PNEUMONIA

PNEUMONIA for adult nursing

1. PNEUMONIA Prepared by: RN Arpana bhusal BNS 7/24/2022 1

2. 7/24/2022 2 welcome

3. pneumonia 7/24/2022 3

4. Contents: Definition Pneumonia classification pathophysiology of pneumonia Risk factors Sign and symptoms 7/24/2022 4

5. Diagnostic tests medical management Nursing management Prevention Complication of pneumonia 7/24/2022 5

6. Pneumonia is an inflammatory condition of alveolar space of the lungs that cause consolidation of the lungs tissues and fill the alveoli with serous fluids, mucus and inflammatory cells in response to infections. Fig:-Pneumonia 7/24/2022 6

7. Pneumonia is the infection and inflammation of the lung parenchyma tissues that impairs gas exchanges.. It is the commonest cause of mortality and morbidity of children below 5 years of age. The elderly are also at high risk . 7/24/2022 7

8. Pneumonia Classification Etiological types Infective viral (influenza) Bacterial (streptococcus pneumoniae ) fungal mycobacterial Non-infective toxins chemicals aspiration 7/24/2022 9

9. Classification contd … 7/24/2022 10 Morphological types Lobar pneumonia Bronchopneumonia Interstitial Duration Acute Chronic Clinical Primary/Secondary Typical/Atypical Community acquired/ Hospital acquired

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12. Risk Factors Age- very young age children (up to 5 yrs) Poor socio-economic condition Malnutrition Vitamin A deficiency Low birth weight 7/24/2022 13

13. Risk factors contd … Lack of breastfeeding Previous history of respiratory tract infection Passive smoking, immobility Indoor and outdoor environmental pollution Family history of bronchitis 7/24/2022 14

14. Sign and symptoms Sudden onset of fever (102F-104F) Chills Cough (unproductive to productive with whitish sputum) Tachypnoea Dyspnoea Chest pain Chest indrawing 7/24/2022 15

15. Sign and symptoms contd … Nasal flaring Pallor/Cyanosis Behaviour : Irritable, restless, and lethargic GI: Anorexia, vomiting, diarrhea, abdominal pain Dull on percussion On auscultation:- Diminished breath sounds on affected areas 7/24/2022 16

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17. Diagnostic tests: History taking Physical examination Chest radiography: patchy infiltration, consolidation, disseminated infiltration, patchy clouding 7/24/2022 18

18. Diagnostic tests contd … Complete blood cell count (CBC): reveal leucocytosis Blood Cultures, gram stain, sputum culture: reveal the causative organism Positive Anti streptolysin -o (ASO) titre : diagnostic of streptococcal pneumonia. 7/24/2022 19

19. Medical Management Antibiotics are prescribed on the basis of Gram stain results and antibiotic guidelines (resistance patterns, risk factors, etiology must be considered). Combination therapy may also be used. Supportive treatment includes hydration, antipyretics for fever , antitussive medications for treat cough, antihistamines, or nasal decongestants. Bed rest is recommended until infection shows signs of clearing. 7/24/2022 20

20. Medical management contd … Oxygen therapy is given for hypoxemia. Respiratory support includes high inspiratory oxygen concentrations, endotracheal intubation, and mechanical ventilation. Treatment of atelectasis , pleural effusion, shock, respiratory failure, or super infection. For groups at high risk for CAP, pneumococcal vaccination is advised 7/24/2022 21

21. Nursing management: Asessment : Assess respiratory symptoms: sypmtoms of fever, chills or night sweats (signs of bacterial pneumonia) Assess clinical manifestations: ( bradycardia , trachypnea , pain) Physical assessment :for body temperature, pulse ,amount odor and color of secretions shortness of breath 7/24/2022 22

22. Nursing diagnosis: Actual diagnosis: Impaired gas exchange related to cough production, Ineffective airway clearance related to presence of inflammation in bronchial walls , Ineffective breathing pattern, Knowledge deficit/Deficient knowledge about the treatment regimen and preventive health measure 7/24/2022 23

23. Nursing diagnosis contd … Potential diagnosis: Risk for infection, Risk for nutritional imbalance: less than body requirements Risk for deficient fluid volume related to fever and dyspnea 7/24/2022 24

24. Nursing interventions: Correcting breathing pattern Assess for hypoxia, signs of respiratory distress, shock such as labored breathing, cold clammy skin, cyanosis, headache, restlessness and change in mental status Monitor vital signs, oximetery , and ABG analysis for oxygenation. Monitor oxygen therapy used to relieve hypoxemia 7/24/2022 25

25. Nursing interventions: Collect sputum specimen for c/s tests in a sterile container; notify the physician if organism is resistant to the antibiotics being given Encourage deep breathing and coughing exercises after chest physiotherapy. Instruct patient to cover nose and mouth while coughing 7/24/2022 26

26. Nursing interventions: Rest and sleep Patient should be kept in bed rest to reduce oxygen demand. Encourage use of relaxation techniques and diversional activities. Position with head of bed should be slightly elevated. Maintain semi-fowler’s position 7/24/2022 27

27. Nursing interventions: Relieving pain Watch patient for signs of discomfort and pain. Maintain semi-fowler’s position. Ascertain if pain worsens with deep breathing and coughing: auscultate for friction rub. Give prescribed medicine, and monitor for pain relief and signs of respiratory depression. 7/24/2022 28

28. Nursing interventions: Reducing anxiety Correct dyspnea and relief physical discomfort. Explain diagnostic procedures and the patients role : correct misconception. Listen to patient concerns; attentive listening relieves anxiety and reduces emotional distress. Speak calmly and slowly. 7/24/2022 29

29. Prevention: Get the flu vaccine each year. People can develop bacterial pneumonia after a case of the flu Get the pneumococcal vaccine Practice good hygiene Increase fluid intake upto 3liters/ day. Plan rest period, balance between rest and activity. 7/24/2022 30

30. Prevention contd … Teach preventive measures:role of nutrition and fluids, vaccination against streptococcus pneumonia and influenza. Wash your hands regularly, especially after you go to the bathroom and before you eat. Eat right, with plenty of fruits and vegetables. Encourage for exercise. Get enough sleep. Quit smoking. 7/24/2022 31

31. Complication Pulmonary: Collapse, Delayed Resolution, Lung Abscess, Pleural: Empyema , Pneumothorax , Effusion, Airway: Bronchiectasis , Sinusitis Cardiovascular: CCF, Shock, Endocarditis Extra- Thoracic: Septicemia, Meningitis, Osteomyelitis , Febrile Convulsion, Acute Haemolytic Anemia 7/24/2022 32

32. References: Mandal G.N, Textbook of medical surgical nursing (adult nursing) published by Makalu publication house, 3 rd edition, page no. 66-67 Brunner and siddarth , Textbook of Medical-Surgical Nursing, 13 th edition, page no. 573-582, 605 https://www.google.com/search?client=firefox-b-d&q=pneumonia 2078/03/09@8pm 7/24/2022 33

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