UNIT III PNEUMONIA

1. UNIT IIIPNEUMONIA Mrs.Indumathi Lecturer YNC

2. Learning Objectives • define pneumonia • enlist the etiology and predisposing factors • explain the pathophysiology • enlist the clinical manifestations • describe the types of pneumonia • explain the complications • enlist the diagnostic tests • explain the treatment and nursing management

3. DEFINITION Pneumonia is an inflammation of the lung parenchyma caused by various micro organisms including bacteria, mycobacteria, fungi, and viruses.

4. INCIDENCE • ARI accounts for 3.9 million young children dying globally. • About 90% of ARI deaths are due to pneumonia. • In developed countries a incidence of pneumonia is as low as 3% to 4% but in the developing countries it as high as 20% to 30%.

5. ETIOLOGY

6. FACTORS PREDISPOSING TO PNEUMONIA • Aging • Air pollution • Altered consciousness • Altered oropharyngeal flora

7. Chronic disesases • HIV infection • Immunosuppressive drugs • Inhalation or aspiration of noxious substances • Malnutrition • Tracheal intubation • Upper respiratory tract infection

8. PATHOPHYSIOLOGY

9. ETIOLOGIC AGENT • Streptococci • Pneumococci • Bacterial mycoplasmpneumonaie • PREDISPOSING FACTORS • Low impervious system • Exposure to toxic gases • Exposure to microorganism Red hepatization & consolidation of lung parenchyma • Microorganism enter alveolar spaces by droplet inhalation/aspiration INFLAMMATION OCCURS • Gray hepatization & deposition of fibrin on pleural surfaces

10. Alveolar sacs filled with exudate • There is loss of spaces and replacement with fluid (consolidation) COMPLICATIONS • Emphysema • Pleurisy • Lung abscess • Cancer of lungs • BRONCHOPNEUMONIA • SIGNS AND SYMPTOMS • Cough with greenish or yellowish mucus • Fever • Rapid, shallow breathing • Shortness of breath • Loss of appetite DEATH

11. CLINICAL MANIFESTATION • Fever- usually high grade • Respiratory • Ronchi or fine crackles • Dullness with percussion • Cough with greenish or yellowish mucus • Rapid, shallow breathing • Shortness of breath • Retractions • Grunting& nasal flaring • Chest pain • Loss of appetite • Cyanosis

12. Gastrointestinal- anorexia, vomiting, diarrhea, abdominal pain • Behaviour- irritable, restless, lethargy

14. On physical examination, signs of pulmonary consolidation, such as dullness to percussion, increased fremitus, bronchial breath sounds, and crackles, may be found.

15. Classification

16. 1. Etiological classification • Bacterial pneumonia: lobar and broncho pneumonia • Viral and micoplasmal pneumonia • Other types a. pneumocyticcarini pneumonia b. aspiration Pneumonia c. lipid pneumonia

17. TYPES OF BACTERIAL PNEUMONIA Pneumonia affects lungs in two Ways . According to areas involved : • Lobar pneumonia : affects a section (lobe) of a lung or entire lobe • Bronchial pneumonia (Bronchopneumonia) : inflammation of terminal bronchioles extends to surrounding alveoli

18. Contd… 2.VIRAL PNEMONIA • Is characterized by patchy inflammatory changes confined to interstitial tissue without any alveolar exudate 3.Pneumocytic carinipneumonia • Caused by inhalation of organism as an opportunistic infection n neonates and immune supppressive patients

19. Contd… 4.Aspiration Pneumonia • Result from entry of endogenous or exogenous substances into the lower airway 5.Lipid pneumonia • results from aspiration of nasal drops, regurgitation of oily medicine, obstruction of airway by tumor

20. BASED ON SETTING • Community-acquired pneumonia • Hospital-acquired pneumonia(nosocomial pneumonia)

21. Community-acquired pneumonia • CAP is defined as a lower respiratory tract infection of the lung parenchyma with onset in the community or during the first 2 days of hospitalization.

