PNEUMONIA - DISORDER OF RESPIRATORY SYSTEM (AHN I).pptx

Pneumonia - INTRODUCTION, DEFINITION, INCIDENCE IN WORLD AND INDIA, ETIOLOGY, TYPES (IN DETAIL), PHASES, PATHOPHYSIOLOGY (FLOW CHART), RISK FACTORS, CLINICAL MANIFESTATIONS, DIAGNOSTIC EVALUATIONS, MEDICAL MANAGEMENT WITH RATIONALE (IN TABLE FORM) , SURGICAL MANAGEMENT WITH RATIONALE (IN TABLE FORM), NURSING MANAGEMENT WITH RATIONALE (IN TABLE FORM), COMPLICATIONS, NANDA NURSING DIAGNOSIS

1. Ms. Vaibhavi N Prabhudessai MSc (N) (MSN – Critical Care Nursing Department of Medical Surgical Nursing ADULT HEALTH NURSING I DISORDERS OF RESPIRATORY SYSTEM “PNEUMONIA”

2. Pneumonia is one of the most common infectious diseases worldwide, affecting individuals across all age groups. It is an acute infection of the lung parenchyma characterized by inflammation and consolidation of the alveoli due to microbial invasion. It is an inflammatory condition of the lung that is caused by a microbial agent. “Pneumonitis" is a general term that describes an inflammatory process in the lung tissue that may predispose a patient to or place a patient at risk for microbial invasion. It is the leading cause of death from the infectious disease. Despite advances in antibiotics and vaccines, pneumonia remains a major cause of morbidity and mortality, especially in developing countries. INTRODUCTION

3. World Health Organization (WHO): Pneumonia is an acute respiratory infection of the lung parenchyma where the alveoli (air sacs) are filled with pus and fluid, making breathing painful and limiting oxygen intake . Medical Definition: Inflammation of the lung tissue, particularly the alveoli, caused by infectious agents (bacteria, viruses, fungi, parasites) or aspiration of foreign substances. DEFINITION

4. Global : Pneumonia is the single largest infectious cause of death in children under 5 years . Responsible for 14% of all deaths of children under 5 worldwide (WHO, 2023 ). Annually, 450 million cases occur globally, leading to ~4 million deaths . India: India accounts for the highest burden of childhood pneumonia deaths (~23% of global childhood pneumonia deaths ). Annual incidence in India: 30–40 episodes per 1,000 children under 5 years . Adult cases also increasing due to smoking, air pollution, and comorbidities. INCIDENCE

5. There are many causes of pneumonia including bacteria, viruses, mycoplasmas, fungal agents and protozoa. It may also result from inhalation of toxic or caustic chemicals, smoke, dusts or gases or aspiration of food, fluids, or vomitus. Pneumonia may complicate to chronic illnesses . Bacterial Causes: Streptococcus pneumoniae (most common), Haemophilus influenzae , Klebsiella pneumoniae , Staphylococcus aureus . Viral Causes: Influenza virus, Respiratory Syncytial Virus (RSV), SARS-CoV-2, Adenovirus. Fungal Causes: Histoplasma capsulatum , Pneumocystis jirovecii (in immunocompromised patients). Aspiration Pneumonia: Inhalation of food, fluids, or gastric contents. Hospital-acquired (Nosocomial): Pseudomonas aeruginosa , MRSA. Community-acquired : Typically S. pneumoniae and related viruses . ETIOLOGY

6. 1. Based on Etiology (Cause) TYPES TYPE PARTICULARS Bacterial Pneumonia Most common cause. Streptococcus pneumoniae → lobar pneumonia (classic). Staphylococcus aureus , Klebsiella , Pseudomonas → bronchopneumonia, abscess formation. Features: Sudden onset fever, chills, productive cough with purulent sputum, chest pain. Viral Pneumonia Common in children and elderly. Caused by Influenza, RSV, Adenovirus, Parainfluenza , SARS-CoV-2. Features: Non-productive cough, myalgia, low-grade fever, interstitial infiltrates on X-ray. Fungal Pneumonia In immunocompromised patients (HIV/AIDS, organ transplant, chemotherapy). Histoplasma capsulatum , Aspergillus fumigatus , Pneumocystis jirovecii . Features: Subacute /chronic presentation, weight loss, night sweats, diffuse infiltrates. Parasitic Pneumonia Caused by Toxoplasma gondii , Strongyloides , Echinococcus . Rare, but seen in endemic regions. Aspiration Pneumonia Inhalation of gastric contents, food, or saliva. Risk: stroke, seizures, alcoholics, tube feeding, unconscious patients. Usually affects right lower lobe (due to straight bronchus).

