Pneumonia is an acute respiratory infection of the lung parenchyma caused by one or co-infecting pathogens. These pathogens cause the lung parenchyma (alveoli) to become inflamed and fill with pus and fluid, limiting oxygen intake and making gas exchange ineffective.
In these notes, we’ll be going over the Pneumonia Nursing Assessment, as well as the medical tests required to determine the severity. But before getting into that, make sure that you’ve understood the:
Pneumonia Nursing Assessment: Health History
As we mentioned above, for Pneumonia to develop, the patient would have had to come across a pathogen most likely of bacterial or viral form. These pathogens are contagious and can be transmitted to other individuals within close contact. Until the patient’s diagnosis and the pathogen is confirmed you should take droplet precautions, this will lower the chance of transmitting the pathogen to yourself or individuals around you.
Before approaching the patient it is advised to put on a disposable apron, gloves and surgical gloves. Start by introducing yourself to the patient, and find a private area to initiate the assessment. While talking to the patient keep a distance of 2 meters, and ask the patient to cover their nose and mouth when coughing. Once the patient is comfortable, you can start by asking about their Exposure to Risk Factors. Specific questions about the type, intensity and duration of exposure will give you a clear indication of where they might have contracted the pathogen, which in turn will help you to classify the type of Pneumonia. You might want to ask:
If the patient has been admitted to a hospital setting or healthcare clinic within the last 3 months.
If they are receiving any home-based care
Whether they’ve been in close contact with individuals who recently had respiratory infections
If they have any difficulty swallowing
You should also ask questions to evaluate the severity of your patient’s condition. Check if their symptoms are:
Disturbing their sleeping patterns and eating habits
Affecting their daily activities, work or sports
Next up, you should ask your patient about their past medical history specifically about any previous hospitalisation, respiratory conditions, including allergies, sinus infections or nasal polyps. This should also include their closest family relatives, so note down the patient’s family history concerning respiratory illnesses.
Lastly, you should ask questions to understand the patient’s knowledge as well as their social and familial support system. Once you’ve obtained a thorough medical history, you can move on to the physical assessment to get a better understanding of the patient’s physiological status.
Pneumonia Nursing Assessment: Physical Assessment
Before starting, take a quick look at your patient’s position, both when sitting and standing. If they have shortness of breath they might rest their hands onto their knees to support their breathing. Next up check their:
Temperature
Pulse
Oxygen Saturation
Blood pressure
Fingers for Central Cyanosis
Record everything onto the patient’s file and move on to assessing their Respirations:
Are their respirations forced?
Can the patient finish off a sentence in one breath?
Are they contracting their abdominal muscles, or using their shoulders during inhalation?
Is the expiration time prolonged?
Can you note any unusual breath sounds? (Wheezing/ Crackles)
Some patients will present with a Cough, if you note that it’s productive you should also assess their Sputum in terms of colour, amount and consistency.
You should also check their breath sounds to look for Lung Consolidation, this would be evident by Tactile Fremitus, Dull percussions, Bronchial breath sounds, Egophony and Whispered Pectoriloquy.
Along with the physical assessment, there’s a series of tests that the patient will be asked to perform. These tests will determine the severity of the disease and guide the medical team when selecting the treatment.
Pneumonia Nursing Assessment: Medical Tests
Sputum Sample: To reveal the pathogen involved in the infection
Blood Cultures: Similar to sputum samples, blood cultures reveal the involved pathogen and aid in the selection of pharmacological treatment.
Arterial Blood Gases check the baseline oxygenation and gas exchange. Respiratory alkalosis (low PaCo2) is the most common early finding in patients with ongoing asthma exacerbation because of hyperventilation
Chest X-ray will exclude any alternative diagnoses.
Summary:
In a few quick words, here is the Nursing Assessment for Pneumonia Patients
1. Health History
Assess if the patient has any risk factors, past medical and family history, the presenting symptoms and how they interfere with the patient’s life.
2. Physical Assessment
Assess the patient’s vital signs and check the patient’s respiratory patterns, cough and sputum.
3. Medical Tests
Sputum and blood cultures, ABGs, Chest X-ray.
If you follow those 3 steps, you should obtain a very thorough assessment for patients with Pneumonia. And if you want to know anything else just use the search button at the top or send me a message on my