If your patient has pneumonia you’ll need to be vigilant about monitoring their symptoms, documenting your observations and administering treatments like humidified oxygen when needed.

nursing interventions of pneumonia

1. Monitor the patient’s respiratory rate, rhythm and depth.

To assess the effectiveness of treatment, you will monitor the patient’s respiratory rate. Because every patient is different, monitoring your own rhythm and depth can help you to make sure that your own breathing matches theirs.

2. Listen for adventitious breath sounds, such as crackles, wheezes and rhonchi.

• Listening to breath sounds
• Chest auscultation
• Lungs auscultation
• Breath sounds
• Breathing patterns

3. Assess the patient’s breath sounds with a bell or diaphragm of the stethoscope.

• Listen to the patient’s chest for abnormal breath sounds.
• Listen for adventitious breath sounds, such as crackles, wheezes and rhonchi.
• Listen for decreased breath sounds.
• Listen for increased breath sounds.
• Listen for diminished breath sounds.

4. Assess the patient’s skin color and temperature.

• Assess the patient’s skin color and temperature.

Skin color changes can indicate that the patient is experiencing hypoxemia or other problems with blood flow, such as shock. In addition to looking at the patient’s normal skin color, check for cyanosis or pallor (a bluish tinge to their skin). This indicates low oxygen levels in the blood.

Taking a person’s temperature is easy: just place a thermometer under their armpit and wait until it beeps! If you don’t have a thermometer handy, you could use your hand instead; if you’re feeling chilly to the touch then it means they’re running a high fever

5. Assess the patient’s mental status.

• Assess the patient’s mental status.
• Check orientation, memory, language and attention. Use AVPU scale: Alertness: Can you open your eyes? Verbalization: Can you talk to me? Pain response: Does this hurt? (Use a “yes” or “no”). Responsiveness to voice stimuli; i.e., verbal commands may be able to understand them.
• Check the patient’s ability to follow commands and communicate needs or wants verbally with you in English; if not English-speaking, assess for ability to communicate needs or wants nonverbally (with gestures).

6. Measure and record the patient’s body temperature at least every four hours.

• You should measure and record the patient’s body temperature at least every four hours.
• The morning is the best time to take the temperature, before any breakfast or activity.
• Take the body temperature in a quiet room where you can easily see it clearly.
• If you used an infant scale first, then use an adult scale next—don’t mix-up your measurements!

7. Note fluctuations in blood pressure, pulse rate, respirations and level of consciousness, as well as fever and cough patterns.

Note fluctuations in blood pressure, pulse rate, respirations and level of consciousness, as well as fever and cough patterns. If auscultation reveals abnormal breath sounds, administer humidified oxygen as prescribed to improve gas exchange. If the patient is having difficulty breathing, administer oxygen as prescribed.

8. If auscultation reveals abnormal breath sounds, administer humidified oxygen as prescribed to improve gas exchange.

• A high-flow nasal cannula (HFNC) is a device that delivers heated and humidified oxygen through a nasal catheter. HFNC can help to decrease secretions and mucus, prevent atelectasis, improve gas exchange, protect the airway from trauma, decrease the need for sedation or paralytic medications during transport to an emergency department, as well as reduce patient anxiety by providing comfort via warmth of the gas delivered.
• A mask is another form of supplemental oxygen delivery method; this allows humidification but not temperature control.

9. When caring for a patient with pneumonia you need to be vigilant about monitoring their symptoms, documenting your observations and administering treatments like humidified oxygen when needed

As a nurse, you must be vigilant about monitoring your patient’s symptoms, as well as documenting and administering treatments like humidified oxygen when needed. To monitor for respiratory rate, rhythm and depth:

• Monitor the respiratory rate by counting how many breaths per minute your patient is taking.
• Listen for adventitious breath sounds such as crackles and wheezes that may indicate pneumonia. You can also listen with a bell or diaphragm of the stethoscope to assess breath sounds.

Closing

We hope this article has helped you to better understand the nursing interventions for pneumonia. As always, we encourage you to continue learning about all aspects of nursing care so that you can provide the best possible treatment and assistance to your patients.