Legionnaires’ disease is a severe form of pneumonia caused by Legionella bacteria. This nursing diagnosis focuses on the care and management of patients with Legionnaires’ disease, a potentially life-threatening condition that requires prompt and effective nursing interventions.
Causes (Related to)
Legionnaires’ disease is primarily caused by inhaling water droplets containing Legionella bacteria. The following are common risk factors and causes associated with Legionnaires’ disease:
- Exposure to contaminated water systems (air conditioning systems, cooling towers, hot tubs, large plumbing systems)
- Age over 50 years
- Smoking history
- Chronic lung disease
- Weakened immune system
- Recent hospitalization or stay in a long-term care facility
- Recent travel with exposure to contaminated water sources
Signs and Symptoms (As evidenced by)
Patients with Legionnaires’ disease may present with various signs and symptoms. During a physical assessment, a nurse may observe the following:
Subjective: (Patient reports)
- High fever (above 104°F or 40°C)
- Cough (may be dry or produce mucus)
- Shortness of breath
- Chest pain
- Gastrointestinal symptoms (nausea, diarrhea, vomiting)
- Headache
- Muscle aches
Objective: (Nurse assesses)
- Elevated body temperature
- Increased respiratory rate
- Decreased oxygen saturation
- Abnormal lung sounds (crackles, wheezes)
- Signs of respiratory distress
- Confusion or altered mental status
- Abnormal chest X-ray findings
- Elevated white blood cell count
- Positive urine antigen test for Legionella pneumophila serogroup 1
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for patients with Legionnaires’ disease:
- The patient will maintain adequate oxygenation (oxygen saturation > 92% on room air)
- The patient will demonstrate improved respiratory function and decreased work of breathing
- The patient will remain afebrile for 24 hours
- The patient will report reduced chest pain and discomfort
Nursing Assessment
The nursing assessment is crucial in identifying and managing Legionnaires’ disease. The following steps outline the assessment process:
- Obtain a detailed patient history
Focus on recent travel, exposure to potential sources of Legionella bacteria, and presence of risk factors. - Perform a thorough physical examination.
Assess respiratory rate, work of breathing, use of accessory muscles, and presence of cyanosis. - Auscultate lung sounds
Listen for crackles, wheezes, or other abnormal breath sounds indicative of pneumonia. - Monitor vital signs
Pay close attention to temperature, respiratory rate, heart rate, and blood pressure. - Assess oxygen saturation
Use pulse oximetry to monitor oxygen levels continuously. - Evaluate mental status
Assess for confusion, disorientation, or other changes in cognitive function. - Review laboratory results
Check white blood cell count, C-reactive protein, and other inflammatory markers. - Examine chest X-ray findings
Look for evidence of pneumonia, particularly unilateral infiltrates. - Review urine antigen test results.
A positive test for Legionella pneumophila serogroup 1 confirms the diagnosis. - Assess hydration status
Monitor fluid intake, urine output, and signs of dehydration.
Nursing Interventions
Effective nursing interventions are crucial in managing Legionnaires’ disease and promoting patient recovery. The following interventions should be implemented:
- Administer oxygen therapy as prescribed
Provide supplemental oxygen to maintain saturation levels above 92%. - Assist with respiratory treatments.
Help the patient with prescribed nebulizer treatments or inhalers to improve breathing. - Encourage deep breathing and coughing exercises.
Teach and assist the patient with techniques to clear secretions and improve lung expansion. - Administer prescribed antibiotics
Ensure timely administration of appropriate antibiotics, typically fluoroquinolones or macrolides. - Monitor fluid balance
Encourage oral fluid intake if possible and administer IV fluids as ordered to prevent dehydration. - Implement fever management techniques.
Administer antipyretics as prescribed and use cooling measures to reduce fever. - Provide positional support
Assist the patient in maintaining a semi-Fowler’s or high Fowler’s position to ease breathing. - Perform regular oral care
Maintain good oral hygiene to prevent secondary infections. - Monitor for complications
Watch for signs of respiratory failure, sepsis, or multiorgan dysfunction. - Educate the patient and family.
