Assessment Findings and Diagnostics

Classic pneumonia presents with fever, productive cough with purulent or rust-colored sputum, pleuritic chest pain, crackles or diminished breath sounds over the affected area, and tachypnea. Older adults often present atypically with confusion, lethargy, or falls rather than fever, which can delay diagnosis if the nurse doesn't consider pneumonia in an elderly client with new confusion. Chest X-ray confirms consolidation, sputum culture identifies the causative organism to guide antibiotic therapy, and elevated WBC count supports a bacterial infection. Pulse oximetry and ABGs assess the degree of hypoxemia, guiding oxygen therapy needs and determining severity of illness.

Treatment Priorities

Antibiotic therapy is guided by whether the pneumonia is community-acquired, hospital-acquired, or ventilator-associated, since hospital-acquired pneumonia involves higher risk of resistant organisms and requires broader-spectrum coverage. Nursing priorities include promoting airway clearance through coughing and deep breathing exercises, incentive spirometry, adequate hydration to thin secretions, and positioning to maximize ventilation, typically semi-Fowler's or high-Fowler's. Oxygen therapy is titrated to maintain adequate saturation, and antipyretics manage fever. Teach clients to complete the entire antibiotic course even if feeling better, since incomplete courses contribute to antibiotic resistance and treatment failure.

Aspiration Pneumonia and Prevention

Aspiration pneumonia occurs when oral or gastric contents enter the lungs, common in clients with dysphagia, decreased level of consciousness, or those who are NPO but not properly monitored. Prevention includes elevating the head of the bed to at least 30-45 degrees during and after meals or tube feedings, checking swallow function before oral intake in post-stroke clients, and thickening liquids as ordered by speech therapy evaluation. The pneumococcal and influenza vaccines are recommended for older adults, immunocompromised clients, and those with chronic respiratory disease to prevent pneumonia altogether, an important primary prevention teaching point tested on health promotion questions.