Steps to take immediately in order to treat pneumonia
When assessing whether a pneumonia patient's condition may be life-threatening, begin with the "A, B, C, Ds," says Amanda Person, RN, an ED nurse at Methodist North Hospital in Memphis, TN:
- Airway. "Assess the patient's ability to speak clearly," says Person. "If the patient's speech is easily audible, that gives you a lot of information about their ability to maintain their own airway. This also helps to determine dyspnea. Look for excess oral secretions."
- Breathing. Assess for low oxygen saturation, increased respiratory effort, increased or decreased respiratory rate. "This assessment is crucial to determine if the patient is in impending respiratory failure or respiratory arrest," says Person.
- Circulation. "Look for signs of shock or decreased cardiac output," says Person. Assess for tachycardia, hypotension, increased capillary refill time, diminished peripheral pulses, and pale or cool skin.
- Disability: Assess for altered level of consciousness. "Objectively determine if the patient is alert or lethargic," says Person. "Question the patient for orientation to person, place, time, and situation."
If pneumonia is suspected and a bed isn't immediately available, Methodist's ED nurses initiate the following protocol:
- Obtain a stat chest X-ray.
- Obtain a complete blood count, complete metabolic panel, serum lactate, and blood cultures every five minutes taken from two sites.
These lab results can confirm suspected pneumonia with evaluation of the white blood cell count and differential, such as leukocytosis or bandemia. "Serum lactate is obtained to determine if the patient may be in septic shock," adds Person. Also, blood cultures before antibiotic administration are critical so that appropriate antibiotics may be given for severe infection.
- Administer azythromycin 500 mg orally if pneumonia is confirmed by the ED physician and venous antibiotics are not yet possible. "Supplemental oxygen is also administered if indicated," says Person.
The protocols used by ED nurses at Methodist's ED expedite identification of patients with pneumonia, speeding diagnostic tests and antibiotics. Otherwise, the delay in diagnosis and treatment is "directly related to the amount of time the patient must wait for a bed assignment," says Person. "In times of boarding or very high census, this wait can be hours."
Using complaint-based protocols also identifies patients who might be much sicker than initially suspected by the triage assessment. "Precious ED beds can be given to those who are truly in the most dire need," says Person.
When assessing whether a pneumonia patient's condition may be life-threatening, begin with the "A, B, C, Ds," says Amanda Person, RN, an ED nurse at Methodist North Hospital in Memphis, TN:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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