Pneumonia, causes, risk factors, treatment.pdf

Pneumonia, causes, risk factors, treatment

1. Pneumonia
Phelan Coy, Charlene Ferguson & Devika
Gill

2. 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.
Objectives

3. Inflammation of the lung parenchyma.
Classified according to morphology,
etiologic agent or clinical form
Clinical manifestations vary on the:
Etiologic agent
Age
Person’s systemic reaction to the infection
Degree of bronchiolar obstruction
Overview of Pneumonia

4. 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 immuno-
competent people
Aspiration pneumonia – occurs from entry of
endogenous or exogenous substances into the lower
airway. Occurs in community or hospital setting.
Classifications of
Pneumonia

5. 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.
TYPES OF PNEUMONIA

6. LOBAR PNEUMONIA

7. BRONCHOPNEUMONIA

8. 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 - CAP causative agents:

9. 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
Etiology - HAP causative agents

10. 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.

11. Invasion and overgrowth of microorganisms in
the lung parenchyma
Provokes intra-alveolar exudates
Pathogen has to reach the alveoli so defenses
become overwhelmed. WBC’s, 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.
Pathophysiology

12. 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

13. Streptococcus pneumoniae: Rust-colored
sputum.
Pseudomonas, Haemophilus, and
pneumococcal species: May produce green
sputum.
Klebsiella species pneumonia: Red currant-
jelly sputum.
Anaerobic infections: Often produce foul-
smelling or bad-tasting sputum.
Older people who have pneumonia sometimes
have sudden changes in mental awareness.
Clinical manifestations

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

15. 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

16. 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

17. Appropriately treating underlying illnesses (such
as HIV/AIDS, diabetes mellitus, and malnutrition)
can decrease the risk of pneumonia.
Get a Pneumonia Vaccination.
Medical management con’t

18. 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 management

19. 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
patient’s
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

20. 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

21. Encourage
fluid
intake of
3-4L/day
or warm
fluids to
drink.
Teach
deep
breathing
exercises
&
coughing
technique.
To help
thinning &
mobilize
secretion for
expectoratio
n
To help with
mobilize
secretion for
expectoratio
n.

22. 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.
Frequent
hand washing
or use of
alcohol base
hand rubs.
Thorough
education
patient will
understand
that fluid
helps
thinning
secretion
for
expectorati
on and
replace lost
during
fever.
To prevent
the spread
of
infection.
Patient
practices
technique
to prevent
the spread
of
infection.

23. 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.

24. Shock & respiratory failure
Pleural Effusion
Complications

25. Bono, M. (2014). Medscape. Retrieved 16 February,
2016, from http://
emedicine.medscape.com/article/1941994- medication#2
Oba, Y. (2015). Medscapecom. Retrieved 16 February,
2016, from
http://emedicine.medscape.com/article/297351-overview
Mosenifar, Z. (2015). Medscapecom. Retrieved 16 February,
2016, from http
://emedicine.medscape.com/article/300455-treatment
Kamangar, N. (2015). Medscapecom. Retrieved 16 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
References