PNEUMONIA

What is Pneumonia?
Pneumonia is a general term that refers to an infection of the lungs, which can be caused by a variety
of microorganisms, including viruses, bacteria, fungi, and parasites.
What causes Pneumonia?
Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi.
The most common are:

Streptococcus pneumoniae the most common cause of bacterial pneumonia in children;
Haemophilus influenzae type b (Hib) the second most common cause of bacterial
pneumonia;
respiratory syncytial virus is the most common viral cause of pneumonia;
in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of
pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected
infants.
Incubation
The incubation period (the length of time between exposure and feeling sick) for pneumonia varies,
depending on the type of virus or bacteria causing the infection. For instance, for RSV, this is 4 to 6
days; for influenza, 18 to 72 hours.
Duration
With treatment, most types of bacterial pneumonia can be cured within 1 to 2 weeks. Viral
pneumonia may last longer. Mycoplasmal pneumonia may take 4 to 6 weeks to resolve completely.
Contagiousness
The viruses and bacteria that cause pneumonia are contagious and usually found in fluid from the
mouth or nose of someone who's infected. Illness can spread when an infected person coughs or
sneezes on others, by sharing drinking glasses and eating utensils, and when someone touches the
used tissues or handkerchiefs of an infected person.
Risk Factors

indoor air pollution caused by cooking and heating with biomass fuels (such as wood or
dung)
living in crowded homes
parental smoking.
A child's immune system may be weakened by malnutrition or undernourishment, especially
in infants who are not exclusively breastfed.
Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a
child's risk of contracting pneumonia.

What are the signs and symptoms?
Symptoms vary depending on the age of the child and the cause of the pneumonia, but common
ones include:
fever
chills
cough
nasal congestion
unusually rapid breathing (in some cases, this is the only symptom)
Children younger than 2 months: Greater than or equal to 60 breaths/min
Children aged 2-11 months: Greater than or equal to 50 breaths/min
Children aged 12-59 months: Greater than or equal to 40 breaths/min
breathing with grunting or wheezing sounds
labored breathing that makes the rib muscles retract (when muscles under the ribcage or between
ribs draw inward with each breath) and causes nasal flaring
vomiting
chest pain
abdominal pain
decreased activity
loss of appetite (in older kids) or poor feeding (in infants), which may lead to dehydration
in extreme cases, bluish or gray color of the lips and fingernails
Someone with pneumonia in the lower part of the lungs near the abdomen might have fever and
abdominal pain or vomiting but no breathing problems.
Kids with pneumonia caused by bacteria usually becomes sick fairly quickly and will have a
sudden onset of a high fever and unusually rapid breathing.
Kids with pneumonia caused by viruses probably will have symptoms that appear more
gradually and are less severe, though wheezing can be more common in viral pneumonia.
Some types of pneumonia cause symptoms that give important clues about which germ is
causing the illness. For example, in older kids and adolescents, pneumonia due
to Mycoplasma (also called walking pneumonia) is notorious for causing a sore throat, headache,
and rash in addition to the usual symptoms of pneumonia.
In infants, pneumonia due to chlamydia may cause conjunctivitis (pinkeye) with only mild
illness and no fever. When pneumonia is due to whooping cough (pertussis), a child may have
long coughing spells, turn blue from lack of air, or make the classic "whoop" sound when trying
to take a breath.
Prevention

Vaccines
Antibiotics
Antiviral
Keep your child away from anyone who has an upper respiratory tract infection.
If someone in your home has a respiratory infection or throat infection, keep his or her
drinking glasses and eating utensils separate from those of other family members, and
wash your hands frequently, especially if you are handling used tissues or dirty
handkerchiefs.

Diagnostic Exams

Auscultation by stethoscope
Cultures
Serology
Complete blood cell count (CBC)
Chest radiography
Ultrasonography

Treatment
Antibiotics - given by mouth as tablets or liquid
Pain relieving medications
Paracetamol to reduce fever
Antibiotics given intravenously (via a drip into a vein)
Oxygen therapy - to ensure the body gets the oxygen it needs
Intravenous fluids - to correct dehydration or if the person is too unwell to eat or drink
Physiotherapy - to help clear the sputum from the lungs.

Nursing Diagnoses

Ineffective airway clearance related to copious tracheobronchial secretions
Activity intolerance related to impaired respiratory function
Risk for deficient fluid volume related to fever and a rapid respiratory rate
Imbalanced nutrition: less than body requirements
Deficient knowledge about the treatment regimen and preventive health measures



Complications
Continuing symptoms after initiation of therapy
Shock
Respiratory failure
Atelectasis
Pleural effusion
Confusion

Nursing Care

Assess for:

Respiratory status including rate, depth, ease, shallow or irregular breathing, dyspnea, use
of accesory muscles, and diminished breath sounds, rhonchi or crackles on auscultation -
provides data baseline.
Changes in mental status, skin color, cyanosis - indicates possible decrease in
oxygenation.
Quality of cough and ability to raise secretions including consistency and characteristics
of sputum - removal of secretions prevents obstruction of airways and stasis leading to
further infection and consolidation of lungs; clearing airways facilitates breathing.

Monitor, record, describe:

Respiratory rate, quality and breath sounds q2-q4 - indicates airway resistance, air
movement, severity of disease.
ABGs, oximeter reading - decreased oxygen levels result in hypoxemia.

Administer:

Oxygen therapy via cannula - maintain optimal oxygen level.
Antitussives/expectorants (terpin hydrate, guaifenesin) - acts on bronchial cells to
increase fluid production and promote expectoration; guaifenesin reduces surface tension
of secretions; both relieve non-productive cough
Mucolytic (acetylcysteine) - decrease viscosity of mucus for easier removal.
Antibiotic (ampicillin, cephalexin) - acts by binding to cell wall organisms preventing
synthesis and destroying pathogens.


Perform or Provide:

Position of comfort in semi or high fowlers and change position q2h - facilitates
breathing and allows for full expansion of lungs.
Encourage coughing if sounds is moist; if dry and hacking, increase fluid intake and
administer cough suppressant - reduces continual irritation to throat and liquefies
secretions.
Coughing and deep breathing exercise q2h; use incentive spirometer 5-10 breaths if
tolerated - coughing clears airway by propelling secretions to mouth deep
breathing promotes ventilation and prolongs expiratory phase.
Assist with coughing by splinting chest; humidified air with cool mist - loosens
secretions and improves ventilation, moistens mucous membranes
Postural drainage and percussion PRN - mobilizes secretion.
Suction secretions if cough ineffective - removal if unable to bring up secretions.
Oral care after expectoration and provide tissues and bag for disposal - promotes comfort
and prevents transmission of organisms to others.






















In partial fulfillment
of the requirements in
Related Learning Experience



San Lazaro Hospital
Pneumonia
(Report)


Submitted to:
Ms. Romelyn Bautista, RN, MAN

Submitted by:
Ms. Krisia E. Castuciano, SN3

May 13, 2014


Holy Trinity University
College of Nursing and Health Sciences
Puerto Princesa City