Understanding Pneumonia: Causes, Symptoms, and Treatment

1. Chapter 23Pneumoania Dr. Maysoon S. Abdalrahim

2. Pneumonia • Pneumonia an inflammation of the lung parenchyma caused by microorganisms (bacteria, fungi, viruses) • Pneumonitisan inflammatory process in the lung tissue that may predispose or place the patient at risk for microbial invasion.

3. Classification (Table 23-1) • community-acquired pneumonia (CAP) • hospital-acquired (nosocomial) pneumonia (HAP) • pneumonia in the immunocompromised host • aspiration pneumonia

4. Pathophysiology • Conditions (low immunity, unconsciouness)  normal flora in the oropharynx enter the pulmonary system  affects both ventilation and diffusion. • Inflammatory reaction occur in the alveoli  produce exudate  interferes with diffusion of O2 & CO2 • WBCs (mostly neutrophils) migrate into the alveoli and fill the normally air-filled spaces. • secretions and mucosal edema partial occlusion to areas of the lung  decrease in alveolar O2 tension.

5. Pathophysiology • Bronchospasm may occur in patients • Venous blood entering the pulmonary circulation passes through the underventilated area and travels to the left side of the heart poorly oxygenated  arterial hypoxemia. • If a substantial portion of one or more lobes is involvedlobar pneumonia. • The term bronchopneumonia: pneumonia that is distributed in a patchy fashion within the bronchi and surrounding lung parenchyma.

6. Pathophysiology

7. Risk Factors (Table 23-2) • Conditions that produce mucus or bronchial obstruction and interfere with normal lung drainage (eg, cancer, smoking, COPD) • Immunosuppressed patients • Smoking • Prolonged immobility and shallow breathing pattern • Depressed cough reflex • aspiration of foreign material into lungs in unconscious patients

8. Risk Factors (Table 23-2) • placement of nasogastric, orogastric, or endotracheal tube • Supine positioning in patients unable to protect their airway • Antibiotic therapy • Alcohol intoxication • General anesthetic, sedative, or opioid • Advanced age • Respiratory therapy with uncleaned equipment

9. Clinical Manifestations • it is not possible to diagnose by clinical manifestations alone. • pneumococcal pneumonia • a sudden onset of chills, rapidly rising fever (38.5 to 40.5C and pleuritic chest pain aggravated by deep breathing and coughing. • tachypnea (25 to 45 breaths/min • signs of respiratory distress • rapid and bounding pulse (increases 10 bpm for every degree (Celsius) of temperature elevation. A relative

10. Clinical Manifestations • viral infection • bradycardia (a pulse–temperature deficit -pulse is slower for a given temperature) • Some patients exhibit an URTI • headache, low-grade fever, pleuritic pain, rash, and pharyngitis. • mucopurulent sputum • Flushed cheeks and central cyanosis • Orthopnea

11. Clinical Manifestations • Poor appetite • Diaphoresis • Fatigue • Fever, crackles, and percussion dullness, • egophony (when auscultated, the spoken “E” becomes a loud, nasal-sounding “A”)  sound is transmitted better through solid or dense tissue (consolidation).

12. Assessment and Diagnostic Findings • Illness history and physical examination • chest x-ray • blood culture (bacteremia) • sputum examination • rinse the mouth with water • breathe deeply several times • cough deeply • expectorate the raised sputum into a sterile container. • Sputum by nasotracheal or orotracheal suctioning • Bronchoscopy

13. Prevention • A pneumococcal vaccine • People 65 years of age or older • People with functional or anatomic asplenia • People living in environments risk of disease • Immunocompromised people • one-time revaccination after 5 years

14. Prevention • for the prevention of HAP: • (1) staff education • (2) infection and microbiologic surveillance • (3) prevention of transmission • (4) modifying host risk for infection.

15. Medical Management • Antibiotics (ineffective in viral) • Treatment of viral pneumonia is supportive. • Hydration • Antipyretics • antitussive • Warm, moist inhalations • Antihistamines • Nasal decongestants • If hypoxemia develops, oxygen is administered. Pulse oximetry or ABGs analysis to evaluate the effectiveness

16. Complications • Shock and Respiratory Failure • Pleural Effusion

17. Nursing Interventions Improving Airway Patency • Removing secretions • hydration (2 to 3 L/day), and Humidification to loosen secretions and improve ventilation. • Encourage coughing • Lung expansion maneuvers (deep breathing + incentive spirometer). • Chest physiotherapy (postural drainage) • administer and titrate O2 therapy as prescribed

18. Nursing Interventions Promoting Rest and Conserving Energy • Encourage rest and avoid overexertion • assume a comfortable position (semi-Fowler’s position) • change positions frequently to enhance secretion clearance and pulmonary ventilation and perfusion.

19. Nursing Interventions Promoting Fluid Intake • An increased respiratory rate  increase in insensible fluid loss during exhalation dehydration. • Encourage increased fluid intake (at least 2 L/day), unless contraindicated. • slowly and with careful monitoring in patients with preexisting conditions such as heart failure.

20. Nursing Interventions Maintaining Nutrition • patients with SOB and fatigue have a decreased appetite and consume only fluids. • Fluids with electrolytes (Gatorade) may help provide fluid, calories, and electrolytes. • IV fluids and nutrients administered if necessary.

21. Nursing Interventions Promoting Patients’ Knowledge • The patient and family are instructed about the cause of pneumonia, management of symptoms, signs and symptoms that should be reported to the physician. • Provide information about risk factors and strategies to promote recovery and prevent recurrence. • Instruct about the importance of management strategies and adhering to them • Use simple language and written instructions

22. Nursing Interventions Monitoring and Managing Potential Complications • observe for response to antibiotic therapy within 24 to 48 hours • Monitor for changes in physical status and for persistent recurrent fever  allergic reaction • monitor for other complications, such as shock and multisystem failure and atelectasis, which may develop during the first few days of antibiotic