Pneumonia: recognition and monitoring
Cough, fever, purulent sputum, pleuritic pain and localized crackles with reduced breath sounds over one area. The findings are localized, which is what distinguishes them from a diffuse process. In an older adult the presentation is frequently atypical: confusion, a fall, reduced appetite or functional decline, with little or no fever. A new confusion in an older adult is a reason to examine the chest. What to monitor and record at each shift: respiratory rate, oxygen saturation and the oxygen delivered with it, temperature, level of consciousness, and the ability to clear secretions. A saturation without the oxygen flow beside it is an uninterpretable number. Signs of deterioration to report: rising respiratory rate, saturation falling despite increased oxygen, new confusion, hypotension, decreasing urine output. These are the elements of a sepsis picture. Nursing interventions that shorten the course: mobilization and sitting up, deep breathing and effective coughing, adequate hydration to thin secretions, pain control so the client can breathe deeply, and mouth care, which reduces aspiration pneumonia more than most people expect. Give the antibiotic on time. The first dose in particular is timed and recorded.