Definition Pneumonia is an infection of one or both lungs, which is usually caused by bacteria, viruses, or fungi.

Signs and Symptoms URTI Fever reaching 40 C accompanied by chills Productive cough sometimes with blood-tinged sputum SOB Chest pain upon inhalation Cyanosis in severe cases

Infectious Agent The most common cause of a bacterial pneumonia is Streptococcus pneumoniae. In this form of pneumonia, there is usually an abrupt onset of the illness with shaking chills, fever, and production of a rust-colored sputum. The infection spreads into the blood in 20%-30% of cases (known as sepsis), and if this occurs, 20%-30% of these patients die. Other infectious agents include: Klebsiella pneumoniae, Hemophilus influenzae, Mycomplasma pneumoniae,

Mode of Transmission Person to person, droplet nuclei

Incubation Period The incubation period may vary, but is generally from 1 to 3 days.

Pathophysiology

Diagnostics o Sputum samples - Examination of Gram-stained sputum is an important step in the diagnosis of acute pneumonia. The presence of numerous neutrophils containing the typical gram-positive, lancetshaped diplococci supports the diagnosis of pneumococcal pneumonia, but it must be remembered that S. pneumoniae is a part of the endogenous flora in 20% of adults, and therefore false-positive results may be obtained. Isolation of pneumococci from blood cultures is more specific but less sensitive (in the early phase of illness, only 20% to 30% of patients have positive blood cultures). Pneumococcal vaccines containing capsular polysaccharides from the common serotypes are used in patients at high risk. o A blood test increased in neutrophils and WBC

o Bronchoscopy

Treatment Antibiotics often used in the treatment of this type of pneumonia include penicillin, amoxicillin and clavulanic acid (Augmentin, Augmentin XR), and macrolide antibiotics including erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), azithromycin (Zithromax, Z-Max), and clarithromycin (Biaxin). Penicillin was formerly the antibiotic of choice in treating this infection. With the advent and widespread use of broader-spectrum antibiotics, significant drug resistance has developed. Penicillin may still be effective in treatment of pneumococcal pneumonia, but it should only be used after cultures of the bacteria confirm their sensitivity to this antibiotic. Nursing Management

Chest and back physiotherapy, as prescribed

Turning from side to side every two hours Administer antibiotics as prescribed Monitoring of V/S Encourage to drink plenty of water, suction secretions if needed

Prevention Two vaccines are available to prevent pneumococcal disease: the pneumococcal conjugate vaccine (PCV13) and the pneumococcal polysaccharide vaccine (PPV23; Pneumovax). PCV13 should be refrigerated, not exposed to light, and not mixed with other vaccines in a syringe. It should also be given intramuscularly.

COMMUNITY-ACQUIRED ACUTE PNEUMONIA

Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus Legionella pneumophila Enterobacteriaceae (Klebsiella pneumoniae) and Pseudomonas spp. COMMUNITYACQUIRED ATYPICAL PNEUMONIA Mycoplasma pneumoniae

Chlamydia spp. (C. pneumoniae, C. psittaci, C. trachomatis) Coxiella burnetii (Q fever)