Pneumonia and it's management

Pneumonia seminar presentation

1. TOPIC:- PNEUMONIA AND ITS NURSING MANAGEMENT [BSC (HONS.) NURSING

2. PNEUMONIA AND ITS NURSING MANAGEMENT

3. INTRODUCTION *It is the inflammatory condition of the lung that is caused by microbial agent. *Pneumonitis is a general term that describes an inflammatory process in the lung tissue that may predispose a patient at risk for microbial invasion. *It is the leading cause of death from infectious disease.

4. DEFINITION OF PNEUMONIA Pneumonia is a inflammatory process in lung parenchyma(the respiratory bronchioles, and the alveoli ) associated with a marked increase in interstitial alveolar fluid. The air sacs may filled with fluid or pus. The infection can be life threatning to anyone but particularly to infants, children and people over 65.

5. epidemiology * Comman illness affecting approximately 450 million people a year occuring in all part of the world, and a 4 million death yearly. *Rates are greater in children less than 5 years and adult older than 75 years. *In India, it is the single largest cause of death in children, resulting in nearly 120 million cases a year.

6. RISK FACTORS Major risk factors for pneumonia include the following: * Age 60 or older * History of smoking * Upper respiratory tract infection * Tracheal intubation * Prolonged immobility * Malnutrition * Altered consciousness:Alcoholism,head injury,anaesthesia,drug overdose * Dehydration * Chronic disease states(such as diabetes,heart disease,chronic lung disease,renal disease and cancer) * Inhalation of noxious substance * Residence in such area/setting where transmission is prone

7. ETIOLOGY - There are many cause of pneumonia including bacteria,virus, Mycoplasmas,fungal agents,viruses and protozoa. - It may also result from inhalation of toxic or causatic chemicals, smoke, dusts , gases or aspiration of food, fluids or vomitus . Pneumonia may complicate to chronic illness.

8. CLASSIFICATION 1. ACCORDING TO CAUSATIVE ORGANISMS 2.ACCORDING TO ENVIRONMENT 3.ACCORDING TO AREAS OF LUNG AFFECTED 4.ACCORDING TO CAUSE

9. 1. ACCORDING TO CAUSATIVE ORGANISMS (a.)Bacterial :- *Pneumococcal pneumonia caused by Streptococcus pneumoniae *Staphylococcus pneumoniae caused by Staphylococcus pneumoniae *Gram negative bacterial pneumonia caused by Kleibseilla pneumoniae * Anaerobical bacterial pneumonia caused by normal flora.

10. b.) Viral * Rhino virus, corona virus, influenza virus and adenovirus * Herpex simplex virus rarely causes pneumonia in newborns,person with cancer and transplant recepients or patient with burns c.)Fungal * Fungal pneumonia caused by histoplasmosis,blastomycosis etc

11. 2. ACCORDING TO ENVIRONMENT * Community Acquired Pneumonia

12. *Ventilator Acquired Pneumonia

13. *Pneumonia in the immuno-compressed host *Hospital Acquired Pneumonia

14. c d.) Parasitic * Parasitic pneumonia caused by protozoa, nematodes etc.

15. 3. ACCORDING TO AREAS OF LUNG AFFECTED * Lobar pneumonia * Necrotizing pneumonia * Segmental pneumonia * Alveolar pneumonia * Interstitial pneumonia *Bronchial pneumonia

16. 4.ACCORDING TO CAUSE * Eosinophillic pneumonia * Chemical pneumonia * Aspiration pneumonia * Allergic pneumonia * Bilateral pneumonia

17. PATHOPHYSIOLOGY Infectious agent,foreign substances,blood borne organisms that enter the blood circulation or aspiration of gastric content. Cause inflammation of pulmonary tissue affecting both ventilation and diffusion The alveoli fills with exudates Mucosal edema of alveolar membrane occur Interferes with the diffusion of oxygen causing occultion of alveoli and carbon dioxide resulting in decrease alveolar oxygen tension Hypoxia occur with retention of carbon dioxide ,shortness of breath , crackles in lungs, fatigue or decrease breath sounds

18. CLINICAL MANIFESTATIONS The onset of all pneumonia by any or all of the following manifestations:fever,chills,,sweat,fatigue,cough and sputum production. Less comman symptoms include haemoptysis,pleuritric chest pain and headache.Older clients may not present with fever respiratory manifestations but with altered mental status and dehydration. Other manifestations may include:- * Crackling sound over affected area * Hypoxemia * Tachypnea * Productive cough * Dyspnea * Decrease in breath sounds * Dulness or percussion over affected area * Unequal chest expansion

