency.
IV Lines & Oxygen Lines
Make sure they are set correctly and flowing properly.
Lifestyle Factors
Ask them about their diet and exercise habits, and if they smoke or not. Smoking
can make pneumonia worse, so you'll need to ask if they smoke or not, how much,
and how often.
NURSING INTERVENTIONS
Increasing fluids, mild activity, and controlled coughing will help
to break up the mucous, and open up the alveoli, increasing gas
exchange.
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Respiratory NursingSOS
Continue to Assess
Do a full respiratory assessment. Look for decreased oxygenation and signs of
worsening infection, and assess the amount, color, and consistency of sputum if
they have a productive cough.
Give Medications
Medications may be given to help increase gas exchange. Expect medications like
bronchodilators to expand the airways and increase oxygenation, mucolytics to
break up all that gunk inside the lungs, and antibiotics to help kill the bacterial
pathogen and fight the infection.
Ensure Proper Positioning
A semi-Fowler's position is best to promote increased oxygenation, and you'll also
need to make sure they walk around a bit regularly and change positions frequently.
This movement helps to prevent the mucous and fluid inside the lungs from
stagnating.
Encourage Incentive Spirometer Use
Using the incentive spirometer frequently will help them expand their lungs, get
more oxygen, and help get rid of the mucous and fluid inside.
Encourage Controlled Coughing
Controlled coughing helps to expel the excess mucous. To do this, have your patient
take a few breaths with their lips pursed and on the last breath, cough a few times
while they hold a pillow against their abdomen. Have them do this a few times a
day, but especially before bedtime so they have clearer lungs while they sleep, and
have them do it again right when they get up in the morning to clear out some of
the overnight mucous and gunk that accumulates.
Encourage Fluid Intake
Increasing fluids will help to thin out respiratory secretions.
Promote Rest
Rest will help their body be able to fight off the infection better.
Encourage Mild Activity
Frequent position changes or mild activity will help break up the mucous and gunk
that accumulates inside the lungs.
