Pathophysiology of Pneumonia A. Description: Acute infection of the lung varying in severity and causing fluid accumulation. B.

Etiology: causative organisms include bacteria, viruses, fungi, and prot ozoan. C. Pathophysiologic process and manifestations. 1. Organisms may enter the respiratory tract through inspiration or aspirat ion of oral secretions; staphylococcus and Gram-negative bacilli may reach the l ungs through circulation in the bloodstream. 2. Normal pulmonary defense mechanisms (cough reflex, mucocilliary transpor t, and pulmonary macrophages) usually protect against infection. However, in sus ceptible hosts, these defenses are either suppressed or overwhelmed by the invad ing organism. 3. The invading organism multiplies and releases damaging toxins, causing i nflammation and edema of the lung parenchyma; this results in accumulation of ce llular debris and exudates. 4. Lung tissue fills with exudates and fluid, changing from an airless stat e to consolidated state. 5. In viral pneumonia, the ciliated epithelial cells become damaged. 6. Severity of symptoms depends on the extent of pneumonia present (e.g., p artial lobe, full lobe [lobar pneumonia], or diffuse [broncho pneumonia]). 7. Symptoms include: i. Fever ii. Chills iii. Malaise iv. Cough v. Pleuritic pain vi. Increased tactile fremitus on palpitation vii. Rales and ronchi on auscultation viii. Dyspnea D. Overview of nursing interventions 1. Administer antibiotics specific for the causative organism, as prescribe d and confirmed by culture and sensitivity. 2. Control fever with acetaminophen as ordered. 3. Assess vital signs, monitor respiratory status. 4. Monitor pulse oximetry. 5. Monitor exercise tolerance. 6. Monitor breath sounds note changes in sputum production. 7. Encourage adequate fluid intake. 8. Provide bronchial hygiene. 9. Maintain adequate fluid intake. 10. Perform chest physiotherapy (CPT) as indicated. 11. Administer O2 therapy as ordered. 12. Attempt to prevent pneumonia in susceptible hosts. For example: i. Frequent positioning, deep breathing and coughing exercises in the postop patient. ii. Chest PT iii. Avoid contact with persons who have respiratory infections, crowds, mall s and shopping center.