19. DIAGNOSTIC EVALUATION *CHEST X-RAY A chest radiograph provides information about the location and extent of the pneumonia consiladation . Definite diagnosis is usually determined through sputum culture and analysis and sensitivity or serologic testing

20. *FIBEROPTIC BRONCHOSCOPY OR TRANSCUTANEOUS NEEDLE ASPIRATION OR BIOPSY It is a procedure that allows your physician to examine the breathing passage of lungs. This procedure can either be for diagnostic reasons, to find out more about a problem or for therauptic reasons,to treat an existing problems.

21. *POLYMERISE CHAIN REACTION PCR applied to whole blood sample appears to be sensitive and very specific diagnostic test for identifying patients with pneumococcal pneumonia with a potential application in clinical practice. Additional evaluation may consist of:- 1. Transcutaneous oxygen level analysis or arterial blood gas(ABG) measurement to assess the need for supplemental oxygen 2. Skin test,if tuberculosis and coccidioidomycosis is suspected 3. Blood and urine culture to assess symetric speed LINK: https :// www.youtube.com / watch?v =Mmc1ImuKJ1g .

22. COMPLICATIONS 1.Empyema 2.Lung abscess 3. Sepsis 4. Bacterimia 5.Hypotension and shock 6.Atelectasis 7.Pleural effusion 8.Pericardiatis 9.Acute Respiratory Disease Syndrome

23. PROGNOSIS With treatment most type of bacterial pneumonia will stabilize in 3-6 days.It often takes a few weeks before most symptoms resolved.In persons requiring hospitisation, mortality may be as high as 10%,and those requiring intensive care as it may reach 30-50%.

24. NURSING MANAGEMENT OF PATIENT WITH PNEUMONIA ASSESSMENT * Take careful history to help establish etiologic diagnosis * Assess the elderly patient for unusual behavior,altered mental status,dehydration ,excessive fatigue and concominant heart failure * Observe for anxious,flushed appearance,shallow respirations,splinting of affected side,confusion,disorientation * Perform respiratory assessment for every 4 hrs,including determination of rate and character of respirations ,auscultations of breath sounds and assessment of skin and nail beds to determine the severity of hypoxia * In addition to physical examination,transcutaneous oxygen level analysis or ABG measurements may be used to evaluate the need for oxygen support

25. NURSING DIAGNOSIS i ). Ineffective airway clearance related to copious tracheo-bronchial secretion GOAL: To improve airway patency INTERVENTIONS: * The nurse encourages hydration 2-3L/day * Humidification may be used to loosen secretions and improve ventilation * Deep breathing exercise should be performed * Spirometry * Chest physiotherapy * Coughing can be initiated either voluntarily or reflex

26. ii).Ineffective breathing pattern related to hypoxia as evidenced by shortness of breath. GOAL: To maintain the effective breathing pattern INTERVENTIONS: * Place patient with proper body alignment for maximum breathing pattern. *Encourage sustained deep breaths by: Using demonstration:highlighting slow inhalation, holding end inspiration for a few seconds and passive exhalation. Utilising incentive spirometer . * Encourage diaphragmatic breathing for patients with chronic disease. * Stay with the patient during actual period of distress. * Encourage frequent rest periods and teach patient to pace activity. * Encourage small frequent meals to prevent crowding of diaphragm. * Avoid high concentrations of oxygen in patients with COPD. * Ambulate patient as tolerated with doctor’s order three times a daily.  

27. iii). Activity intolerance related to impaired respiratory function GOAL: To promote rest and conserving energy INTERVENTIONS: * The patient should assume comfortable position to promote rest and breathing (eg:-Semi fowler’s position) * Positions of the patient should be changed frequently to enhance secretion clearance and ventilation of the lungs *Instruct outpatients not to overexert themselves and to engage only in moderate activities during the initial phase of treatment *The nurse encourages the debilitated patient to rest and avoid overexertion and possible exacerbation of symptoms

28. iv).Risk for defecient flood volume related to fever and dyspnea GOAL: To promote adequate fluid intake INTERVENTIONS: * Encourage increase fluid intake atleast(2L/day) * Respiratory rate of the patient should be maintained. * Careful monitoring in patients with pre- existing conditions such as heart disease.