7. 2 . Based on Site/Pattern of Lung Involvement TYPES TYPE PARTICULARS Lobar Pneumonia Involves entire lobe of lung. Classic cause: Streptococcus pneumoniae . Has well-defined pathological stages (congestion → red hepatization → gray hepatization → resolution). Broncho pneumonia (Lobular Pneumonia) Patchy consolidation around bronchioles. Usually bilateral and basal. Caused by Staphylococcus aureus , Klebsiella , Pseudomonas. Seen in elderly, bedridden, debilitated patients. Interstitial Pneumonia (Atypical Pneumonia) Involves alveolar septa and interstitium rather than alveoli. Caused by viruses ( Mycoplasma pneumoniae , Chlamydia pneumoniae , RSV ). Features: Dry cough, minimal sputum, diffuse infiltrates on chest X-ray. Necrotizing Pneumonia / Lung Abscess Severe, destructive form. Causative organisms: Klebsiella pneumoniae , Staphylococcus aureus , Anaerobes. Leads to cavitations , abscesses, gangrene.

8. 3 . Based on Environment TYPES TYPE PARTICULARS Community-Acquired Pneumonia (CAP) Occurs outside hospital setting. Common causes: S. pneumoniae , Mycoplasma, H. influenzae , Influenza virus. Hospital-Acquired Pneumonia (HAP) After ≥48 hrs of hospital admission. Common in ICU, ventilated patients. Caused by Pseudomonas aeruginosa , MRSA, Klebsiella . Ventilator-Associated Pneumonia (VAP) Subtype of HAP, develops after 48–72 hrs of mechanical ventilation. High mortality. Aspiration Pneumonia Inhalation of gastric contents, food, or saliva. Risk: stroke, seizures, alcoholics, tube feeding, unconscious patients. Usually affects right lower lobe (due to straight bronchus).

9. 4. Based on Host Condition 5. Based on Duration/Progression TYPES TYPE PARTICULARS Primary Pneumonia Occurs in healthy person with no co-morbidities. Secondary Pneumonia Occurs in immunocompromised patients or as a complication of another illness (e.g., measles, influenza, HIV). Acute Pneumonia Rapid onset (hours–days). Usually bacterial or viral. Chronic Pneumonia Lasts >3–4 weeks, insidious onset. Causes: Mycobacterium tuberculosis, Histoplasma , Blastomyces , Nocardia .

10. 6 . Based on Mode of Transmission 7. Based on Host Immunity / Predisposition TYPES TYPE PARTICULARS Airborne / Droplet spread Viral, bacterial pneumonia. Aspiration Aspiration pneumonia Hematogenous spread Secondary to bacteremia /endocarditis. Direct inoculation Trauma, surgery, chest procedures. Acute Pneumonia Rapid onset (hours–days). Usually bacterial or viral. Chronic Pneumonia Lasts >3–4 weeks, insidious onset. Causes: Mycobacterium tuberculosis, Histoplasma , Blastomyces , Nocardia .

11. 8. Other Types TYPES TYPE PARTICULARS Hypostatic Pneumonia Due to prolonged bed rest/immobility (common in elderly, bedridden). Poor ventilation of lung bases → stasis → infection. Chemical Pneumonitis Inhalation of irritant gases or toxic chemicals (e.g., chlorine, ammonia, hydrocarbons). Radiation Pneumonitis Secondary to radiation therapy for chest cancers. Lipoid Pneumonia Aspiration or inhalation of oily substances (e.g., mineral oil, petroleum jelly). Eosinophilic Pneumonia Characterized by eosinophil accumulation in lungs. Causes: parasites, medications, allergens. Cryptogenic Organizing Pneumonia (COP) Idiopathic, non-infectious pneumonia with inflammation and fibrosis in alveoli/bronchioles. Previously called BOOP ( Bronchiolitis Obliterans Organizing Pneumonia ).

12. 8. Other Types TYPES TYPE PARTICULARS Hypostatic Pneumonia Due to prolonged bed rest/immobility (common in elderly, bedridden). Poor ventilation of lung bases → stasis → infection. Chemical Pneumonitis Inhalation of irritant gases or toxic chemicals (e.g., chlorine, ammonia, hydrocarbons). Radiation Pneumonitis Secondary to radiation therapy for chest cancers. Lipoid Pneumonia Aspiration or inhalation of oily substances (e.g., mineral oil, petroleum jelly). Eosinophilic Pneumonia Characterized by eosinophil accumulation in lungs. Causes: parasites, medications, allergens. Cryptogenic Organizing Pneumonia (COP) Idiopathic, non-infectious pneumonia with inflammation and fibrosis in alveoli/bronchioles. Previously called BOOP ( Bronchiolitis Obliterans Organizing Pneumonia ).

