After this report, we will be able to know what is Pneumonia is, causes of Pneumonia, how it is acquired and prevented,

its prevention and treatments of occurrence of Pneumonia. Define what is Pneumonia Trace the Patho/Physio of Pneumonia Enumerate different signs and symptoms Formulate and apply NCP

Pneumonia is an inflammatory illness of lungs. Frequently, it is describe as lung parenchyma, alveolar inflammation, and abnormal filling with fluid. Pneumonia is an inflammation of the lungs caused by an infection. It is also called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health. Although pneumonia is a special concern for older adults and those with chronic illnesses, it can also strike young, healthy people as well.

It is a common illness that affects thousands of people each year in the Philippines, thus, it remains an important cause of morbidity and mortality in the country. An inflammatory condition of the lungespecially affecting the microscopic air sacs (alveoli)associated with fever, chest symptoms, and a lack of air space (consolidation) on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes. Infectious agents include: bacteria, viruses, fungi, and parasites. It 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. A form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.
Is the single largest cause of death in children worldwide. Every year, it

kills an estimated 1.4 million children under the age of five years, accounting for 18% of all deaths of children under five years old worldwide.

Common disease throughout human history

Disease name by the ancient

Basic symptoms

First seen the bacteria

Identify two common bacteria

Captain of the Man of Death

Penicillin and surgical technique

Vaccine against bacteria

Community Acquired Pneumonia

Aspiration Pneumonia

Health Care Associated Pneumonia

Hospital Acquired Pneumonia

Ventilator Associated Pneumonia

Lobar Pneumonia

Broncho Pneumonia

Acute Interstitial Pneumonitis

Streptococcus Pneumoniae

Haemophilus influenzae

Chlamydophila Pneumoniae

Mycoplasma Pneumoniae

Rhinovirus

Coronavirus

Adenovirus

Histoplasma capsulatum

Cryptococcus neoformans

Pneumocytis jiro vecii

Toxoplasma gondii

Strongloides stercorales

Ascariasis

R E S P I R A T O R Y S Y S T E M

The

nose has two openings called nostrils. The air enters the nasal passages through the nostrils. The air that you breathe may not be fit to enter the lungs. It must be cleaned, warmed, and moistened before it reaches the lungs. The hairs in your nostrils filter the larger particles of dust and dirt as air enters the nostrils. The nasal passages are lined with tiny hairs called cilia and a moist tissue lining called mucous membrane. The cilia filter the smaller particles of dust and dirt. The moist mucous membrane also catches particles of dirt. It also warms and moistens the incoming air. The tiny blood vessel inside the nose also warm and moisten the passing air

The clean, warm, and moist air travels from the nasal passages to the pharynx. The pharynx is found at the back of the throat. The pharynx seperates into two tubes: Esophagus leading to the stomach. Trachea leading to the lungs. At the bottom of the pharynx is a flap of cartilage called the epiglottis. The epiglottis opens and closes the trachea. It prevents the food from going to the trachea by closing it during swallowing. Most of the time, the epiglottis is open to allow the flow of air in the breathing process.

From the pharynx, the clean air moves down to the larynx. The Larynx is found at the lower end of the pharynx. It is the enlarged upper portion of the trachea. It is also called the voice box. The larynx contains the vocal cords that vibrate when air passes through them. The vibration of the vocal cords, together with the movements of the mouth and tongue, produces the sound of your voice.

The trachea, or windpipe, is a tube about 13 centimeters long. It is the tube leading to the lungs. It is a tough, flexible passageway that air can move through all the time. The trachea lies just in front of the esophagus at the lower part of the larynx. Like the nasal passages, the inner wall of the trachea is lined with cilia. The cilia catch the dust particles that reach the windpipe. The dust particles are then pushed out and up toward the throat and mouth for expulsion. This explains why one coughs or sneezes when dirt gets into the upper respiratory tract. The lower end of the trachea branches into two large tubes called the bronchi.

