Legionnaire’s Disease

Legionnaire’s Disease Nursing Care Plans Diagnosis and Interventions

Legionnaire’s Disease NCLEX Review Care Plans

Nursing Study Guide on Legionnaire’s Disease

Legionnaire’s disease is a waterborne infection that causes a serious form of pneumonia.

The infective organism that causes legionnaire’s disease is a human pathogen called Legionella pneumophila.

Healthy people who contract legionella may not necessarily get sick, however, legionnaire’s disease can be serious with reports of one death per ten cases due to complications from the disease.

The bacterium legionella is rampant in freshwater environments, but once it reaches a building water system it may cause an infection outbreak.

Nearly 10,000 cases of legionnaire’s disease were reported in 2018 in US alone. However, it is believed that it is underdiagnosed hence the numerical data may not be the true estimate of the disease.

Incidence is generally higher during summer and early fall, but infection may happen any time of the year.

The bacterium legionella also causes Pontiac fever and extrapulmonary infections which are collectively referred to as legionellosis.

Legionella enters the body through inhalation of small water droplets containing the bacteria.

Signs and Symptoms of Legionnaire’s Disease

The signs and symptoms of Legionnaire’s disease often develop within 2-10 days of exposure to the bacteria (also called the incubation period).

However, in some cases, symptoms develop even longer than ten days hence it is advised to watch out for signs and symptoms for about two weeks after exposure.

The signs and symptoms of Legionnaire’s disease are similar to those of other types of pneumonia. The first symptoms may start of as follows:

  • Headache
  • Muscle aches
  • Fever of 40⁰ C or higher

After two to three days of the onset of the first signs and symptoms, the following may occur:

  • Cough – coughing may be productive with phlegm and, in some cases, may include hemoptysis or blood-streaked sputum
  • Shortness of breath
  • Chest pain
  • Gastrointestinal symptoms such as nausea, vomiting, and diarrhea
  • Confusion and any other mental changes

Causes of Legionnaire’s Disease

The main cause of Legionnaire’s disease is the pathogen legionella.

It is normally found in freshwater systems but rarely causes any infection when in an outside environment.

The potential for it to infiltrate human hosts is higher when the bacteria enters a man-made water source such as the following:

  • Showerheads and sink faucets
  • Cooling towers for air conditioning
  • Hot tubs with stagnant water
  • Decorative fountains and other water features
  • Hot water tanks and heaters
  • Large plumbing systems
  • Swimming pools
  • Birthing pools

The mode of transmission of legionella is through inhalation of water droplets containing the bacteria into the lungs.

Most common way of acquisition is through aspiration of liquids containing the bacterium.

However, other reports show infection through contact with contaminated soil after working in the garden and accidental aspiration of contaminated water when drinking.

The following are the risk factors for developing the infection:

  • Smoking – cigarette smoking damages the lungs and predisposes an individual to develop any type of infection.
  • Weak immune system – people on chemotherapy, radiotherapy, long-term steroids use, and having medical conditions causing low immune system may have higher predisposition to developing Legionnaire’s disease after infection.
  • Having chronic lung conditions or any other serious medical diseases – the presence of other chronic and serious medical conditions such as diabetes, liver diseases, and heart conditions weaken the body’s response to fight the infection.
  • Age 50 years and older

Complications of Legionnaire’s Disease

  1. Respiratory Failure. Respiratory failure may occur if the body cannot compensate to provide enough oxygen and excrete enough carbon dioxide.
  2. Septic Shock. Septic shock is a serious condition which occur when a severe drop in blood pressure causes significant reduction in blood flow. The heart will try to compensate by pumping blood harder causing it to weaken and cause further blood flow reduction.
  3. Acute kidney failure. Legionnaire’s disease can cause serious infection resulting to the loss of kidneys’ ability to filter waste in the blood from the body.

