Nursing Management of Pneumonia
Nurses should provide comprehensive care for pneumonia patients including oxygen therapy, medication administration, condition monitoring, nutritional support, and infection prevention measures to reduce mortality and improve outcomes. 1
Assessment and Monitoring
Vital Signs Monitoring
- Monitor respiratory rate (maintain below 25 breaths/min) 1
- Check oxygen saturation (SpO₂) regularly (target >92%) 1, 2
- SpO₂ <90% is a clinical emergency
- SpO₂ <94% indicates possible hypoxia requiring oxygen therapy
- Monitor temperature, blood pressure, and heart rate 1
- Assess for complications including ARDS, septic shock, DVT 1
Laboratory Monitoring
- Monitor infection indicators 1
- Track water-electrolyte balance and acid-base balance 1
- Monitor organ function 1
Oxygen Therapy
Mild Cases
- Administer oxygen via nasal catheter or mask 1
- Adjust flow rates according to patient's condition and provider's instructions 1
- Ensure SpO₂ remains above 92% 1, 2
Severe Cases
- For critically ill patients, implement sequential oxygen care using:
- High-flow nasal oxygen (HFNO)
- Non-invasive ventilation (NIV)
- Invasive mechanical ventilation as needed 1
- Position patients appropriately to optimize oxygenation 1
- For moderate to severe ARDS, use prone positioning with invasive mechanical ventilation 1
Medication Administration
Antibiotics
- For mild pneumonia in children under 5 years: administer amoxicillin as first choice 1
- For older children (5+ years): consider macrolide antibiotics (e.g., azithromycin) 1
- For adults with community-acquired pneumonia: administer prescribed antibiotics, typically:
- Monitor for and report adverse reactions:
Symptomatic Treatment
- Administer antipyretics and analgesics to keep patients comfortable and help with coughing 1
- Administer antiemetics as needed to prevent aspiration 1
Infection Prevention
Isolation Precautions
- Implement appropriate isolation measures based on infection type 1
- Ensure proper room setup with clean and contaminated areas clearly marked 1
- Limit visitors and use appropriate PPE 1
Prevention of Secondary Infections
- Perform oral care and skin care regularly 1
- Follow aseptic techniques for all procedures 1
- Prevent ventilator-associated pneumonia, catheter-related sepsis, and urinary tract infections 1
- Remove indwelling catheters as soon as possible 1
Nutritional Support
- Provide high-protein, high-vitamin, carbohydrate-containing diets 1
- For patients who can eat: recommend eggs, fish, lean meat, milk 1
- For patients unable to eat: provide enteral nutrition when possible 1
- For patients incompatible with enteral nutrition: administer parenteral nutrition 1
Additional Nursing Interventions
Positioning and Mobility
- Encourage early mobility to prevent pneumonia complications 1
- Implement proper positioning to optimize respiratory function 1
- For severe cases requiring prone positioning, follow standard operating procedures 1
Psychological Support
- Respond promptly to patient questions 1
- Provide positive encouragement to reduce anxiety and fear 1
- Implement psychological techniques like mindfulness-based stress reduction for awake patients 1
Special Considerations
Chest Physiotherapy
- Chest physiotherapy is not beneficial and should not be performed in children with pneumonia 1
- For critically ill patients, minimize handling to reduce metabolic and oxygen requirements 1
Home Care Instructions
- Educate patients to monitor body temperature and respiratory symptoms 1
- Instruct patients to seek medical attention if temperature exceeds 38°C or breathing worsens 1
- Ensure home caregivers monitor their own temperature 1
Pitfalls to Avoid
- Do not delay oxygen therapy when SpO₂ falls below 94% 2
- Avoid unnecessary indwelling catheters to prevent UTIs 1
- Be aware that factors such as anemia, peripheral vasoconstriction, and dark skin tone may affect SpO₂ readings 2
- Do not perform chest physiotherapy in children with pneumonia as it is not beneficial 1
- Recognize that pneumonia presentation may differ in children and elderly (headache, nausea, abdominal pain) 5