22. The organisms associated with community acquired pneumonia are: • streptococcus pneumonia, • mycoplasma pneumonia, • hemophilus influenza, • respiratory viruses, • Chlamydia pneumonia, • legionellapneumophila, • staphylococcus aureus, • eneteric aerobic gram negative bacteria, fungi, • and mycobacterium tuberculosis.

23. HOSPITAL-ACQUIRED (NOSOCOMIAL) PNEUMONIA • Pneumonia occurring at least 48 h after hospital admission and not incubating at the time of admission • HAP is the second most common nosocomial infection, accounting for up to 30% of all nosocomial infections • A subset of HAP — ventilator-acquired pneumonia (VAP) — has been defined as pneumonia occurring after at least 48 h of mechanical ventilation and not incubating at the time of intubation. • VAP occur within the first 4 days of intubation.

24. HAP-Clinical manifestation • the presence of a new or progressive infiltrate on chest radiography plus at least two of the following: • fever [>37.8°C (>100 oF)], • leukocytosis (>10,000 white blood cells/uL), • the production of purulent sputum. • Other findings, such as dyspnea, hypoxemia, and pleuritic chest pain

25. HAP - Prevention • Health care providers must adhere strictly to hand-washing protocols. • Surveillance of pneumonia rates should be routinely performed and reported. • In patients undergoing mechanical ventilation, • extubate rapidly, • ensure careful periodic drainage of tubing condensate. • Use of endotracheal tubes with a separate posterior lumen that allows continuous suctioning of subglottic secretions • When the patient is receiving enteral feedings, • a small-bore feeding tube should be placed distal to the pylorus, • Elevation of the head of the bed by at least 30°, • decontamination of the digestive tract

26. Pleural effusion Atelectasis Bacteremia Complications Empyema Lung abscess Pericarditis Endocarditis Meningitis

27. Diagnostic studies • History and physical examination • Chest X-ray

28. Chest x-ray: usually shows scattered or localized infiltration and identifies structural distribution

29. CT scan • Sputum gram stain • Sputum culture • Complete blood count • Serology testing • Pulse oximetry • Arterial Blood Gases • Fiberopticbronchoscopy

31. PREVENTION Prevents bacteremic pneumococcal disease Chronic illness, recovering from illness 65 years of age or older, immuno-suppressed Pneumococcal vaccine

32. Prevention of ventilator associated pneumonia Avoid ET intubation

33. Use of non-invasive ventilation Short course antibiotic therapy

35. MEDICAL MANAGEMENT • Antibiotics • Bronchodilators • Bed rest • Antipyretic • Nebulization • Liberal oral intake of fluid • Hospitalization is indicated when pleural effusion or empyema accompanies the disease.

36. Empirical antibiotic therapy for CAP

37. Oxygen therapy • Indicated for the client who is tachypneic or hypoxemic • Oxygen may be administered by either a low-flow or high-flow system. • Severe hypoxia may necessitate intubation and mechanical ventilation

38. CHEST PHYSIOTHERAPY: • Percussion • Vibration • Postural drainage

39. COMPLEMENTARY THERAPY • The herb Echinacea is widely used to stimulate immune function and treat URIs.

40. GOLDENSEAL HERB

41. NURSING MANAGEMENT: • ASSESSMENT

42. NURSING MANAGEMENT Nursing Assessment • History • Physical Examination • Psychological factors / developments stage to understand the action • Knowledge of family / parents.

43. NURSING PRIORITIES • Maintain/improve respiratory function • Prevent complications • Support healing/curative process • Provide information about disease process, prognosis and treatment

44. NURSING DIAGNOSES • Ineffective breathing pattern related to inflammation and pain as evidenced by dyspnea, tachypnea, nasal flaring, altered chest excursion. • Ineffective airway clearance related to retained secretions and excessive mucus as evidenced by ineffective cough and dyspnea.

45. Acute pain related to inflammation as evidenced by patient report of pleuritic chest pain and presence of pleural friction rub, shallow respirations.