Pneumonia is a serious lung infection that causes the air sacs, or alveoli, to become inflamed and fill with fluid or pus. For bedridden or immobile patients, the risk of developing this condition increases significantly due to the effects of gravity on the body. Prolonged stillness allows secretions to pool in the lower lobes of the lungs, a condition known as hypostatic pneumonia. This lack of movement also leads to shallow breathing, which prevents the full expansion of the lungs and compromises the natural clearance of mucus. Another threat is the silent aspiration of bacteria from the mouth and throat, which can introduce infectious agents directly into the respiratory tract.
Managing Patient Positioning and Mobility
Physical positioning defends against the fluid stagnation that encourages infection. Caregivers should implement a strict turning schedule, repositioning the patient every two hours, often utilizing a slight tilt to the side. This passive movement redistributes air and blood flow, preventing respiratory secretions from settling consistently in one area of the lungs. Regular rotation helps mobilize mucus and allows gravity to assist the body’s natural drainage mechanisms.
Maintaining an elevated torso supports lung function and reduces the risk of breathing difficulties. The Semi-Fowler’s position involves raising the head of the bed to an angle between 30 and 45 degrees. This elevation allows abdominal organs to shift downward, providing the diaphragm with more space to contract and enabling a deeper, more complete breath. This intervention improves ventilation and gas exchange in the deepest parts of the lungs.
Passive range-of-motion exercises contribute to overall respiratory wellness by promoting circulation. Even minor movements of the limbs help stimulate the patient, reducing the general deconditioning that contributes to shallow breathing. Incorporating these small, consistent movements throughout the day provides a mechanical stimulus that supports the mobilization of secretions and maintains muscle tone.
Implementing Respiratory Clearance Techniques
Patients who are able should perform regular deep breathing exercises. Sustained maximal inspiration (SMI) involves taking a slow, deep breath in, holding it for a few seconds to fully expand the alveoli, and then exhaling slowly. This action helps inflate collapsed lung tissue and encourages the movement of mucus toward the larger airways for expulsion.
An incentive spirometer guides the patient through the deep breathing process. The patient slowly inhales through a mouthpiece, causing a piston or ball to rise within a chamber, indicating the volume of air inhaled. The goal is to keep the ball elevated for several seconds, ensuring the inhalation is slow and maximal to reach and open the deepest lung passages. These exercises should be performed ten times every hour while the patient is awake to maintain consistent lung aeration.
For patients who have secretions but struggle to cough them up effectively, assisted coughing, or splinting, can make the process less painful and more productive. This technique involves applying firm pressure to the chest wall or abdomen during the forced exhalation phase of a cough. The physical support helps stabilize the trunk and maximize the force of the cough. If a patient cannot perform this action, a healthcare professional may employ techniques like chest percussion or vibration to mechanically dislodge the pulmonary secretions.
Strict Infection and Oral Hygiene Protocols
Meticulous hygiene is a powerful preventive measure against aspiration pneumonia. Caregivers must rigorously adhere to hand hygiene protocols, washing their hands with soap and water for at least 20 seconds before and after every interaction. This measure prevents the transfer of infectious agents to the patient’s immediate environment.
The mouth is a reservoir for bacteria, and poor oral care allows these microbes to multiply rapidly. Teeth, gums, and the tongue must be thoroughly brushed at least twice a day, or ideally after every meal, using a soft-bristled toothbrush. Cleaning should involve all surfaces, including the roof of the mouth and the inside of the cheeks.
In high-risk cases, the use of an antiseptic oral rinse, such as one containing chlorhexidine, can reduce the bacterial concentration. For patients with a compromised cough or gag reflex, use a suction-toothbrush or have suction readily available during the cleaning process. This ensures that contaminated secretions are removed immediately and not inadvertently aspirated into the lungs during the procedure.
Minimizing Aspiration Risk During Feeding
Aspiration is a leading cause of pneumonia in this population. The patient must be positioned fully upright for all oral intake, with the trunk elevated to a 90-degree angle. This posture uses gravity to direct food toward the esophagus and stomach, rather than allowing it to fall back toward the trachea.
Monitoring for signs of dysphagia, or difficulty swallowing, is essential during mealtimes. Caregivers must watch for symptoms that indicate the patient is at high risk for aspirating material:
- Coughing or choking during or immediately after a swallow.
- A gurgly or “wet” sounding voice.
- The “pocketing” of food in the cheeks.
The pace of feeding must be controlled, ensuring that only small bites are offered, and the patient’s mouth is completely clear before the next spoonful. Diet modifications, such as thickening liquids or pureeing solid foods, may be necessary to allow for control during swallowing. After the meal, the patient must remain in an upright position for a minimum of 30 minutes to allow for gastric emptying, reducing the chance of stomach contents refluxing and being inhaled.