Diagnosis of Legionnaire’s Disease

  • Chest imaging. Images of the chest to confirm presence of pneumonia are taken in suspected people with legionnaire’s disease. Chest imaging is normally taken through X-rays.
  • Urine test. A simple urine sample can be used to identify the presence of Legionella bacteria by testing the sample for legionella.
  • Laboratory test of sputum sample or washing from the lung. These samples can be sent for testing to identify the presence of legionella bacteria. 

Treatment of Legionnaire’s Disease

  1. Antibiotics. Legionnaire’s disease is treated with a course of antibiotics. In most cases, antibiotic treatment with quinolones or macrolides is enough to fight the infection; however, the antibiotic needs to be prescribed and administered carefully as complications may still arise despite antibiotic treatment.
  2. Supplementary treatment. Other treatments to help manage the signs and symptoms may be provided in the hospital.
    1. Anti-pyretics may be administered for fever.
    1. Oxygen supplementation may also be helpful to aid the body maintain an adequate oxygen saturation.
    1. Hydration. Supplemental hydration through intravenous fluid may be required in patients who are unable to stay hydrated.

Nursing Care Plans for Legionnaire’s Disease

Nursing Care Plan 1

Nursing Diagnosis: Hyperthermia related to the disease process of Legionnaire’s disease as evidenced by temperature of 40 degrees Celsius, rapid and shallow breathing, flushed skin, and profuse sweating.

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

InterventionsRationales
Assess the patient’s vital signs at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Paracetamol) administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.Use the antibiotic to treat the bacterial infection, which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan 2

Ineffective Airway Clearance related to the disease process of Legionnaire’s disease as evidenced by shortness of breath, wheeze, SpO2 level of 85%, productive cough, difficulty to expectorate greenish phlegm

Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, have respiratory rates between 12 to 20 breaths per minutes, oxygen saturation above 96%, and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.
Encourage coughing up of phlegm. Suction secretions as needed. Perform steam inhalation or nebulization as required/ prescribed.To help clear thick phlegm that the patient is unable to expectorate.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within target range.
Administer the prescribed airway medications (e.g. bronchodilators) and antibiotic medications.Bronchodilators: To dilate or relax the muscles on the airways. Steroids: To reduce the inflammation in the lungs. Antibiotics: To treat bacterial infection.
Elevate the head of the bed and assist the patient to assume semi-Fowler’s position.Head elevation and proper positioning help improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan 3

Nursing Diagnosis: Alteration in comfort related to hyperthermia as evidenced by irritability and restlessness

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range and will verbalize feeling more comfortable.

InterventionsRationales
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed anti-pyretic medications.Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.
Provide a cooling blanket to the patient.To facilitate the body in cooling down and to provide comfort.

Nursing Care Plan 4

Nursing Diagnosis: Fluid Volume Deficit related to dehydration or diarrhea secondary to Legionnaire’s disease as evidenced by reduced skin turgidity, dark yellow urine output, profuse sweating, and blood pressure of 89/58.

Desired Outcome: Within 24 hours of nursing interventions, the patient will be able to achieve a normal fluid balance with absence of fever.

InterventionsRationales
Commence a fluid balance chart, monitoring the input and output of the patient.To monitor patient’s fluid volume accurately and effectiveness of actions to reverse dehydration.
Start intravenous therapy as prescribed. Encourage oral fluid intake as tolerated.To replenish the fluids lost from profuse sweating, and to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at bedside.To help the patient or the guardian take ownership of the patient’s care, encouraging them to drink more fluids as needed, or report any changes to the nursing team. 
Monitor patient’s serum electrolytes and recommend electrolyte replacement therapy (oral or IV) to the physician as needed.Sodium is one of the important electrolytes that are lost when a person is sweating. Hyponatremia or low serum sodium level may cause brain swelling.

Other possible nursing diagnoses:

  • Impaired Gas Exchange
  • Acute Pain
  • Diarrhea
  • Ineffective Breathing Pattern

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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