Pneumonia

Pathophysiology An inflammatory process in which there is consolidation

caused by exudates filling the alveolar spaces.

Gas exchange cannot take place in consolidated area

Pneumonia
Classifications (causative agents) Viral pneumonia Bacterial Pneumonia
Streptococcus pneumoniae Pneumocystis carninii

Fungal pneumonia Radiation pneumonia Chemical pneumonitis Aspiration pneumonia Hypostatis pneumonia

Pneumonia
Which of the following components of respiration would pneumonia affect? (there may be more than one answer) A. Ventilation B. Perfusion C. Diffusion Answer: A&C

Pneumonia
Pathophysiology Inflammation h Exudate i movement of O2 and CO2 WBC migrate into the alveoli Fill air-containing spaces i ventilation PaO2 ? i

Pneumonia
Etiology Community acquired pneumonia
Strep

Hospital acquired pneumonia

Nosocomial (CDC: 15-20% all pt get HAP)

Pneumonia
Etiology Bacterial pneumonia
Occurs from normal flora in a pt whose resistance has been altered

Viral pneumonia
Occurs in previously healthy persons

Pneumonia
S&S: bacterial
Onset:
Sudden Cough Painful Sputum Rust colored Breathing Shallow Rapid rate Wheezing & crackles Decreased BS Peristaltic activity Slows down PaO2 i Cyanotic

Pain:
Severe chest pain sharp Guarding i mobility (affected side)

Temperature
High temp (>106) Chills

Pneumonia: S&S: viral pneumonia

Blood cultures:
Sterile

Pulse
Slow

Sputum
Copious

PaO2
i Cyanotic

Temperature
Seldom chills

Respirations
Slow Wheezing & crackles Diminished BS

Viral less severe than bacterial Mortality is low

Pneumonia
S&S Elderly General deterioration Weakness Abd. Symptoms Anorexia Confusion Tachycardia Tachypnea Do Not C/O
Cough Pain Fever Sputum

Pneumonia: Risk factors

Immunosuppressant Smoking Prolonged immobility Depressed cough reflex NPO Alcohol intoxication Gen. anesthetic or opiod Advanced age

Pneumonia
Dx Sputum C&S CBC / WBC
h
Bacteria

What is a normal WBC count?

5,000 10,000 mm3

i
Viral

ABGs Chest x-ray

Pneumonia
What would you expect the ABGs of a person with bacterial pneumonia to have? PaO2? PaCO2? pH HCO3- ? - Why? Analysis?

ANSWER! PaO2
i

PaCO2
h acidosis

pH
i acidosis

HCO3h alkalosis Compensation

Respiratory acidosis

Pneumonia
Treatment Antibiotics? Rest Fluids
h Humidifier

Analgesics O2 Mucolytic drug

Alivaire Via nebulizer

Antipyretic Anti-tussive?

Pneumonia: Nrs. diagnosis

Ineffective airway clearance: r/t copious secretions Activity intolerance: r/t impaired resp. function Risk for deficient fluid volume: r/t fever & dyspnea Imbalanced nutrition: less than body requirement Deficit knowledge: about the treatment regimen and preventive health measures

Pneumonia
Nursing interventions Improve airway patency
Hydration
2-3 L/day Humidifier

Promoting rest & conserving energy Position

Semi-fowler Affected side for pain

TCDB Lung expansion maneuvers

Incentive spirometer

Chest physiotherapy O2

Turn frequently Moderate activity only Promoting fluid intake Maintaining nutrition Gatorade Ensure Promoting the patients knowledge

Pneumonia
Prevention Vaccine
Pneumonia Flu

Treat URI Avoid irritants

Pneumonia
Complications CHF Empyema Pleurisy Septicemia Atelectasis

Pneumonia: Small Group Questions

1. Describe the pathophysiology of pneumonia. 2. What is the difference btw bacterial and viral pneumonia? 3. What causes pneumocystis carinii? 4. What leads to hypostatis pneumonia? 5. What lab values are associated with bacterial pneumonia? / viral pneumonia?

Pneumonia: Small Group Questions

6. What is Nosocomial pneumonia 7. Identify 5 risk factors for developing pneumonia 8. What medications might be administered to treat a pt. with pneumonia? 9. What nursing education would you give to a patient with pneumonia? 10. What ABGs are associated with pneumonia? 11. What are the gerontological considerations of caring for the elderly in regards to pneumonia?