PNEUMONIA

Prepared by: Rosemarie M. Guiang & Michael D. Valdez

DEFINITION:

An inflammatory process in lung parenchyma usually associated with a marked increase in interstitial and alveolar fluid. OTHER NAME: Pneumonitis

PATHOGNOMONIC SIGN Rusty or prune juice like colored sputum INCUBATION PERIOD 1 to 3 days with a sudden onset of shaking chills, rapidly rising fever and stabbing chest pain

CAUSATIVE AGENT:

Streptococcus Pneumoniae Staphylococcus Aureus Haemophilus Influenzae Klebsiella Pneumoniae (Friedlanders Bacilli)

ETIOLOGY
Bacteria Viruses Mycoplasmas Fungal Agents Protozoa Others: Aspiration of Foods, Fluids, or vomitus or from inhalation of toxic or caustic chemicals, smoke, dusts or gases.

RISK FACTORS

Advanced age History of Smoking Upper Respiratory Infection Tracheal Intubation Prolonged immobility Immunosuppresive Therapy Non-functional Immune system Malnutrition Dehydration Homelessness Chronic disease States (e.g. Diabetes and Heart

MODE OF TRANSMISSION
1.

Droplet infection droplets from the

mouth and nose of an infected person via the nasopharynx carry the infectious disease and the disease is transmitted through intimate contact with carriers

2.

Indirect contact through

contaminated objects

CLASSIFICATION
1.

According to place and how the client was exposed to the disease

2.

According to anatomical location

General classification

3.

According to place and how the client was exposed to the disease:
1. Community-acquired pneumonia Acquired in the course of ones days life-at work, at school or at the gym Streptococcus pneumoniae (pneumococcus) the most common bacterial cause of community-acquired pneumonia. 2. Nosocomial pneumonia develops while the client is in the hospital

3. Aspiration pneumonia occurs when a foreign matter is inhaled (aspirated) into the lungs most commonly the gastric contents entering the lungs after vomiting. Clients Prone to Aspiration Pneumonia - Decreased LOC - Clients with poor gag reflex - Elderly - Very young

ANATOMICAL CLASSIFICATION OF PNEUMONIA: (base on location and radiologic

appearance)

Bronchopneumonia (Bronchial Pneumonia) Interstitial Pneumonia (Reticular Pneumonia)

Alveolar Pneumonia (Acinar Pneumonia)

Necrotizing Pneumonia

General classification:
1. Primary pneumonia Direct result of inhalation or aspiration of pathogens or noxious substances Includes some cases of pneumococcal pneumonia, mycoplasma pneumonia and pneumonia caused by tubercle bacilli 2. Secondary pneumonia -Due to complication of a disease

Bronchopneumonia vs. Lobar Pneumonia

Microorganism inhaled to alveoli

infect type II Alveolar cells

multiply in the alveolus and invade alveolar epithelium through the pores of the Kohn.

producing inflammation (systemic infection)and consolidation along lobar compartments

inflamed and fluid/ pus filled alveolar sacs cannot exchange Oxygen and Carbon Dioxide effectively

alveolar exudate tends to consolidate

difficulty to expectorate exudates

signs and symptoms: Sudden onset of chills with rising fever Rusty/ prune juice like color sputum Labored respiration and dyspnea increased sputum production Cough Wheezing/ rales/ Rhonchi consolidation Hypoxemia chest pain dullness

CLINICAL MANIFESTATIONS
1. Hypertrophy of Mucous Membrane Increased sputum production Wheezing Dyspnea Cough Rales/crackles 2. Increased Capillary Permeability Consolidation Hypoxemia

3. Inflammation of the Pleura Stabbing chest pain Pleural effusion Dullness Decreased breath sounds 4. Hypoventilation Decreased chest expansion Respiratory acidosis

Other clinical manifestations:

Increased WBC Increased RR Increased PR and bounding pulse Fever Body malaise Diaphoresis

DIAGNOSTIC PROCEDURES
1.Chest X-Ray
2. Sputum Analysis, Smear, and Culture

3. Blood/serologic exam

Nursing Diagnosis And Interventions

IMPAIRED GAS EXCHANGE

Titrate

Oxygen delivery rates to maintain oxygen saturation above 92% OUTCOME:

Improved

gas exchange, as evidenced by maintained oxygen saturation over 92% on decreasing amounts of inspired oxygen, having no manifestations of pallor or cyanosis retaining baseline mental status.

Nursing Interventions

INEFFECTIVE AIRWAY CLEARANCE

Increase fluid intake, teaching and encouraging effective cough and breathing techniques and frequent turning. Use incentive spirometer every 2 hours while awake. Clients w/ altered level of consciousness should be turned at least every 2 hours and should be placed in side lying position. Only thickened liquids should be given Bronchodilators OUTCOMES:

Maintain effective airway clearance as evidenced by keeping a patent airway and clearing secretions

Nursing Interventions

INEFFECTIVE BREATHING PATTERN

Raise

head of bed at 45 degree Teach patient to splint the chest wall with pillow Administer cough suppressants and analgesics CAUSIOUSLY. OUTCOMES;
Improved

breathing pattern as evidenced by 1 respiratory rate within normal 2adequate chest expansion 3clear breath sounds 4 decreased dyspnea

Nursing Interventions

ACTIVITY TOLERANCE
Teach

client to avoid conditions that increase oxygen demand, such as smoking, temperature extremes, weight gain, and stress. Pursed-Lip and diaphragmatic breathing, which improve airflow, as well as techniques to lower energy use, should be reinforced. Activities that are tiring should be interpersed with rest OUTCOMES:
Improved

activity tolerance as evidenced by ability to perform activities of daily living and a progressive increase in physical activity without dyspnea and fatigue.

Drug Therapy

Antibiotics- depending on type of microorganisms involved (e.g. cotrimoxazole, cephalosphorins, Cotrimoxazole) Mucolytics or expectorants Bronchodilators aminophylline Pain relievers for pleuritic pain

Complication

Otitis media (children) Pleural effusion Pericarditis

Atelectasis