Non-Modifiable Factors: Extremes of Age: The Very Young The Elderly (60 and Above) Race or Ethnicity: Native Americans Native Alaskans Gender: Male Environmental: Inhalation of foreign materials into the lungs
Modifiable Factors: Lifestyle: Smoking and Alcohol abuse Improper diet causing malnutrition Environmental: Exposure to Pathogens: S. Pneumoniae, H. Influenza, Lagionella, P. Aureginosa, other gram (-) rods and viruses Exposure and inhalation of Secondhand smoke and other chemical pollutants Genetics: The immunocompromised or immunosuppressed patients with low neutrophil count Underlying Diseases: HIV/AIDS Diabetes Mellitus Cardiovascular Diseases Respiratory Diseases: Pulmonary tuberculosis and Chronic Obstructive Pulmonary Disease Medication: Drugs that may cause Respiratory Depression: General Anesthetics, Opioids, Sedatives Drugs that may cause Immunosuppresion: Corticosteroids, Chemotherapeutic Drugs Self-medicating with antibiotics that may cause bacterial/viral resistance: Penicillin, Cephalosporins Others:
Depressed Cough Reflex
Legend: Modifiable and Non-Modifiable Risk Factors Clinical Manifestations/Signs and Symptoms
RACE
AGE
GENDER
ENVIRONMENTAL
LIFESTYLE
GENETICS
UNDERLYING DISEASES
MEDICATION
OTHERS
Male
Exposure to pathogens:
S. Pneumoniae, H. Influenza, Lagionella, P. Aureginosa, other gram (-) rods and viruses
Aspiration of bacteria in lower respiratory tract Bacterial invasion into the lungs and lower respiratory tract (trachea > bronchus > bronchioles > alveoli) Immune response triggered
Inflammatory response
Release of chemical mediators (Histamine, Bradykinin, etc.) Vasodilation and capillary permeability Fluid shifting and edema
Migration to alveoli Killer T-Cells, macrophages, phagocytes and anti-bodies take effect to pathogens
Filling of WBC in alveoli and the normally air containing space Exudate/Fluid accumulation in alveoli Partial occlusion of bronchi and alveoli Altered ventilation and diffusion
Decrease oxygen level of blood that passes on the lungs Alveolar O2 tension
Hypoventilation Cerebral hypoxia CNS Alterations Headache, dizziness, fatigue, lethargy, restlessness, confusion, irritability, loss of appetite, mood swings
Pallor Cyanosis
Hemoptysis
Alveolar damage
Alveolar collapse
Pulmonary consolidation
Atelectasis
RBC
Hyperventilation
Secondary necrosis of other phagocytes Further damage to other lung parenchyma near the affected part
Inflammation
Permeability of pleural capillary membrane
Non-productive cough
Oncotic pressure
Dullness in percussion
Empyema
Chest pain
> 150-200ml
Mediastinal compression
Dyspnea
Lung expansion
Ventilation-perfusion mismatch
Arterial hypoxemia
Gas-exchange capacity
Compromised breathing Shallow breaths Hypoxemia Tachypnea Hypoxia Breath sounds on affected area Unmanaged effusion
Lung compliance
Ventilatory restriction
Atelectasis Source: Focus on Pathophysiology by Bullock and Henze pp253-285 & 572-573 Medical-Surgical Nursing by Brunner and Suddarth pp328330 & 574