3. LEARNING OBJECTIVES
By the end of the session, the participants should be able to;
Define pneumonia
Differentiate between the various types of pneumonia
State the causes of pneumonia
Discuss the signs and symptoms of pneumonia
Explain the conservative management of Pneumonia
Outline the treatment of patient with pneumonia based on
nursing process approach
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5. INTRODUCTION
Pneumonia is an inflammation of the lung parenchyma that is commonly
caused by a microbial agent.
“Pneumonitis” is a more general term that describes an inflammatory
process in the lung tissue that may predispose a patient to or place a
patient at risk for microbial invasion.
Pneumonia is the most common cause of infectious death in children
worldwide and also the most serious for people older than 65 years and
people with health problems or weaken immune system.
It is the seventh leading cause of death in the United States for all ages
and both genders, resulting in almost 70,000 deaths per year.
In persons 65 years of age and older, it is the fifth leading cause of death
(National Centre for Health Statistics, 2000; Minino & Smith, 2001).
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6. INTRODUCTION Cont.
Although it is usually associated with an acute infection,
pneumonia can also result from radiation therapy, chemical
ingestion or inhalation, or aspiration of foreign bodies or gastric
contents.
It is characterized by cough, fever, headache, chest pain, shortness
of breath, sweating, tachycardia, greyish sputum etc.
Pneumonia caused by infectious agent are mostly contagious
either by direct or indirect contact with an infected person.
Pneumonia is the cause of more than 10% of hospital admissions
each year and is the most common cause of death from infection.
It is treated extensively on both an inpatient and outpatient basis.
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7. DEFINITION
Pneumonia can be defined as an inflammation of the lung
parenchyma that is commonly caused by a microbial agent
(bacteria, viruses and fungi).
Pneumonia is an inflammatory process affecting the
bronchioles and alveoli usually associated with an acute
infection but can also result from radiation therapy,
chemical ingestion or inhalation, or aspiration of foreign
bodies or gastric contents (American Lung Association,
2007).
It is inflammatory condition of the lung most commonly
due to an infection affecting primarily the microscopic air
sac known as the alveoli.
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8. CLASSIFICATIONS/TYPES
Pneumonia can be classified based on the following;
Causative factors – bacterial pneumonia, viral pneumonia,
fungal pneumonia, chemical pneumonia
Area of the lung affected – bronchopneumonia & lobar
pneumonia
Where or how it was acquired – hospital acquired
pneumonia, community acquired pneumonia, ventilator-
associated pneumonia, aspiration pneumonia, walking
pneumonia, hypostatic pneumonia.
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9. TYPES OF PNEUMONIA
BACTERIAL PNEUMONIA – this is the type of pneumonia caused by bacteria.
The common bacteria is Streptococcus pneumoniae; also called
pneumococcal pneumonia. This organism accounts for approximately 90% of
all bacterial pneumonias. It is the most common cause of community-
acquired pneumonia, Other bacteria include Staphylococcus aureus,
Mycoplasmapneumoniae, Escherichia coli, and Pseudomonas aeruginosa,
among others.
VIRAL PNEUMONIA – this is the type of pneumonia caused by viruses.
Influenza viruses are the most common cause of viral pneumonia. The
presence of viral pneumonia increases the patient’s susceptibility to a
secondary bacterial pneumonia.
FUNGAL PNEUMONIA – is the type of pneumonia caused by fungi. Candida
and Aspergillus are two types of fungi that can cause pneumonia.
Pneumocystis carinii is a fungus that typically causes pneumonia in patients
with AIDS.
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10. TYPES OF PNEUMONIA cont.
ASPIRATION PNEUMONIA – is the type of pneumonia caused by
aspiration of foreign substances. This most often occurs in patients with
decreased levels of consciousness or an impaired cough or gag reflex. This
condition can occur with alcohol ingestion, stroke, general anesthesia,
seizures, or other serious illness. Aspiration pneumonia increases the risk
for subsequent bacterial pneumonia.
VENTILATOR–ASSOCIATED PNEUMONIA - A type of aspiration
pneumonia, ventilator-associated pneumonia (VAP), develops in patients
who are intubated and mechanically ventilated. The endotracheal tube
keeps the glottis open, so secretions can be aspirated in to the lungs.
HYPOSTATIC PNEUMONIA - Patients who hypo ventilate because of bed
rest, immobility, or shallow respirations are at risk for hypostatic
pneumonia. Secretions pool in dependent areas of the lungs and can lead
to inflammation and infection.
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11. TYPES OF PNEUMONIA cont.
COMMUNITY ACQUIRED PNEUMONIA - This develop on
people with limited or no contact with medical institutions or
settings. It occurs either in the community setting or in the first
48 hours after institutionalization
HOSPITAL ACQUIRED PNEUMONIA - This develops typically
after about 2days or more of hospitalization and does not
appear to be incubating at the time of admission.
PNEUMONIA IN THE IMMONOCOMPROMISED PEOPLE - This
occur in people whose immune system is weakened for
example by AIDS, organ transplantation, use of certain drugs
such as corticosteroids, immunosuppressive agents,
chemotherapy, nutritional depletion etc.
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12. TYPES OF PNEUMONIA cont.
CHEMICAL PNEUMONIA – this type of pneumonia
occur due to Inhalation of toxic chemicals into the lung
causing inflammation and tissue damage in the lungs.
BRONCHOPNEUMONIA – is the type of pneumonia
that can affect areas throughout both lungs. It’s often
localized close to or around the bronchi.
