Pneumonia

THE slides cover all the basic information regarding pneumonia including nursing management#MEDICAL-SURGICAL NURSING

1. PRACTICE TEACHING ON PNEUMONIA Presented by, Gautami S. Tirpude F.Y.M.Sc Nursing, B.V.C.O.N, Pune

2. OUTLINES Introduction Of Pneumonia. Review of anatomy and physiology. Anatomical classification of Pneumonia. Types of pneumonia. Epidemiology Etiology of Pneumonia. Risk factors of Pneumonia.

3. Pathophysiology of pneumonia. Sign and symptoms of pneumonia Diagnostic findings. Management-Medical Nurses role in management of Pneumonia. Complications of pneumonia.

4. Prevention of Pneumonia. Diagnostic findings. Nurses role in management of Pneumonia. Prevention of pneumonia. Complications of Pneumonia Summary Conclusion Bibliography

5. INTRODUCTION Respiratory diseases are rampant today because it is easier spread in crowded areas.  Pneumonia is one of the most common respiratory problems and it affects all stages of life.

6. DEFINITION Pneumonia  is an  inflammation of the lung parenchyma  caused by various microorganisms, including bacteria, mycobacteria , fungi, and viruses.

7. It’s described as lung parenchyma /alveolar  inflammation and abnormal alveolar filling with fluid(consolidation and exudation).

8. ANATOMICAL CLASSIFICATION: Lobar Pneumonia : All or a large segments of one or more pulmonary lobes is involved

9. Bronchopneumonia: Terminal bronchioles becomes clogged with muco -purulent exudates to form consolidation patches in nearby lobes. Also known as lobular pneumonia. Interstitial Pneumonia

10. TYPES OF PNEUMONIA 1.Community–Aquired Pneumonia - occurs in the community setting -within the  first 48 hours after hospitalization -causative agents include  streptococcus   pneumoniae ,  H. influenza ,  Legionella , and  Pseudomonas aeruginosa -most common cause of CAP  in people younger than 60 years of age.

11. -most common cause of CAP  in people younger than 60 years of age.

12. 2.Hospital-Aquired Pneumonia -  Nosocomial pneumonia is defined as the onset of pneumonia symptoms  more than 48 hours after admission  in patients with no evidence of infection at the time of admission.

13. -Common microorganisms that are responsible for HAP include  Enterobacter species ,  Escherichia coli ,  influenza ,  Klebsiella species ,  Proteus ,  Serratia marcescens ,  S. aureus , and  S. pneumonia .

14. 3. Pneumonia in the Immunocompromised Host: Occurs in immunocompromised hosts includes Pneumocystis pneumonia, fungal pneumonias and Mycobacterium tuberculosis

15. 4.Health Care-Associated Pneumonia -Health care settings, such as nursing homes, dialysis centers and outpatient clinics

16. 5.Aspiration Pneumonia -Occurs when person accidentally inhale food, drink, vomit, or saliva from mouth into lungs. -most common form of aspiration pneumonia is a bacterial infection from aspiration of bacteria that normally reside in the upper airways -Common pathogens are  S. pneumonia ,  H.influenza , and  S. aureus . E.g Disturbed normal gag reflex, such as a brain injury or swallowing problem, or excessive use of alcohol or drugs

17. 6. VENTILATED ASSOCIATED PNEUMONIA

18. Epidemiology : Pneumonia has affected a lot of people, especially those who have a weak immune system.

19. Contd …… Pneumonia and influenza account for nearly  60,000 deaths annually. It also ranks as the  eighth leading cause of death  in the United States.

20. Contd …… It is estimated that more than 915, 000 episodes of CAP occur in adults 65 years old and above in the United States.

21. HAP accounts for 15% of hospital-acquired infections and is the leading cause of death in patients with such infections.

22. ETIOLOGY Bacteria: Streptococcus pneumoniae , Legionella pneumohila , Chlamydophila pneumoniae,Staphylococcus aureus , Moraxella catarrhalis , Streptococcus pyogenes , Neisseria meningitides, Klebsiella pneumonia, and Hemophilus influenza, Pneumocystis jiroveci

23. Contd …… Viruses Influenza virus, Adenovirus, Rhinovirus Fungal e.g.: Pneumocystis carini

24. RISK FACTORS Age: 65 or older Smoking Chronic illness

25. Weakened immune system Recent viral respiratory infections

26. Chronic exposure to certain chemicals Recent surgery trauma Infants and very young children

27. Alcohol and drug abuse Hospitalization in an intensive care unit

28. PATHOPHYSIOLOGY Infectious agents that causes pneumonia invade the Respiratory tract Irritants will reach the lungs by inhalation of droplets, aspiration of organisms from the upper airway or bloodstream

