There are many symptoms with pneumonia and people react to illnesses sometimes in different ways. Pneumonia is an illness that primarily affects the lungs. The alveoli in the lungs is what is affected the most. However, the victim will cough and have chest pain from the coughing and he or she will have more trouble breathing due to the inflammation of the lungs.
The airway may cause problems with the breathing. If a nurse has a patient who has multiple problems, she should assess those things and decide which one is the most life-threatening. In this case, the skin lesions and falls are not as important as the pneumonia. First, the skin lesions are known why they occurred and the falling has not happened yet and may not happen.
Ineffective airway clearanceis the priority nursing diagnosis for this client. Pneumonia involves excess secretions in the respiratory tract and inhibits air flow to the capillary bed. Aclient with pneumonia may not have an ineffective breathing pattern, such astachypnea, bradypnea, orcheyne-stokes respirations. Risk for falls and impaired tissue integrity aren't priority diagnoses for this client.