The Lungs are the main organs for breathing. The left bronchus leads to the left lung while the right bronchus leads to the right lung. Inside the lungs, each bronchus divides into smaller tubes called bronchial rami. The bronchial rami branches off further into smaller tubes called bronchial tubesor bronchioles. At the ends of these bronchioles are the tiny air sacs called alveoli. The bronchioles and alveoli look like the branches of a tree. The biggest branches are the bronchi. Bronchi are covered by cilia and a thin film of mucus. Dust and pollen are trapped by the mucus before they reach the alveoli. Each of the lungs contains about 300 million alveoli. Each alveolus is surrounded by tiny blood vessels called capillaries. The exchange of oxygen andcarbon dioxide during the breathing process takes place in the capillaries of each alveolus.

These are tiny air sacks that are enveloped in a network of capillaries. It is here that the air we breathe is diffused into the blood , and waste gasses are returned for elimination.

Air-breathing of humans, respiration of oxygen includes four stages: Ventilation from the ambient air into the alveoli of the lung. Pulmonary gas exchange from the alveoli into the pulmonary capillaries. Gas transport from the pulmonary capillaries through the circulation to the peripheral capillaries in the organs. Peripheral gas exchange from the tissue capillaries into the cells and mitochondria.

ventilation (breathing) interchange of CO2 and O2 between air in the lungs' alveoli and blood in lung capillaries by diffusion transport of CO2 and O2 through the bloodstream interchange of CO2 and O2 between blood in lung capillaries and alveolar air by diffusion use of O2 and production of CO2 by cells through metabolism Ventilation

Pre disposing factor Age, Sex

Etiology Virus, Bacteria, Parasite, Fungal

Precipitating factor Lifestyle, Environment, underlying illness

Enter of microorganism enter the nose (nasal passage) Passes to the pharynx, larynx and trachea Microorganism enters and affect both airway and lung parenchyma

Airway damage

Lung invasion

Infiltration of bronchi

Flattening of epithelial cell

Infectious organism lodges stimulation in bronchioles Alveolar wall collapse Increase pyrogen in the body

Macrophages and leukocytes Mucus and phlegm production COUGHING

Necrosis of bronchial tissue

FEVER
Necrosis of pulmonary tissue Hazy portion of chest Inflammation of lungs Overwhelming sepsis DEATH Narrowing of air passage Difficulty of breathing

Productive cough

Fever accompanied with shaking chill and shortness of breath

Sharp or Stabbing Chest Pain

Confusion

Increase Respiratory rate

Symptoms frequency in Pneumonia

Symptom Cough Fatigue Fever Shortness of breath Sputum Chest pain Frequency 7991% 90% 7175% 6775% 6065% 3949%

Low blood pressure; high heart rate ; low Oxygen saturation Examination of the chest may be normal but may show decrease chest expansion on the affected side. With harsh breath sound With rales Dulled

Struggling to breathe Confusion Blue tinge skin

Chest radiograph

C T scan

Thoracentesis

Bronchoscopy

Spirometry

Pulmonary Volumes :

Pulmonary Capacities :

Tidal Volume

Inspiratory reserve volume

Expiratory reserve volume Residual volume

Functional residual capacity Inspiratory capacity

Vital capacity

Total lung capacity

Sputum Culture Test

Abscess in the lungs

Respiratory failure

Bacteremia

Empyema and Pleural Effusion

Collapse Lung

Hemoptysis

Vaccination

Environment

Other Underlying disease

Beta lactam Penicillin : Pen G and Pen V Anti staphylococcal Penicillin, Augmetin Cephalosporin 1st gen. : Ceplotexin (keplex), cefadroxil (ultracef),Cephradine (volosef) 2nd gen. : Cefaclon (ceclon),Cefuroxime (ceftin, Cefrozil (cefzil)

3rd. Gen. : Cefpodoxime (vantin), Cefdimin (ceftin) Ceftriaxone Flouroquinolones Ciprofloxacin (cipro) 2nd gen. Macrolides,Azalides and Ketolides Erythromycin ER Azithromycin Telithromycin