29. When the Organisms reach the alveoli, an intense inflammatory reaction occurs Cytokines are released which causes leaking of fluid into the alveoli Leads to exudation

30. Impairs gas exchange Combination of cellular destructon and fluid-filled alveoli interrupts the transportation of oxygen Lung is unable to oxygenate blood from the heart

31. Results in Hypoxemia Decrease supply of oxygen Difficulty in breathing Death

32. SIGN AND SYMPTOMS Rapidly Rising Fever Pleuritic  Chest Pain Rapid and bounding pulse Tachypnea Purulent sputum

33. Assesment & Diagnostic findings History taking Physical examination Chest x-ray: Identifies structural distribution (e.g., lobar, bronchial); may also reveal multiple abscesses/infiltrates, empyema (staphylococcus)

34. 4. Chest x-ray: Identifies structural distribution (e.g., lobar, bronchial); may also reveal multiple abscesses/infiltrates, empyema (staphylococcus) 5. Fiberoptic   bronchoscopy :

35. 6. ABGs/pulse oximetry 7. Gram stain/cultures: Sputum collection; needle aspiration of empyema , pleural, and transtracheal or transthoracic fluids; lung biopsies and blood cultures may be done to recover causative organism. 8. CBC

36. 9. Pulmonary function studies Volumes may be decreased (congestion and alveolar collapse) 10. Electrolytes Sodium and chloride levels may be low.

37. MANAGEMENT Medical Management 1.Pharmacological Management Antibiotics A zithromycin , Clarythromycin , or Erythromycin powerful or higher dose antibiotics: Floroquinolone,levofloxacin,Sarfloxacin,Gemifloxacin,Moxifloxacin and high dose Amoxicillin.

38. Viral Pneumonia caused by influenza A- Rimatidine Viral pneumonia caused by influenza A and B- Oseltamivir or Zanamivir Anti- pyretics /pain relievers aspirn,non -steroidal anti-inflammatory drugs(NSAIDs, such as ibuprofen or naproxen), or acetaminophen

39. Cough medicines/ Antitussive /Expectorants Breonesin , Glycotuss , Glytuss , Hytuss , Robitussin Antihistamines Nasal decongestants Nebulized mist treatment

40. 2.NON-PHARMACOLOGIC MANAGEMENT: Turning, coughing, deep breathing to remove secretions Perform postural drainage and chest physiotherapy Supplemental oxygen via nasal cannula or mask and warm moist inhalation Increased fluid intake (2-3 liters per day) to thin and loosen secretions.

41. 3.DIETARY MANAGEMENT: Patient must be kept on a liquid diet like: Freshly made smoothies, milk shakes light meals containing lean meat, fishes and boiled vegetables

42. Food Items To Limit Avoid eating foods that you are allergic or sensitive to All sugar and sugar products, including an excess of sweet fruits Soft drinks Milk and dairy products Milk and dairy products

43. NURSING DIAGNOSIS: 1. Impaired gas exchange related to alveolary -capillary membrane changes(inflammatory effects)as evidenced by dyspnea , cyanosis, restlessness and hypoxia.    

44. 2. Ineffective airway clearance related to trachea bronchial inflammation, edema formation, increased sputum production, as evidenced by changes in rate/depth of respirations, abnormal breath sounds, use of accessory muscles, dyspnoea, cyanosis and cough with/without sputum production.

45. 3. Acute pain related to inflammation of lung parenchyma, cellular reactions to circulating toxins and persistant coughing as evidenced by reports of pleuritic chest pain, restlessness.

46. 4. Ineffective breathing pattern related to inflammation of lung parenchyma as evidenced by chest pain and hypoxia.

47. 5. Risk for deficient fluid volume related to excessive fluid loss (fever, profuse diaphoresis,mouth breathing/ hyperventilation,vomiting )and decreased oral intake.

48. PREVENTION 1.Get vaccinated 2.Wash hands 3.Don’t smoke 4. Proper rest and a diet rich in fruits, vegetables and whole grains 5. Moderate exercise 6. Get treatment of GERD

49. 7. Get plenty of rest 8. Drink plenty of fluids, especially water 9. Staff education: To help prevent HAP, encouraged staff education and involvement in infection prevention.

50. Summary: Today we have seen about the pneumonia, its definition, causes, risk factors, pathophysiology , sign and symptoms, complications, medical management, nursing management , prevention.

51. Conclusion : The class has learnt about the pneumonia & got depth knowledge about responsibilities of the nurse in management of pneumonia.