13. 1.Congestion (1–2 days): Alveoli filled with serous fluid, bacteria, few WBCs. Lungs are heavy, red, and boggy. 2.Red hepatization (2–4 days): Alveoli filled with RBCs, fibrin, neutrophils. Lung appears liver-like (firm, red). 3.Gray hepatization (4–6 days): RBCs break down, WBCs and fibrin remain. Lung appears grayish, firm. 4.Resolution (7–10 days): Enzymatic digestion of exudates. Macrophages clear debris → normal lung architecture restored. PHASES

14. - Extremes of age (infants, elderly ): Age 60 or older - Immunosuppression (HIV/AIDS, cancer, chemotherapy, steroids) - Smoking , alcohol consumption - Malnutrition - Poor living conditions, overcrowding, air pollution: Residence in institutional areas/setting where transmission is prone. - Recent viral infection (flu, COVID-19) - Prolonged hospitalization/ventilation - Altered consciousness: Alcoholism, head injury, anaesthesia, drug overdose - Tracheal intubation - Upper Respiratory Tract Infection - Chronic Disease: Chronic lung disease, Diabetes mellitus, Heart disease, C ancer, COPD, CKD - Inhalation of noxious substances. - Prolonged Bed rest and immobility - Aspiration of fluid, liquid, foreign or gastric content. - Fatigue RISK FACTORS

15. PATHOPHYSIOLOGY Infectious agent, Foreign substance, 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 and carbon dioxide C ausing occlution of alveoli resulting in decrease alveolar oxygen tension Нурохіа occur with retention of carbon dioxide, Shortness of breath, Fatigue,Crackles in lungs Or decrease Breath sounds

16. -Fever , chills, night sweats -Productive cough with purulent/rust- colored sputum - Dyspnea , tachypnea , orthopnea - Pleuritic chest pain -Fatigue , malaise, confusion (in elderly) -Cyanosis -Hypoxemia - Shortness of breath -Hemoptysis -Headache -Inspection: Unequal chest expansion -Percussion: Dullness on affected area - Auscultation : Crackling sounds over affected area / crackles, bronchial breath sounds, decreased air entry, decrease in breath sounds CLINICAL MANIFESTATIONS

17. -History & Physical examination -Chest X-ray: Infiltrates, consolidation -CT scan THORAX(if needed) – Complicated pneumonia/abscess -Sputum culture and sensitivity tests & Gram stain: Identify organism -Pulse oximetry : Hypoxemia -Blood cultures: Systemic infection -CBC : Leukocytosis (bacterial), lymphocytosis (viral) -Immunologic test - To detect microbial antigens -Bronchoscopy – In resistant/atypical cases - Transtracheal aspirate - Fiberoptic bronchoscopy -Transcutaneous needle aspiration / biopsy -Transcutaneous oxygen level analysis or ABG: Hypoxemia DIAGNOSTIC EVALUATIONS

18. MEDICAL MANAGEMENT Intervention Rationale Broad-spectrum antibiotics (e.g., Ceftriaxone, Azithromycin) To eradicate bacterial pathogens. Antiviral drugs (Oseltamivir for influenza, Remdesivir for COVID-19) For viral pneumonia to reduce viral load. Antifungals (Amphotericin B, Fluconazole) For fungal infections in immunocompromised patients. Oxygen therapy To correct hypoxemia and improve oxygenation. Antipyretics ( Paracetamol ) To reduce fever and discomfort. Analgesics (NSAIDs) To relieve pleuritic chest pain. IV fluids To maintain hydration and loosen secretions. Mucolytics & bronchodilators To ease breathing and sputum clearance. Corticosteroids (selected cases) To reduce severe inflammation and prevent ARDS. Bronchodilators To reduce dyspnea, shortness of breath

19. SURGICAL MANAGEMENT Procedure Rationale Thoracentesis Drain pleural effusion caused by pneumonia. Chest tube insertion For empyema (pus in pleural cavity). Lobectomy / Pneumonectomy In severe cases with necrotizing pneumonia or abscess not responding to therapy. Video-assisted thoracoscopic surgery (VATS) To remove localized collections and prevent spread.

20. NURSING MANAGEMENT Nursing Intervention Rationale Assess vital signs, respiratory status, SpO ₂ regularly Early detection of hypoxemia and deterioration. Position patient in semi-Fowler’s Facilitates lung expansion and improves breathing. Administer oxygen as prescribed Corrects hypoxemia. Encourage coughing, deep breathing, incentive spirometry Promotes alveolar expansion and secretion clearance. Provide adequate hydration (oral/IV) Helps liquefy and mobilize secretions. Administer prescribed medications on time Ensures effective treatment and prevents complications. Maintain airway clearance (suctioning if needed) Prevents obstruction and hypoxia. Educate on hand hygiene, vaccination, smoking cessation Prevent recurrence and complications. Provide rest and nutritional support Enhances immune response and recovery.

21. Actual Diagnosis - - Impaired Gas Exchange related to alveolar-capillary membrane changes as evidenced by hypoxemia and dyspnea. - Ineffective Airway Clearance related to excessive secretions as evidenced by productive cough and abnormal breath sounds. - Hyperthermia related to infectious process as evidenced by elevated temperature. - Activity Intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue and dyspnea . - Knowledge Deficit related to lack of information about pneumonia management and prevention. Potential Diagnosis - - Risk for Fluid Volume Deficit related to fever, tachypnea, and poor intake . - Risk for Infection Transmission related to contagious respiratory infection . - Risk for infection related to prolonged hospitalization. NANDA DIAGNOSIS