Tetracyclines Doxycycline,tetracycline,minocycline Aminoglycosides Gentamicin, Amikacin Lincosamides Clindamycin (cleocin)

Pneum onia: Comm unity acquire d. Adult 1860yo

Hospitalized patient:* Erythromycin 500mg to 1 gram IV every 6 hours + Cefuroxime 750 mg IV every 8 hours (may substitute Azithromycin 500mg IV once daily for erythromycin) or Erythromycin 500mg to 1 gram IV every 6 hours + [Ceftriaxone 1 gram IV q12h or Cefotaxime 2 grams IV every 4 to 8 hours] or If mild (monotherapy): Azithromycin 500mg IV once daily x 2-5 days, then 500mg orally once daily or Levofloxacin 500 - 750 mg IV/PO once daily. Outpatient therapy: Azithromycin 500mg once daily or Clarithromycin 500mg twice daily orLevofloxacin 500mg once daily or Augmentin 875mg orally twice daily

Hospital acquired (nosoco mial)

[Piperacillin 3-4 grams IV every 6 hours +tobramycin] or [Ceftazidime 1-2 grams IV every 8 hours orCefepime 12 grams q 12h ] + tobramycin or Ticarcillinclavulanic acid 3.1g IV every 6 hours +Tobra/gent or Imipenem 500mg IV every 6 hours. Special considerations: Add Erythromycin 500mg to 1 gram IV every 6 hours or Azithromycin 500mg IV once daily if legionella suspected. Substitute: Aztreonam for piperacillin, timentin or cephalosporin if allergic to penicillin.

[Severe penicillin allergy]: Levofloxacin 500mg IV qd + aminoglycoside or Aztreonam + Aminoglycoside

Aspirati on pneum onia

Community acquired: Clindamycin 600mg ivpb every 6 to 8 hours or Augmentin 875mg PO bid or 500mg tid x 10 days Hospital acquired: Piperacillin-tazobactam 3.375g ivpb q6h orTicarcillin-clavulanic acid 3.1g ivpb q6h or Ampicillinsulbactam (Unasyn) 1.5-3.0 grams ivpb q6h.Cefoxitin 2 grams ivpb q6-8h or Cefotetan 1-2 grams IV q12h.[Cefotaxime 2g ivpb q8h or Ceftriaxone 2 grams ivpb q24h] + Clindamycin 600mg IV q6-8h.Clindamycin 600mg IV q6-8h + [Ciprofloxacin400mg IV q12h or Levofloxacin 500mg IV qd. ]

(Elderly, nursing home, other risk factors, pseudomon as not suspected) OR Non-ICU patient:

Ceftriaxone 1-2 grams q1224h or Cefepime 1-2 grams q12h] + Azithromycin 500mg IV qd. Or Levofloxacin 500mg IV qd. Or Moxifloxacin 400mg IV qd.

Classification : Antibiotic Rx: Erymax Action: Long lasting activity; inhibit protein synthesis Side effects: pain ; GI disorder; N&V and Increase heart rate Contraindication: jaundice, and pre existing liver dysfunction. Nursing consideration: Identify any allergy to antibiotic; Document indication for therapy; shake suspension well before using and not store for more than 2 weeks; chew or crush chewable tablets and report lack of response or adverse reaction

Classification : antibiotic Rx: Zithromax Action: derived from erythromycin inhibit RNA protein synthesis. Side effects: pain ; dyspepsia; palpitation Contraindication: hypersensitivity to erythromycin Nursing consideration: Determine any history of sensitivity; Give suspension at least 1 hr prior to or least 2 hour after a meal.; tablets may taken with or with out food; do not give as a bolus or IM and assess for evidence of prolonged QT intervals.