Provide information about Legionnaires’ disease, its treatment, and prevention strategies.
Nursing Care Plans
The following nursing care plans address common problems associated with Legionnaires’ disease:
Care Plan 1: Ineffective Breathing Pattern
Nursing Diagnosis: Ineffective Breathing Pattern related to inflammation and congestion of airways secondary to Legionnaires’ disease
Related factors: Inflammation of lung tissue, accumulation of secretions, fatigue
Nursing Interventions and Rationales:
- Assess respiratory rate, depth, and pattern every 2-4 hours
Rationale: Early detection of changes in respiratory status allows for prompt intervention - Position the patient in semi-Fowler’s or high-Fowler’s position
Rationale: Promotes optimal lung expansion and eases the work of breathing - Teach and assist with deep breathing and coughing exercises every 2 hours while awake
Rationale: Helps mobilize secretions and improve ventilation - Administer oxygen therapy as prescribed and monitor oxygen saturation
Rationale: Ensures adequate oxygenation and prevents hypoxemia - Assist with prescribed respiratory treatments (e.g., nebulizers, inhalers)
Rationale: Helps reduce airway inflammation and improves breathing
Desired Outcomes:
- Within 24 hours, the patient will demonstrate improved respiratory rate and depth within normal limits (12-20 breaths/minute).
- The patient will maintain oxygen saturation > 92% on prescribed oxygen therapy.
- The patient will report decreased shortness of breath and work of breathing within 48 hours.
- The patient will demonstrate effective use of deep breathing and coughing techniques.
Care Plan 2: Hyperthermia
Nursing Diagnosis: Hyperthermia related to inflammatory response secondary to Legionnaires’ disease infection
Related factors: Bacterial infection, inflammatory process, dehydration
Nursing Interventions and Rationales:
- Monitor body temperature every 4 hours or as needed
Rationale: Allows for early detection of fever spikes and evaluation of treatment effectiveness - Administer antipyretics as prescribed
Rationale: Helps reduce fever and associated discomfort - Apply cooling measures (e.g., cool compresses, fan) as needed
Rationale: Promotes heat dissipation and patient comfort - Encourage increased fluid intake, if not contraindicated
Rationale: Helps prevent dehydration associated with fever - Monitor for signs of dehydration (e.g., dry mucous membranes, decreased urine output)
Rationale: Early detection of dehydration allows for prompt intervention
Desired Outcomes:
- The patient will maintain body temperature within normal range (97.8°F-99°F or 36.5°C-37.2°C) within 24 hours.
- The patient will report increased comfort and decreased muscle aches within 12 hours.
- The patient will demonstrate adequate hydration status (urine output > 30 mL/hr, moist mucous membranes) within 24 hours.
Care Plan 3: Activity Intolerance
Nursing Diagnosis: Activity Intolerance related to fatigue and respiratory compromise secondary to Legionnaires’ disease
Related factors: Increased oxygen demand, fatigue, weakness
Nursing Interventions and Rationales:
- Assess the patient’s level of fatigue and ability to perform activities of daily living
Rationale: Provides baseline data for planning care and evaluating progress - Assist with gradual mobilization as tolerated
Rationale: Prevents complications of immobility while respecting the patient’s energy limitations - Encourage rest periods between activities
Rationale: Allows for energy conservation and prevents exhaustion - Teach energy conservation techniques (e.g., sitting while performing tasks)
Rationale: Helps the patient manage activities without excessive fatigue - Monitor oxygen saturation during activity and rest
Rationale: Ensures adequate oxygenation during increased demand
Desired Outcomes:
- The patient will report decreased fatigue and increased energy levels within 3 days.
- The patient will demonstrate improved tolerance for activities of daily living within 5 days.
- The patient will maintain oxygen saturation > 92% during activities within 48 hours.
