PNEUMONIA

GROUP 7
• Definition
Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent.
“Pneumonitis” is a more 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.

Classification of pneumonia
a, Community acquired pneumonia- this is the pneumonia that is acquired outside the hospital or
occur within 48 hours after hospitalisation.
B, Hospital acquired pneumonia- is acquired at the hospital during hospitalisation of another illness
( 48 hours or more of hospitalisation.
C, Aspiration pneumonia-is due to inhalation of foreign body from mouth to lungs .
D, Lobar pneumonia – is characterised by inflammatory exudate within the intra-alveolar space
resulting in consolidation that affect one or more lobes of the lung.
 Pathophysiology
Upper airway characteristics normally prevent potentially infectious particles from reaching the
normally sterile lower respiratory tract. Thus, patients with pneumonia caused by infectious
agents often have an acute or chronic underlying disease that impairs host defenses. Pneumonia
arises from normally present flora in a patient whose resistance has been altered, or it results
from aspiration of flora present in the oropharynx. It may also result from bloodborne organisms
that enter the pulmonary circulation and are trapped in the pulmonary capillary bed, becoming
a potential source of pneumonia.

Pneumonia often affects both ventilation and diffusion. An inflammatory reaction can occur in
the alveoli, producing an exudate that interferes with the diffusion of oxygen and carbon
dioxide. White blood cells, mostly neutrophils, also migrate into the alveoli and fill the normally
air-containing spaces. Areas of the lung are not adequately ventilated because of secretions and
mucosal edema that cause partial occlusion of the bronchi or alveoli, with a resultant decrease
in alveolar oxygen tension. Bronchospasm may also occur in patients with reactive airway
disease. Because of hypoventilation, a ventilation–perfusion mismatch occurs in the affected
area of the lung. Venous blood entering the pulmonary circulation passes through the
underventilated area and exits to the left side of the heart poorly oxygenated. The mixing of
oxygenated and unoxygenated or poorly oxygenated blood eventually results in arterial
hypoxemia.
• CAUSES
1.Septiceamia/infection- Infection occurs when virus , bacteria or other microbes enter your
body and begin to multiply , so with pneumonia these microbes invade and multiply in your
lungs .
2.Epiglottal reflex-the epiglottis prevent food from entering the respiratory tract , so when
there`s epiglottal reflex the epiglottis won`t be able to prevent food from getting in the
respiratory tract leading to aspiration pneumonia.
3.Poor personal hygiene- when someone has poor persona hygiene , they`ll have bacteria all
over their body and it easy for the bacteria to gain access to the inner body it may be through
touching your eyes , mouth with dirty hands.
4.Poor environment-with poor environment is always dirty and on that dirty space there are
bacteria , so the bacteria may gain access to your through inhalation or when you touch a
contaminated area and then touch your eyes, mouth e.t.c
•RISK FACTORS
1. Alcohol intoxication -because alcohol suppresses the body’s reflexes,
may be associated with aspiration, and decreases white cell mobilization and tracheobronchial ciliary motion.
2. Depressed cough reflex -due to medications, a debilitated state, or
weak respiratory muscles.
3. Smoking; cigarette smoke disrupts both mucociliary and
macrophage activity.
4. Antibiotic therapy -in very ill people, the oropharynx is likely to be
colonized by gram-negative bacteria.
5.Respiratory therapy with improperly cleaned equipment.
6. General anesthetic, sedative, or opioid preparations that promote
respiratory depression, which causes a shallow breathing pattern
and predisposes to the pooling of bronchial secretions and potential development of pneumonia.
7. Conditions that produce mucus or bronchial obstruction and interfere with normal lung drainage (eg, cancer,
cigarette smoking,
COPD)
• Risk factors continues…..
8. Advanced age, because of possible depressed cough and glottic
reflexes and nutritional depletion.
9. Immunosuppressed patients and those with a low neutrophil count
(neutropenic).
 Clinical manifestation.
1, Chest pain-Deep breathing and coughing aggravate the pain in the chest.
2,Purulent sputum- the sputum becomes purulent because of the infection in
the lung parenchyma which produce sputum filled with pus.
3,Tachypnea- there`s fast breathing because the body tries to compensate for
low oxygen concentration in the body.
4,Dyspnea- Occur due to pulmonary edema
5,Productive cough-Occur due to pulmonary edema , the body is trying to get
the fluid out of the lungs through coughing.
6,Central cyanosis-due to lack of oxygen and blood circulation.
 Nursing assessment.
Subjective data- take medical and surgical history , ask questions relating to clinical manifestesion .Ask about smoking
history ,environmental exposure and also symptoms she/he has experienced.
Assess elderly patient for unusual behavior , dehydration, altered mental status .
Observe for confusion , shallow respiration ,disorientation and flushed appearance.
Ask the patient about the chief complaint. Ask about the medications the person is taking,the dose and reason it was
prescribed.
Ask the patient if they are coughing if yes , ask if the cough is productive or not, if the cough is productive ask the colour
of the mucus.

