Pneumonia

PNEUMONIA
Nursing Path
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Definition:
 An inflammatory
process in lung
parenchyma
usually
associated with
a marked
increase in
interstitial and
alveolar fluid.
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Etiology & Risk factors:
Etiology:
 Bacteria, viruses, mycoplasmas, fungal
agents & protozoa.
 Aspiration of food, fluids, / vomitus.
 Inhalation of toxic/caustic chemicals, smoke,
dusts/gases.
 Influenza.

Risk Factors:
• Advanced age.
• History of smoking.
• Upper respiratory infection.
• Tracheal intubation.
• Prolonged immobility.
• Immunosuppressive therapy.
• Nonfunctional immune system.
• Malnutrition.
• Dehydration.
• Chronic disease state.

 Cigarette smoking
 Recent viral respiratory infection (common
cold, laryngitis, influenza)
 Difficulty swallowing (due to stroke,
dementia, Parkinson's disease, or other
neurological conditions)
 Chronic lung disease (COPD, bronchiectasis,
cystic fibrosis)
 Cerebral palsy
 Other serious illnesses, such as heart
disease, liver cirrhosis, /diabetes mellitus

Cont….
 Exposure to air pollution.
 Altered consciousness(Alcoholism, Drug
overdose, General anesthesia, Seizure
disorder).
 Inhalation of noxious substances.
 Residing in Institutional settings.

 Living in a nursing facility
 Impaired consciousness (loss of brain
function due to dementia, stroke, or other
neurologic conditions)
 Recent surgery or trauma
 Immune system problem

Path-physiology:
Offending organism/agent.
Inflammatory pulmonary response.
Lose defense mechanisms of the lungs.
Allow organisms to penetrate the sterile LRT.
Develop inflammation.

Disruption of the mechanical defenses
(cough & ciliary motility)
Colonization of the lungs.
Inflamed & fluid-filled alveolar sacs.
Alveolar exudates tends to consolidate.
Difficult to expectorate.

Types:
1. Pneumococcal pneumonia:
 Caused by Streptococcus pneumonia.
 C/M:- high fever.
- stabbing pleuritic chest pain.
- malaise.
- weakness.
- elevated WBC count.
- tachypnea.
- dyspnea.
- blood-streaked purulent sputum.

2. Staphylococcal pneumonia:
 Caused by Staphylococcus aureus.
 C/M:- fever with multiple chills.
- pleuritic pain.
- rales.
- decreased breath sounds.
- dyspnea.

3. Influenzal pneumonia:
 Caused by Haemophilus influenza.
- stabbing pleuritic chest pain.
- malaise.
- weakness.
- tachypnea.
- dyspnea.
- blood-tinged purulent sputum.

4. Gram-negative bacterial pneumonia:
 Caused by Klebsiella pneumonia.
 C/M:- fever with multiple chills.
- pleuritic pain.
- rales.
- cyanosis.
- dyspnea.

5. Anaerobic bacterial pneumonia:
 Caused by normal oral flora.
 C/M:- low-grade fever.
- hypertension.
- crackles.
- cyanosis.
- dyspnea.
- foul smelling purulent sputum.
- tachycardia.

6. Legionnaires’ disease:
 Caused by Legionella pneumophila.
 C/M:- fever.
- pleuritic pain.
- nausea.
- confusion.
- dyspnea.
- blood-tinged sputum.

7. Mycoplasma pneumonia:
 Caused by Mycoplasma microorganisms.
 C/M:- slowly rising fever.
- headache.
- myalgia.
- malaise.
- normal WBC count.
- scant mucoid sputum.

8. Viral pneumonia:
 Caused by Influenza A virus.
- headache.
- myalgia.
- dyspnea.
- normal/slightly WBC count.
- mucoid sputum.
- normal breath sounds.

9. Aspiration pneumonia:
 Caused by aspiration of gastric contents.
 C/M:- tachypnea.
- apnea.
- cyanosis.
- hypotension.
- leukocytosis.
- adventitious lung sounds.
- fever.

Clinical manifestations:
♥ Fever.
♥ Chills.
♥ Sweats.
♥ Pleuritic chest
pain.
♥ Cough.
♥ Sputum
production.
♥ Hemoptysis.
♥ Dyspnea.
♥ Headache &
fatigue. 6/6/2018 20www.drjayeshpatidar.blogspot.com

Diagnostic evaluation:
Chest auscultation.
Sputum culture analysis & sensitivity/
serologic testing.
Fiber optic bronchoscopy/ Transcutaneous
needle aspiration/ biopsy.
Skin tests.
Blood & urine cultures.
Transcutaneous oxygen level analysis/ ABG
measurements.
Chest X-ray examination.

Classification:
i. Based on area affected:
Segmental pneumonia.
Lobar pneumonia.
Bilateral pneumonia.
ii. Basis of location & radiologic appearance:
Bronchopneumonia.
Interstitial(reticular) pneumonia.
Alveolar(acinar) pneumonia.
Necrotizing pneumonia.

Medical Management:
☻Specific antibiotic therapy: Broad spectrum
antibiotics.
☻Respiratory support:
 Administer oxygen.
 Bronchodilator medications.
 Postural drainage.
 Chest physiotherapy.
 Tracheal suctioning.
☻Nutritional support.
☻Fluid & electrolyte management.

Nursing management:
Ineffective airway clearance R/t excessive
secretions & weak cough.
Ineffective breathing pattern R/t tachypnea.
Activity intolerance R/t decreased oxygen
levels for metabolic demands.
Deficient fluid volume R/t fever, diaphoresis,
& mouth breathing.
Imbalanced nutrition: less than body
requirements R/t dyspnea.
Pain R/t frequent coughing.

Cont….
Impaired oral mucous membrane R/t mouth
breathing & frequent cough.

Possible complications:
 Respiratory failure.
 Empyema or lung abscesses. These are
infrequent, but serious, complications of
pneumonia. They occur when pockets of pus
form inside or around the lung. These may
sometimes need to be drained with surgery.
 Sepsis, a condition in which there is
uncontrolled swelling (inflammation) in the
body, which may lead to organ failure
 Acute respiratory distress syndrome (ARDS),
a severe form of respiratory failure

Pneumonia At A Glance:
Pneumonia is a lung infection that can be caused by
different types of microorganisms, including bacteria,
viruses, and fungi.
Symptoms of pneumonia include cough with sputum
production, fever, and sharp chest pain on inspiration
(breathing in).
Pneumonia is suspected when a doctor hears abnormal
sounds in the chest, and the diagnosis is confirmed by a
chest x-ray.
Bacteria causing pneumonia can be identified by sputum
culture.

Thank You

Pneumonia

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