Care Plan #4: Risk for Impaired Gas Exchange
Nursing Diagnosis: Risk for Impaired Gas Exchange related to alveolar-capillary membrane changes secondary to Legionnaires’ disease pneumonia
Related factors: Inflammation of lung tissue, accumulation of exudates in alveoli
Nursing Interventions and Rationales:
- Assess respiratory status, including rate, depth, and use of accessory muscles every 2 hours
Rationale: Allows for early detection of respiratory distress and the need for intervention - Monitor arterial blood gas results and oxygen saturation
Rationale: Provides objective data on gas exchange efficiency - Implement prescribed oxygen therapy and adjust as needed
Rationale: Ensures adequate oxygenation and prevents complications of hypoxemia - Encourage frequent position changes and deep breathing exercises
Rationale: Promotes optimal ventilation and perfusion matching - Administer prescribed medications (e.g., bronchodilators, mucolytics) as ordered
Rationale: Helps improve airway patency and secretion clearance
Desired Outcomes:
- The patient will maintain oxygen saturation > 92% on prescribed oxygen therapy.
- The patient will demonstrate arterial blood gas values within normal limits within 48 hours.
- The patient will report decreased shortness of breath and improved breathing comfort within 72 hours.
Care Plan #5: Deficient Knowledge
Nursing Diagnosis: Deficient Knowledge regarding Legionnaires’ disease, its treatment, and prevention
Related factors: Lack of exposure to information, misinterpretation of information, anxiety interfering with learning
Nursing Interventions and Rationales:
- Assess the patient’s and family’s current understanding of Legionnaires’ disease
Rationale: Provides a baseline for education planning - Provide clear, concise information about Legionnaires’ disease, its causes, and treatment
Rationale: Increases understanding and promotes adherence to treatment plan - Teach about the importance of completing the full course of antibiotics
Rationale: Ensures effective treatment and prevents antibiotic resistance - Discuss prevention strategies, including proper maintenance of water systems
Rationale: Empowers the patient and family to prevent future infections - Provide written materials and reputable online resources for reference
Rationale: Reinforces verbal teaching and allows for later review
Desired Outcomes:
- Patient and family will verbalize understanding of Legionnaires’ disease, its treatment, and prevention within 48 hours.
- The patient will demonstrate adherence to prescribed treatment plan throughout the hospital stay
- Patient and family will identify at least three strategies for preventing future Legionnaires’ disease infections before discharge.
References
- Centers for Disease Control and Prevention. (2021). Legionella (Legionnaires’ Disease and Pontiac Fever). Retrieved from https://www.cdc.gov/legionella/index.html
- Burillo, A., Pedro-Botet, M. L., & Bouza, E. (2017). Microbiology and Epidemiology of Legionnaire’s Disease. Infectious Disease Clinics of North America, 31(1), 7-27. https://doi.org/10.1016/j.idc.2016.10.002
- Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International Nursing Diagnoses: Definitions and Classification 2018-2020. Thieme.
- Cunha, B. A., Burillo, A., & Bouza, E. (2016). Legionnaires’ disease. The Lancet, 387(10016), 376-385. https://doi.org/10.1016/S0140-6736(15)60078-2
- American Lung Association. (2021). Learn About Legionnaires’ Disease. Retrieved from https://www.lung.org/lung-health-diseases/lung-disease-lookup/legionnaires-disease
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales (15th ed.). F.A. Davis Company.
- World Health Organization. (2018). Legionellosis. Retrieved from https://www.who.int/news-room/fact-sheets/detail/legionellosis
- Carpenito, L. J. (2017). Nursing Diagnosis: Application to Clinical Practice (15th ed.). Wolters Kluwer.
- Pierre, D. M., Baron, J., Yu, V. L., & Stout, J. E. (2017). Diagnostic testing for Legionnaires’ disease. Annals of Clinical Microbiology and Antimicrobials, 16(1), 59. https://doi.org/10.1186/s12941-017-0229-6
- Gulanick, M., & Myers, J. L. (2017). Nursing Care Plans: Diagnoses, Interventions, and Outcomes (9th ed.). Elsevier.