Classification : antibiotic Rx: amoxiclav Action: effective against microorganism that manifest resistant to amoxicillin Side effects: pain ; dyspepsia; palpitation Contraindication: use in those with history of amoxicillin resistant. Nursing consideration: Determine any history of sensitivity; asses for any previous reactions to penicillin; pedia formulation no available in fruit flavor.

Classification : cephalosporin Rx: Ceptaz Action: Only for IM or IV use and 90 % excreted Side effects: renal impairment; jaundice and pain Nursing consideration: Determine any history of sensitivity; in administering IM,use large muscle mass and inject deeply;do not add ceftazidime to solution containing aminoglycosides.

Classification : antibiotic Rx: Cleocin Action: suppress protein synthesis by microorganism by binding to ribosomes Side effects: N & V; diarrhea and metallic taste. Contraindication: hypersensitivity to clindamycin and lactation Nursing consideration: Determine any history of sensitivity; for anaerobic infection, use parenteral form ; for hospitalized patient only; do not refrigerate solution as it may become thickened and difficult to pour.

Age Certain Disease Smoking Exposure to Chemical, pollutant, type of work

Hospitalized Patients For people who require hospitalization for pneumonia, the mortality rate is between 10% and 25%. If pneumonia develops in people already hospitalized for other conditions, the mortality rates are higher. They range from 50% to 70% and are greater in women than in men.

Older Adults Community-acquired pneumonias are responsible for ~350,000 to 620,000 hospitalizations in older adults every year. The elderly have less survival rates than younger people, and pneumonia and flu are the 5th major causes of death in this population. Even when older people recover from communityacquired pneumonia, they have higher than normal mortality rates over the next few years. Older adults at particular risk are those with some other medical problems and hospitalized patients. Very Young Children About 20% of deaths in stillborn and very young infants are because of pneumonia. Little children who develop pneumonia and survive are at also at risk for developing lung problems in adulthood.

Maintain a patent airway and adequate oxygenation. Obtain sputum specimens as needed. Use suction if the patient cant produce a specimen. Provide a high calorie, high protein diet of soft foods. To prevent aspiration during nasogastric tube feedings, check the position of tube, and administer feedings slowly. To control the spread of infection, dispose secretions properly. Provide a quiet, calm environment, with frequent rest periods. Monitor the patients ABG levels, especially if hes hypoxic. Assess the patients respiratory status. Auscultate breath sounds at least every 4 hours. Monitor fluid and intake output. Evaluate the effectiveness of administered medications. Explain all procedures to the patient and family.

NURSING PROFILE a. Patients Profile Name: R.C.S.B. Age: 1 yr,1 mo. Weight:10 kgs Religion: Roman Catholic Mother: C.B. Address: Valenzuela City b. Chief Complaint: Fever Date of Admission: 1st admission Hospital Number: 060000086199

c. History of Present Illness 2 days PTA (+) cough (+) nasal congestion, watery to greenish (+) nasal discharge Tx: Disudrin OD Loviscol OD Few hrs PTA - (+) fever, Tmax= 39.3 C (+) difficulty of breathing (+) vomiting, 1 episode Tx: Paracetamol Sought consultation at ER: Rx=BPN, Salbutamol neb. IE: T = 38.3C, CR= 122s, RR= 30s (+) TPC SCE, (-) retractions, clear BS, (-) cyanosis, (-) edema d. Past Illness (-) asthma (-) allergies e. Family History PMHx: (+) asthma (mother)

f. Activities of Daily Living Sleeping mostly at night and during afternoon Usually wakes up early in the morning (5AM) to be milkfed. Eats a lot (hotdogs, chicken, crackers, any food given to her) Active, responsive BM (1-2 times a day) Urinates in her diaper (more than 4 times a day) Likes to play with those around her g. Review of Systems Neuromuscular: weakness of muscles Integumentary: (-) cyanosis Respiratory: tachypnea; (+) DOB; (+) coarse crackles, (+) wheezes, Digestive: food aversion, vomits ingested milk