Objective data
Blood culture –to check bloodstream invasion called bacteremia.
Sputum culture-used to identify the bacteria or fungi causing the airways or lung infection and guid antibiotic therapy.
Chest x-ray –to take picture of your lungs to look for any signs of infection and determine if you have collapsed lungs.
Auscultate- use stethoscope to listen if there`s any crackles, wheezing and breath sounds.
 Objective data continues………
Vital signs-Respiratory rate , heart rate, blood pressure and temperature should all be
monitored and documented , in pneumonia the respiratory rate may be elevated and the
temperature may be elevated.
Oxygen saturation- The nurse should monitor the oxygen saturation using a pulse oximeter as
pneumonia can cause hypoxia.
White blood cell count-A complete blood cell count with differential may be ordered to assess
for leukocytosis which often present in pneumonia
Physical examination- the nurse should assess the patient`s general appearance , including their
level of consciousness and skin colour , as well as their respiratory effort , chest expansion and
use of accessory muscle.
Blood gas analysis – An arterial blood gas may be ordered to assess the patient`s acid-base
balance and oxygenation status.
 Nursing intervation
-Improve airway patency-removing secretions because retained -secretions interfere with gas exchange and slow recovery
-Encourage hydration 2-3 litre per day because adequate hydration thins and loosens pulmonary secretions
-Administer a high humidity facemask as prescribed to deliver warm , humidified air to tracheobronchial tree to liquefy
secretions
-Chest physiotherapy is important in loosening and mobilizing secretions
-Assist the patient in semi fowlers position to promote rest and breathing ,enhance secretion clearance and ventilation in
the lungs
-Maintain nutrition by administering fluids and nutrients intravenously to provide fluid , calories and electrolytes
-Promote rest and conserve energy-encourages the debilitated patient to rest and avoid overexertion and possible
exacerbation of symptoms
-Promote patients knowledge by alerting the patient about the risk factors and external factors that may have contributed
to develop pneumonia
- Monitor vital signs closely especially during the initiation of therapy .
-Assess the respiratory status, skin colour , mental state, heart rhythm and body temperature.
-Administer analgesics and antitussives as prescribed.
 Medical interventions
Administer macrolides as prescribed to people with drug resistant S
Administer antipyretics to treat fever, headache and antitussive
medications are used to treat cough
Antibiotics are indicated with a viral respiratory infection only when a
secondary bacterial pneumonia ,brochitis or sinusitis is present
Corticosteroids may be administered to combat shock and toxicity in
patients who are extremely ill with pneumonia and in apparent danger
of dying of infection
 Nursing diagnosis
• Impaired gas exchange related to inflammation of the lung tissue , as evidenced by
shortness of breath , decreased oxygen saturation levels, and increased respiratory rate.
• Ineffective airway clearance related to excessive mucus production and impaired cough
reflex , as evidenced by wheezing, crackles, and difficulty in breathing.
• Risk for flid volume deficit related to increased volume loss from fever, sweating, and
increased respiratory rate evidenced by decreased urine output and dry mucus membrane.
• Risk of infection related to the presence of microorganisms in the lung tissue , increased
white cell count , and sputum culture positive for bacteria and virus.
• Activity intolerance related to decreased oxygen saturation level and shortness of breath ,
as evidenced by fatigue, decreased endurance and inability to perform activities of daily
living.
 Preventative measures
Promote coughing and expectoration of secretions.
Encourage smoking cessation. Initiate special precautions against infection.
Encourage smoking cessation.
Reposition frequently and promote lung expansion exercises and coughing.
Initiate suctioning and chest physical therapy if indicated.
Reposition frequently to prevent aspiration and administer medications judiciously, particularly those that increase
risk for aspiration.
Perform suctioning and chest physical therapy if indicated.
Promote frequent oral hygiene.
Minimize risk for aspiration by checking placement of tube and proper positioning of patient.
Encourage reduced or moderate alcohol intake (in case of alcohol stupor, position patient to prevent aspiration).
Observe the respiratory rate and depth during recovery from general anesthesia and before giving medications.
If respiratory depression is apparent, withhold the medication and contact the physician.
 Preventative measures continues……
Promote frequent turning, early ambulation and mobilization, effective
coughing, breathing exercises, and nutritious diet.
Make sure that respiratory equipment is cleaned properly; participate
in continuous quality improvement monitoring with the respiratory
care department.
Complications
1.Respiratory failure and shock-occur when your breathing becomes difficult that
you need a machine called ventilator to help you breathe.
Severe complications of pneumonia include hypotension and shock and respiratory
failure (especially with gram-negative bacterial disease in elderly patients). These
complications are encountered chiefly in patients who have received no specific
treatment or inadequate or delayed treatment. These complications are also
encountered when the infecting organism is resistant to therapy and when a
comorbid disease complicates the pneumonia. If the patient is seriously ill,
aggressive therapy may include hemodynamic and ventilatory support to combat
peripheral collapse, maintain arterial blood pressure, and provide adequate
oxygenation.
2. SUPERINFECTION Superinfection may occur with the administration of very large
doses of antibiotics, such as penicillin, or with combinations of antibiotics.
Superinfection may also occur in the patient who has been receiving numerous
courses and types of antibiotics. In such cases, bacteria may become resistant to
the antibiotic therapy. If the patient improves and the fever diminishes after initial
antibiotic therapy, but subsequently there is a rise in temperature with increasing
cough and evidence that the pneumonia has spread, a superinfection is likely.
 Complication continues…….
3. ATELECTASIS AND PLEURAL EFFUSION Atelectasis (from obstruction of a bronchus by
accumulated secretions) may occur at any stage of acute pneumonia. Parapneumonic pleural
effusions occur in at least 40% of bacterial pneumonias. A parapneumonic effusion is any
pleural effusion associated with bacterial pneumonia, lung abscess, or bronchiectasis. After
the pleural effusion is detected on a chest x-ray, a thoracentesis may be performed to remove
the fluid. The fluid is sent to the laboratory for analysis. There are three stages of
parapneumonic pleural effusions based on pathogenesis: uncomplicated, complicated, and
thoracic empyema. An empyema occurs when thick, purulent fluid accumulates within the
pleural space, often with fibrin development and a loculated (walled-off) area where the
infection is located. (Empyema is discussed in greater detail in the section Pleural Conditions,
below.) A chest tube may be inserted to treat pleural infection by establishing proper
drainage of the empyema. Sterilization of the empyema cavity requires 4 to 6 weeks of
antibiotics.