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Bacterial Pneumonia Nursing Guide

This clinical guide provides a quick reference for understanding bacterial pneumonia, emphasizing nursing considerations using the nursing process. 

Copy reviewed by Ann Dietrich, MD, FAAP, FACEP. 

Bacterial Pneumonia Etiology and Epidemiology 

Bacterial pneumonia is an infection of the lungs that can range from mild to life-threatening. The most common causative bacterium is Streptococcus pneumoniae (Gamache, 2020a). Other causative bacteria include:  

Transmission Routes: 

  • Inhalation 
  • Aspiration 
  • Hematogenous route 

Classifications: 

  • Community-acquired pneumonia (CAP): Contracted within the community. 
  • Hospital-acquired pneumonia (HAP): Contracted in healthcare settings by nonintubated patients after 48 hours of hospitalization.  
  • Ventilator-Associated Pneumonia (VAP): Contracted post-ventilator use. 
  • HCAP (healthcare-associated pneumonia) is included in the spectrum of HAP and VAP (ventilator-associated pneumonia). Patients with HCAP need therapy for MDR pathogens contracted in healthcare settings such as acute care, assisted living, long-term care facilities and dialysis centers. 

Types of Bacteria 

CAP: 

Typical bacteria 

  • S. pneumoniae (most common bacterial cause) 
  • Haemophilus influenzae 
  • Moraxella catarrhalis 
  • Staphylococcus aureus 
  • Group A streptococci 
  • Enterobacteriaceae 

Atypical bacteria 

  • Mycoplasma pneumoniae 
  • Chlamydia trachomatis 
  • Chlamydophila pneumonia 

Viruses 

  • RSV 
  • Human metapneumovirus 
  • Parainfluenza  
  • Adenovirus 
  • Influenza A or B 

 Atypical Pneumonia (Walking Pneumonia): 

  • Mycoplasma species 
  • Chlamydophila species 
  • Legionella species 
  • Coxiella burnetii 
  • Bordetella pertussis 

HAP, HCAP, and VAP: 

  • Pseudomonas aeruginosa 
  • S aureus  
  • Klebsiella pneumoniae 
  • MSSA 
  • Escherichia coli 
  • Acinetobacter baumannii 
  • Moraxella catarrhalis 

Aspiration Pneumonia: 

  • K pneumoniae 
  • S pneumoniae 
  • H influenza 
  • S aureus 
  • K pneumoniae 
  • E coli 

ICD-10 Code for Bacterial Pneumonia: 

  • J15.9 (Unspecified bacterial pneumonia) 

Risk Factors for Bacterial Pneumoniae: 

  • Recent infections (e.g., cold, flu, viral pneumonia) 
  • Comorbidities (e.g., lung disease, asthma, heart disease, diabetes, HIV/AIDS) 
  • Weakened immune system 
  • Age (children under 2 and adults over 65) 
  • Malnourishment 
  • Exposure to chemicals, pollutants, or toxic fumes 
  • Smoking 
  • Excessive alcohol use 
  • Acute care (ventilator use, recent surgery, sedation, intubation) 
  • Aspiration risks (e.g., stroke, seizure, weakened gag reflex) 

Bacterial Pneumonia Symptoms: 

  • Fever (up to 105°F) 
  • Chills with shivering 
  • Excessive sweating 
  • Sharp or stabbing chest pain 
  • Productive cough with yellow, green, or bloody secretions 
  • Tachycardia 
  • Tachypnea 
  • Dyspnea 
  • Fatigue 
  • Confusion (especially in older adults) 
  • Anorexia 
  • Cyanosis of lips and nails 

Complications: 

  • Respiratory failure 
  • Bronchiectasis 
  • Pulmonary abscess 
  • Superinfection 
  • Necrotizing pneumonia 
  • Parapneumonic pleural effusions 
  • Empyema 
  • Ventilator dependence 
  • Acute respiratory distress syndrome (ARDS) 
  • Meningitis 
  • Death 

Bacterial Pneumonia Diagnosis 

Diagnosis includes: 

  • Imaging: 
    • Chest x-ray 
    • CT scan 
  • Laboratory Tests: 
    • CBC with differential 
    • Chemistry panel 
    • Arterial blood gas (ABG) 
    • Pleural fluid culture 
    • Sputum gram stain and culture 
    • Bronchoscopy 
    • Pulse oximetry 

Bacterial Pneumonia Management 

Management includes: 

  • Medications: 
    • Antibiotics (based on bacteria) 
    • Analgesics 
    • Antipyretics 
    • Intravenous (IV) fluids 
    • Oxygen supplementation 
  • Therapies: 
    • Chest physiotherapy 
    • Mechanical ventilation 
    • Cardiac monitoring 

Bacterial Pneumonia Nursing Care Plan

Assessment 

  • History: 
    • Past/present health conditions 
    • Current symptoms 
    • Medication history 
    • Surgical history 
    • Recent social habits (e.g., exposure to illness, smoking) 
  • Physical Examination: 
    • Tachycardia, tachypnea, dyspnea 
    • Lung sounds (rhonchi, rales, wheezing, egophony, tracheal deviation, dullness on percussion, diminished breath sounds, accessory muscle use, pleural friction rub, lymphadenopathy) 
    • Low oxygen saturation 
    • Weakness, anorexia 
    • Altered level of consciousness, disorientation, decreased cognition, confusion 

Nursing Diagnoses/Patients at Risk For 

  • Deficient knowledge of disease and disease processes 
  • Electrolyte imbalance 
  • Fatigue 
  • Altered levels of consciousness 
  • Acute confusion 
  • Deficient fluid volume 
  • Imbalanced fluid volume 
  • Unstable blood pressure 
  • Imbalanced nutrition 
  • Impaired gas exchange 
  • Ineffective breathing pattern 
  • Falls 
  • Injury 

Interventions 

  • Monitor vital signs, levels of consciousness, efficacy of treatment, input and output, respiratory status, pulse oximetry (oxygenation), cardiac status, ABG 
  • Provide comfort measures and therapies as ordered (medications, IV fluids, oxygen) 
  • Provide cool mist humidification 
  • Increase fluid intake 
  • Encourage chest physiotherapy (manual and/or vest) 
  • Encourage deep breathing and coughing 
  • Suction if needed 
  • Encourage ambulation if possible 
  • Maintain fall precautions 

Note: Do not encourage cough suppression; coughing aids in moving and removing excess fluid in the lungs (American Lung Association, 2021b). 

Expected Outcomes 

  • Reduction of symptoms 
  • Vital signs within a normal clinical range 
  • Respiratory status improvement 
  • Lab values reflecting adequate respiratory and cardiac function 
  • Compliance with medication regimen 
  • Compliance with adequate fluid intake 
  • No report of new falls and/or injuries 

Individual/Caregiver Education 

  • Disease process and management 
  • Importance of fluid intake 
  • Home humidification 
  • Monitoring pulse oximetry if available 
  • Self-care measures (quiet space, relaxation techniques, deep breathing, ambulation, steamy bath/shower) 
  • Medication compliance 
  • Smoking cessation support 
  • Available vaccines (PCV13, PPSV23) 
  • Family and caregiver support for ADLs and monitoring symptoms 
  • Signs and symptoms to notify the provider (e.g., persistent headaches, increased confusion difficulty breathing, shortness of breath with activity) 

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2024

References

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