PHYSICIANS ORDER SHEET 11/19/06 Admit patient to ROC under the service of Dr. Vitan secure consent for admission and management, TPR every shift then record. May have diet for age with strict aspiration precaution, IVF D5 0.3NaCl 500cc to run at 62-63mgtts/min.May give paracetamol 125mg 1supp/rectum if oral paracetamol is not tolerated. 11/20/06 For urinalysis, IVF to follow D5 0.3 NaCl 500 at SR (62-63mgtt/m Use zinacef brand of cefuroxine 750mg- given vial 375mg every 8hours, nebulize (Ventolin 1 nebule) every 6 hours, paracetamol drugs prn every 4hours (Temp 37.8). 11/21/06 Continue cefuroxine and nebulizer every 6 hours. May not reinsert IVF, revise Cefuroxine IV to Cefuroxine 500mg via deep Intramuscular BID,continue management. 11/22/06 Continue management and refer.

NURSING ACTIONS
INDEPENDENT positioning of the patient with head on mid line, with slight flexion rationale: to provide patent, unobstructed airway , maximum lung excursion auscultating patients chest rationale: to monitor for the presence of abnormal breath sounds provide chest and back clapping with vibration rationale: chest physiotheraphy facilitates the loosening of secretions considering that the patient is an infant, and has developed a strong stranger anxiety as manifested by white coat syndrome , it is a nursing action to play with the patient. rationale: to establish rapport, and gain the patients trust DEPENDENT administer due medications as ordered by the physician, bronchodilators, anti pyretics and anti biotics rationale: bronchodilators decrease airway resistance, secondary to bronchoconstriction, anti pyretics alleviate fever, antibiotics fight infection placing patient on TPN prn rationale: to compensate for fluid and nutritional losses during vomiting COLLABORATIVE assist respiratory therapist in performing nebulization of the patient rationale: nebulization is a favourable route of administering bronchodilators and aid in expectorating secretions, hence patients breathing

CUES NURSING

DIAGNOSIS

BACKGROUND KNOWLEDGE Bacterial microorganism enter the airways Inflammation of the lung/s Air sacs filled with pus & other liquids Presence of obstructions in the airways Inability to breathe properly

PLANNING NURSING

INTERVENTIONS RATIONALE

EVALUATION

S> Nahihirapan yata syang huminga saka lagi na lang sumusuka ng plema, as verbalized by the Pts grandmother. O> (+) sputum production Rapid, shallow breathing (+) crackles, gargles

Ineffective Airway Clearance related to inability to maintain clear airway as characterized by (+) sputum, (+) crackles, rapid & shallow breathing

After 8 hours of Nursing Intervention, the Pts breathing will have no more adventitious sounds present (crackles/gargles) when auscultated

> Monitor respiratory patterns, including rate, depth, and effort. > Assist with clearing secretions from pharynx by offering tissues and gentle suction of the oral pharynx if necessary > Provide postural drainage, percussion, and vibration as ordered > Administer medications such as bronchodilators or inhaled steroids as ordered.

> With secretions in the airway, the respiratory rate will increase > It is preferable for the client to cough up secretions. Gentle suctioning of the posterior pharynx may stimulate coughing and help remove secretions > Chest physical therapy helps mobilize bronchial secretions > Bronchodilators decrease airway resistance secondary to bronchoconstriction

After 8 ours of Nursing Intervention, the Pts breathing had no more adventitious sounds (crackles/gargles) present when auscultated

CUES NURSING
S> May lagnat po yata ang anak ko, as verbalized by the Pts mother. O> febrile moist skin tachypnea, RR= 33 cpm (+) crackles Age: 1 yr.1 mo

DIAGNOSIS
Altered body temperature related to bacterial invasion in the lungs as manifested by body temperature higher than normal, tachypnea, (+) crackles

