Pneumonia

Phelan Coy, Charlene Ferguson & Devika

Gill

Objectives
At the end of this presentation, students will be able to:
Give a basic overview of Pneumonia.
Define the classifications of Pneumonia.
State the etiology of Pneumonia.
Describe the pathophysiology of Pneumonia.
List the clinical manifestations of Pneumonia.
State the diagnostic tests for Pneumonia.
Describe the medical management for Pneumonia.
Discuss the nursing management for Pneumonia.
Review a nursing care plan for a patient with
Pneumonia.
State possible complications of Pneumonia.

Overview of Pneumonia
Inflammation of the lung parenchyma.
Classified according to morphology,
etiologic agent or clinical form
Clinical manifestations vary on the:

Etiologic agent
Age
Persons systemic reaction to the infection
Degree of bronchiolar obstruction

Classifications of
Pneumonia
Occurs in different settings:
Community-acquired pneumonia (CAP) occurs within
48 hours after hospitalization.
Hospital-acquired (nosocomial) pneumonia (HAP)
onset of symptoms more then 48 hours after admission
in patients with no evidence of infection at the time of
admission
Pneumonia in the immuno-compromised host caused
by organism in CAP OR HAP; can also occur in immunocompetent people
Aspiration pneumonia occurs from entry of
endogenous or exogenous substances into the lower
airway. Occurs in community or hospital setting.

TYPES OF PNEUMONIA
Pneumonia affects your lungs in two ways.
According to areas involved :
Lobar pneumonia : affects a
section (lobe) of a lung.

Bronchial pneumonia
(Bronchopneumonia) :
affects patches throughout both lungs.

LOBAR PNEUMONIA

BRONCHOPNEUMONIA

Etiology - CAP causative agents:

S. pnuemoniae ( s. pneumococcus), gram

positive most common young people & elderly
with comorbidity.
H. influenza affects elderly & those with
comorbidity such as COPD, DM & alcoholism. Its
subacute with cough & low grade fever.
Mycoplasma pneumonia spreads by person-to
person contact through air droplets & spread to
the entire respiratory system.
Virus cytomegalovirus is common in
immunocomprised adults. Inflammation extends
to alveolar area resulting in edema & exudation

Etiology - HAP causative agents

Bacteria pneumonia- associated with
mechanical ventilator or endotracheal
intubation. This type is known as
nosocomial pneumonia & causes the air
sacs to become inflamed and filled with pus
Staphylococcal pneumonia occurs through
inhalation of organism or spread through
hematogenous route. Overuse of
antimicrobial agents should be noted

Pneumonia in immunocomprised host:

Fungal pneumonia & mycobacterium
tuberculosis can affect those on
chemotherapy, nutritional depletion, use of
broad spectrum antimicrobial agents, AIDS,
long term MV & genetic immune disorder.
Aspiration Pneumonia:
Entry of endogenous or exogenous
substances into lower airway e.g. bacterial
infection of natural bacteria of the upper
airways.
Other substances can aspirated into the
lungs such as gastric contents, irritating
gases.

Pathophysiology

Invasion and overgrowth of microorganisms in

the lung parenchyma
Provokes intra-alveolar exudates
Pathogen has to reach the alveoli so defenses
become overwhelmed. WBCs, mainly
neutrophils fill the normally air-filled spaces.
Small blood vessels of the lungs becomes leaky
with protein rich fluid seeping into the alveoli.
Results in a less functional area for gas
exchange. It affects both ventilation and
diffusion.

Clinical manifestations
High

fever, Shaking Chills

Shortness of breath (Dyspnoea)
Increased breathing rate (Tachypnea)
Chest pain when you breathe deeply or cough
Dusky or purplish skin colour (cyanosis) from
poorly oxygenated blood
Fatigue and muscle aches
Nausea, vomiting or diarrhoea
Cough, particularly cough productive of
sputum

Clinical manifestations
Streptococcus

pneumoniae: Rust-colored

sputum.
Pseudomonas, Haemophilus, and
pneumococcal species: May produce green
sputum.
Klebsiella species pneumonia: Red currantjelly sputum.
Anaerobic infections: Often produce foulsmelling or bad-tasting sputum.
Older people who have pneumonia sometimes
have sudden changes in mental awareness.

