Pneumonia pneumonia pneumonia pneumonia

Pneumonia

1. pneumonia

2. What is it? Inflammation of lung parenchyma (lung bronchioles/alveoli) with increased alveolar and interstitial fluid 8 th leading cause of death Organisms enter the body through contaminated air, secretions, aspiration and bloodstream or from the bloodstream Healthy people can get sick too!! Germs enter through oropharynx (nose and mouth),overwhelming body’s defenses by large numbers or virulence (disease causing ability)

3. Patho Invading microorganisms enter lungs Microorganisms release endotoxins that damage lung tissue. Inflammatory and immune responses continue ALL causing vascular congestion and edema Alveoli become filled with fluid or other exudate

4. patterns of pneumonia Lobar pneumonia -bacteria distribute evenly throughout the lobe, causing a consolidation of lung tissue. Abrupt onset Bronchopneumonia -viruses cause a patchy distribution, usually alveoli or bronchioles (less edema and congestion). Slower, gradual onset Interstitial -the bacteria effect the interstitial tissues (connective tissues and outside of alveoli). Slower onset Miliary pneumonia -bacteria travels through bloodstream, usually in immunocompromised patients

5. Other Classifications Legionnaires disease -type of bronchopneumonia, caused by Legionella bacteria. Primary atypical- typically caused by mycoplasma. Usually mild symptoms "walking Pneumonia”. Viral -usual causes are H. FLU, adenovirus and CMV. Usually more mild disease, but can be sudden or gradual onset Pneumocystis jiroveci -parasitic cause, affects severely compromised (AIDS opportunistic infection). Abrupt onset, usually very symptomatic Aspiration -entering of foreign contents into the lung, causes a chemical/bacterial infection. Vomiting may be present or “silent aspiration”

6. Where it comes from Community acquired (cap)- strep pneumoniae (pneumococcus) causes approx. 50% of infection, influenza, legionella, chlamydia pneumoniae Hospital acquired (HAP)- s. Aureus , s. Pneumoniae, Pseudomonas, e. coli Ventilator acquired (VAP)- s. aureus , Pseudomonas, Acinetobacter Other -usually opportunistic with immunocompromised patients at greatest risk. Pneumocystis , mycobacterium TB, CMV, fungi

7. Clinical manifestations Fever will vary based on the causative agent. Low grade-very high Cough: dry and hacking versus wet and purulent Breathing pattern/oxygenation may change very quickly: crackles, wheezes and/or dull percussion

8. Diagnostics and labs Chest x-ray-helps to determine pattern of infection. Helps to identify disease especially in elderly client with vague complaints. CT scan-will further evaluate patterns/characteristics Pulse oximetry-less than 95% MAY indicate impaired gas exchange Sputum testing-gram stain(quicker) and c/s. CBC with Differential, ABG’s, Blood cultures, electrolytes Other blood tests for specific pathogens such as legionella, PJP

9. Nursing diagnoses Ineffective Airway clearance *increased airway edema and inflammation, increased sputum and inability to clear Assess resp status, breath sounds cough, sputum production, labs/abg’s High fowler’s position, suction if needed, monitor i /o, ambulate pt (if able) Teach cough/deep breathing, increasing fluids, chest PT

10. Nursing diagnoses Impaired gas exchange- *poor delivery of oxygen(poor perfusion), inflammation, increased mucus, hypoventilation Assess resp status, **vital signs, breathing patterns, abg’s, pulse ox, pain status, mental status, level of anxiety give o2, control fever, promote Position of comfort and reassure pt which helps to decrease anxiety teach pt slow, abdominal breathing; splinting of the chest, bedrest and increasing activity as tolerated, maintain adequate nutrition

11. Additional diagnoses Activity intolerance Hyperthermia Anxiety Nutrition: less than This Photo by Unknown Author is licensed under CC BY-NC-ND

12. Common medications Antibiotics-Penicillin/cephalosporins (Rocephin), macrolides (z-pack) Bronchodilators-help to relax smooth muscle by decreasing bronchospasm and constriction. Short acting/long acting, theophylline and aminophylline included Mucolytics-Help to thin or break up secretions (guaifenesin) Anti-inflammatories- decrease airway inflammation Antipyretics-decrease fever oxygen

13. Lifespan considerations Younger in age: infants and children-immature airway makes child more susceptible. Condition deteriorates very quickly Pregnant women: based on smoking status and/or history of recent resp illness Older adults*: d/t aging, cough and gag reflexes weaken; cilia get destroyed, immobility, pre-existing medical problems ( copd , kidney damage). They usually don’t follow the “rules”

14. prevention Hand hygiene Avoid crowded areas at times known for high infection (flu etc ) Vaccine: 2 separate shots that protect against different strains

15. Important terms Pleural effusion-accumulation of excess fluid in the lung cavity Empyema-purulent exudate in the lung cavity Pleuritic pain-sharp, local chest pain; worsens with breathing Atelectasis-lung/alveolar collapse Retractions-visible appearance of chest being drawn in on inspiration