LOBAR PNEUMONIA – is the type of pneumonia that
affects one or more lobes of the lungs. Each lung is
made of lobes, which are defined sections of the lung.
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13. CAUSES/RISK FACTOR
The causative factors for pneumonia are mainly microbial organisms;
Bacteria such as Streptococcus pneumonia, Mycoplasma pneumonia,
Haemophilus influenza & Legionella pneumophila
Viruses such as nfluenza (flu), rhinoviruses (common cold), human
parainfluenza virus (HPIV) human metapneumovirus (HMPV), SARS-CoV-2
infection (the virus that causes COVID-19)
Fungi such as candida, aspergillus, Pneumocystis jirovecii, Cryptococcus
species, Histoplasmosis species.
Other causes include but not limited
Irritants/foreign bodies
Chemicals
Aspiration
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14. RISK FACTORS
Anyone can get pneumonia, but some people are at higher risk than
others. Some of the risk factor include the following;
Cigarrete smoking
Alcohol abuse
Infants and aged
Recent viral respiratory infections such common cold, influenza,
laryngitis etc.
Chronic lung disease such COPD, Bronchiectasis, asthma etc
Cerebral palsy
Dysphagia due to neurological conditions
Malnutrition etc
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15. PATHOPHYSIOLOGY
Pneumonia is an inflammation of the lungs caused by various micro-
organism and or other causative factors.
It arises from patients whose resistance has been altered or from aspiration of
flora present in oropharynx or from blood borne organism that enter
pulmonary circulation and are trapped.
Once the organism or particles enters the lungs, an inflammatory reaction
occur in the alveoli producing fever.
The irritation of the pleura following the inflammatory reaction produces
chest pain and exudate formation that interferes with the diffusion of oxygen
and carbon-dioxide causing difficulty in breathing.
The presence of exudate and mucus interfere with gaseous exchange and
triggers the cough reflex causing constant coughing.
If treatment is not instituted empyema, septicaemia, pleural effusion and
atelectasis may occur as complications.
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16. CLINICAL MANIFESTATION
Although symptoms may vary greatly depending on the presence
of other underlying condition, common symptoms include;
Cough
Fever
Shortness of breath
Chest pain (pleuritis pain)
Nausea and vomiting
Sweating/diaphoresis
Tachycardia
Fatigue
Headache
Muscle pain
Purulent sputum
Anorexia
Tachypnoea
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18. DIAGNOSTIC EVALUATION
History taking
Physical examination – Ausculation will reveal
crepitation, percussion will reveal dullness in the
affected part.
Sputum and blood culture to identify the causative
organism
Pleural fluid test
Chest X-ray to reveal the area of consolidation
Pulse oximetry
Bronchoscopy
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20. CONSERVATIVE MANAGEMENT
The aim of the conservative management is
to relief symptoms, promote healing and
prevent complications. The conservative
management is categorized into:
Home remedy
Medical/pharmacologic management
Nursing management
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21. Home remedy
Although home remedies don’t actually treat pneumonia, there are some
things you can do to help ease symptoms.
Coughing is one of the most common symptoms of pneumonia, Natural
ways to relieve a cough include gargling salt water or drinking
peppermint tea or honey with hot water.
Steam inhalation reduces congestion
Drinking warm water or having a nice warm bowl of soup can help with
chills.
You can help your recovery and prevent a recurrence by getting a lot of
rest and drinking plenty of fluids.
Although home remedies can help ease symptoms, it’s important to stick
to your treatment plan. Take any prescribed medications as directed.
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22. Medical treatment
Antibiotics – the choice of antibiotics depend on the result of
the sensitivity test. Common group used are penicillins such as
ampicillin, amoxicillin, augumentin, xtaphen etc others include
streptomycin, septrin and chloramphenicol.
Analgesics – paracetamol, aspirin, chymoral are used to relief
pain and pyrexia
Cough syrups/expectorant – Benylin cough mixtures
Vitamins – vitamin C and B complex are used as adjuvant
therapy
Iv fluid therapy to replace fluid loss in severe cases
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23. Nursing management
Encourage the patient to adhere to the medication regimen
Rest should be advocated especially during the acute phase of
the disease.
Reducing stress requires physical and psychological
modifications
Help patient identify and manage stressful situations
Admitting patient in fowlar’s position promote lung expansion
Biofeedback or behavior modification may be helpful
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24. Nursing management cont.
Strongly encouraged to stop smoking
High nourishing diet
Maintaining fluid intake and output balance
chart
Providing passive and active exercise
including breathing exercise is essential
Oxygen administration in severe cases is
also helpful
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25. NURSING DIAGNOSIS
Ineffective breathing pattern r/t alveolar congestion aeb patient
difficulty in breathing and respiratory circle of 10c/m
Acute pain (chest pain) r/t pleural irritation or inflammatory
process aeb patient verbalization
Hyperthermia r/t inflammatory process aeb temperature
reading 39 decree celcius
Deficient fluid volume r/t vomiting aeb loss of skin turgor
Imbalanced nutrition: less than body requirements r/t nausea &
vomiting aeb weight loss
Anxiety r/t unknown disease prognosis aeb patient’s
verbalisation/asking questions
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27. PREVENTION OF RECURRENCE
A number of steps can be taken to help prevent getting
pneumonia include;
Adheres to treatment regimen
Stop smoking
Avoid respiratory infections
Regular hand hygiene
Avoid extreme exposure to cold
Pneumococcal conjugate vaccine (PCV) where available
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