Diagnostic tests
History taking
Physical examination
Chest x-rays
Blood and sputum cultures
Gram stain

Medical management
Most people can be treated at home.
If pneumonia becomes so severe that
treatment is in the hospital, you may receive
fluids and antibiotics, oxygen therapy, and
possibly breathing treatments.
Viral Pneumonia: Anti-virals like Oseltamivir
(Tamiflu) and zanamivir (Relenza)
Bacterial pneumonia: Patients with mild
pneumonia who are otherwise healthy are
treated with oral macrolide antibiotics
(azithromycin, clarithromycin, or erythromycin).

Medical management

Patients with other serious illnesses, such as

heart disease, chronic obstructive pulmonary
disease, or emphysema, kidney disease, or
diabetes are often given more powerful and/or
higher dose antibiotics.
Don't smoke.
Practice good hygiene.
Stay rested and fit.

Medical management cont

Appropriately treating underlying illnesses (such

as HIV/AIDS, diabetes mellitus, and malnutrition)
can decrease the risk of pneumonia.
Get a Pneumonia Vaccination.

Nursing management

Conserve strength.
Encourage rest to prevent exhaustion
Turn and reposition frequently
IV therapy
Provide humidified oxygen
Check SpO2 regularly
Encourage chest physiotherapy
Give frequent small feedings
Stay hydrated.Drink plenty of fluids, especially
water, to help loosen mucus in your lungs.
Educate about medication adherence

Nursing Care Plan

Assessme
nt

Diagnosis

Planning
/ Goals

Interventio
ns

Rationale

Evaluatio
n

25 year old
male with
chest pain,
cough,
crackles
and
malaise

Ineffective
airway
clearance
related to
immobile
mucous
secretion
AEB
consistent
coughing &
pleuritic
pain.

Patient will
be able to
demonstra
te
effective
coughing
technique.

Monitor
patients
vital signs,
respiratory
status and
breath
sounds.

To
compare
base line
measurem
ents to
maintain
homeostas
is. To
assess for
tachypnea
or
adventitio
us sounds

The patient
was able to
effectively
demonstrat
e proper
coughing
technique

Administer
bronchoacti
ve
medications
as ordered
0.5cc
ventolin
and 2.5 cc
normal
saline.
Elevate
head of bed

Medication
aids in the
dilation of
the
bronchiole
s.

For lungs
expansion,
mobilizati
on & to
relieve
chest pain
& provide
comfort

Encourage
fluid
intake of
3-4L/day
or warm
fluids to
drink.

To help
thinning &
mobilize
secretion for
expectoratio
n

Teach
deep
breathing
exercises
&
coughing
technique.

To help with
mobilize
secretion for
expectoratio
n.

Assessme
nt

Diagnosis

Plannin
g/
Goals

Interventio
ns

Rationale

Evaluatio
n

Risk for
infection
related to
stasis of
secretion.

The
patient
will be
able to
prevent
and
reduce
risks for
infection.

Encourage
the patient to
drink plenty
of water to
keep
hydrated.

Thorough
education
patient will
understand
that fluid
helps
thinning
secretion
for
expectorati
on and
replace lost
during
fever.

Patient
practices
technique
to prevent
the spread
of
infection.

Frequent
hand washing
or use of
alcohol base
hand rubs.

To prevent
the spread
of
infection.

Encourage
the patient
to cover
mouth while
expectoratin
g secretion.

Explain the
need to
adhere to
medication
prescription,
especially
antibiotics.

To help
contain the
mucous
secretion
prevent
spreading
infection.

Noncomplian
ce of
antibiotic
and lead to
developing
resistance to
specific
antibiotic.

Complications

Shock & respiratory failure

Pleural Effusion

References
Bono, M.(2014).Medscape.Retrieved16 February,
2016,from http://
emedicine.medscape.com/article/1941994- medication#2
Oba, Y.(2015).Medscapecom.Retrieved16 February,
2016,from
http://emedicine.medscape.com/article/297351-overview
Mosenifar, Z.(2015).Medscapecom.Retrieved16 February,
2016,from http
://emedicine.medscape.com/article/300455-treatment
Kamangar, N.(2015).Medscapecom.Retrieved16 February,
2016,from http://
emedicine.medscape.com/article/300157-treatment
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H.
(2012). Brunner & Suddraths Textbook of Medical-Surgical
Nursing (12th ed., Vol. 1). Wolters Kluwer Health