29. v).Imbalanced nutrition:less than body requirements GOAL: To maintain adequate nutrition INTERVENTIONS: * Provide more fluid to the patient with shortness of breath as they have decreased apetite * Fluid with electrolytes(commercially available drinks such as gatrode) may help provide fluid and electrolytes *Nutritionally enriched shakes and drinks are helpful * Fluids and nutrients may be administered intravenously,if necessary

30. vi).Defecient knowledge about the treatment regime and preventive measures GOAL: To promote patients knowledge INTERVENTIONS: * The patient and family are instructed about the cause of pneumonia, management of symptoms of pneumonia and the need to follow up * The patient should also be informed about factors(both risk and external factors)that have contributed to developing pneumonia and stratgies to promote recovery and to promote recurrence * The patient is instructed about the purpose and the importance of management stratgies that have been implemented and the importance of adhering to them during and after the hospital stay

31. * The patient may require that instructions and explanations be repeated several times,because of severity of symptoms * If possible,written instruction and information should be provided EVALUATION Expected patient outcomes may include: 1.Demonstrates improved airway patency as evidenced by pulse,adequate oxygenation by pulse oximetry or arterial b;lood gas analysis,normal breath sounds and effective coughing 2.Rests and conserves energy by limiting activities and remaining in bed while asymptomatic and slowly increasing activities 3.Maintains adequate hydration as evidenced by an adequate fluid intake and urine output

32. 4.Consumes adequate dietary intake,as evidenced by maintenance or increase in body weight without excessive fluid gain 5.Exhibits no complications: a.) Has normal vital signs,pulse oximetry and arterial blood gas b.)Reports productive cough that deminishes over time c.)Has absence of signs and symptoms of shock d.)Remains oriented and aware of surroundings e.)Maintains or increase weight

33. PATIENT EDUCATION AND HEALTH MAINTENANCE *Advise patient to complete entire course of antibiotics *Once clinically stable , encourage gradual increase in activities to bring energy level back to pre-illness stage *Explain that a chest x-ray usually taken 4 to 6 weeks after recovery *Advise smoking cessation *Advise patient to keep up natural resistance with good nutrition and adequate rest *Instruct patient to avoid fatigue,sudden extremes in temperature and excessive alcohol intake * Advise patient to practice frequent handwashing,especially after contact with others

34. RESEARCH INPUT StudyOral health ventilator- associated pneumonia among critically ill patients : a prospective Saensom D merchant AT, wara-Aswapati N, Ruaisungneon w , Pitihat W OBJECTIVE:- To evaluate the association between oral health and ventilator associated pneumonia (VAP) among critically ill patients METHODS:- A prospective cohort study was conducted among 162 critically ill patients who are newly intubated and treated with mechanical ventilator in one tertiary hospital in Thailand. Oral health status was assessed using Oral Health Assessment Tool (OHAT) ,Plaque Index (PI), and number of teeth VAP , defined as Clinical Pulmonary Infection Score >6, was assessed on Day 4 after intubation. Hazard ratios 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression adjusted for confounders.

35. RESULTS:- Critically ill patient had deteriorating oral health status after intubation. Early- onset VAP developed in 69 patients (42.6%) , with VAP incidence of 117 episodes per 1000 ventilator days. Patients with moderate – to – very poor oral hygiene assessed by Phad increased VAP risk of 1.66 folds. The no. of teeth was not associated with VAP development CONCLUSIONS:- There is a strong association between poor oral health and increased risk for early-onset VAP. Routine oral care possibly prevents VAP development among critical patients treated with mechanical ventilator.

36. SUMMARY Today we have discussed about the topic Pneumonia and its nursing management. Here we studied about what is pneumonia, its classifications, risk factors and nursing management. Because as a nurse we encounters so many patient with respiratory tract infection in which pneumonia is most comman. We have also discussed the health teachings given to him/her. Hope this teaching will be helpful in future also and we will treat our patient with proper care.

37. Bibliography Medical-Surgical Nursing 10th edition Brunner and Siddharth pg no:-522-531   Black and Joyce: Medical Surgical Nursing 8 th edition; Elsevier publication; pg no:-1599-1603 https://www.slideshare.net/mobile/GAMANDEEP/pneumonia