BACKGROUND PLANNING NURSING INTERVENTIONS KNOWLEDGE

Bacterial microorganisms (e.g. pulmonary pathogens) enter the airway These bacteria/viruses infects the lung/s Inflammation of the lung/s Signs and symptoms of Pneumonia (e.g.temperature may be greater than 37.5C), tachypnea, coughs with greenish secretions After 2 hours of Nursing Intervention, the Pts temperature will decrease from 39.8 C to normal range (36.6 - 37.5 C) After 2 hours of Nursing Intervention, the Pts skin will cool off > Monitor Pts temperature q1 hr

RATIONALE
> To determine if the Pts temperature is above the normal body temperature > Allows the patient to recuperate physical strength > To maintain hydration status and increased fluid intake helps lessen febrility > Sponge bath with warm water evaporates off his skin, thus, cooling off the Pt > Promotes return of body temperature to normal

EVALUATION
After 2 hrs of Nursing intervention, the Pts temperature had decreased from 39.8 C to 37.4 C After 2 hrs of Nursing Intervention, the Pts skin has cooled off a bit

> Encourage Pt to rest

> Encourage Pt to increase fluid intake

> Encourage the Pts guardian to do tepid sponge bath > Administer antipyretic medications as prescribe

CUES NURSING

DIAGNOSIS

BACKGROUND KNOWLEDGE

PLANNING NURSING

INTERVENTIONS

RATIONALE

EVALUATION

S> Ayaw nyang kumain, yung gatas sinusuka lang naman nya, and Mas payat sya ngayon, dati ang lakas naman kumain as verbalized by the Pts grandmother. O> vomits ingested milk Food aversion Decreased wt weakness

Imbalanced Nutrition due to frequent vomiting and not eating the usual foods taken as manifested by decreased weight, food aversion, and weakness.

Bacteria or virus attacks the lung/s weakened immune systems Pneumonia Symptoms of Pneumonia: nausea or vomiting, may experience profound weakness w/c lasts for a long time.

After 4 hours of Nursing Intervention, the Pt will start taking foods which he usually eat (rice, crackers, chicken breast,etc) After 4 hours of Nursing Intervention, the Pt will not vomit anymore the ingested milk

> Assess for recent changes in physiological status that may interfere with nutrition

> Provide companionship at mealtime to encourage nutritional intake > Determine healthy body weight for age and height > Assess client's ability to obtain and use essential nutrients.

> The consequences of malnutrition can lead to a further decline in the patient's condition that then becomes self-perpetuating if not recognized and treated. > Often toddlers will eat more food if other people are present at mealtimes. > Protein-calorie malnutrition most often accompanies a disease process > Cases of vitamin D deficiency have been reported among darkskinned toddlers who were exclusively breast fed and were not given supplemental vitamin D.

After 4 hours of Nursing Intervention, the Pt started taking foods which he usually eat (crackers) After 4 hours of Nursing Intervention, the Pt didnt vomit anymore the ingested milk

DISCHARGE PLAN Take the entire course of any prescribed medications. After a patients temperature returns to normal, medication must be continued according to the doctors instructions, otherwise the pneumonia may recur. Relapses can be far more serious than the first attack. Get plenty of rest. Adequate rest is important to maintain progress toward full recovery and to avoid relapse. Drink lots of fluids, especially water. Liquids will keep patient from becoming dehydrated and help loosen mucus in the lungs. Keep all of follow-up appointments. Even though the patient feels better, his lungs may still be infected. Its important to have the doctor monitor his progress. Encourage the guardians to wash patients hands. The hands come in daily contact with germs that can cause pneumonia. These germs enter ones body when he touch his eyes or rub his nose. Washing hands thoroughly and often can help reduce the risk. Tell guardians to avoid exposing the patient to an environment with too much pollution (e.g. smoke). Smoking damages ones lungs natural defenses against respiratory infections. Give supportive treatment. Proper diet and oxygen to increase oxygen in the blood when needed. Protect others from infection. Try to stay away from anyone with a compromised immune system. When that isnt possible, a person can help protect others by wearing a face mask and always coughing into a tissue.

Worlds Pneumonia Awareness Month