BAB 1Background of Study

Case:

A 61-year-old woman presents to the emergency room

complaining of cough for 2 weeks. The cough is productive of green

sputum and is associated with sweating, shaking chills, and fever up

to 102˚F (38,8˚C). She was exposed to her grandchildren who were

told that they upper respiratory infections 2 weeks ago, but now are

fine. Her past medical history is significant for diabetes for 10 years,

which is under good control using oral hypoglycemics. She denies

tobacco, alcohol, or drug use. On examination, she looks ill and

distress, with continuous coughing and chills. Her blood pressure is

100/80 mmHg, her pulse is 100 beats/min, her temperature is 101˚F

(38.3˚C), her respiratory are 24 breaths/min, and her oxygen

saturation is 97% on room air. Examination of the head and neck is

unremarkable. Her lungs have ronchi and decreased breath sound,

with dullness to percussion in bilateral bases. Her heart is tachycardic

but regular. Her extremities are without signs of cyanosis or edema.

The remainder of her examination is normal. A complete blood count

(CBC) shows a high white blood cell (WBC) count of 17.000

cells/mm3, with a differential of 85% neutrophils and 20%

lymphocytes. Her blood sugar is 120 mg/dL

BAB 2Definition / theory

Pneumonia is inflammation (swelling) of the tissue in one or both of your

lungs. It is usually caused by an infection. At the end of the breathing

tubes in your lungs are clusters of tiny air sacs. If you have pneumonia,

these tiny sacs become inflamed and fill up with fluid.Terms such as

bronchopneumonia, lobar pneumonia and double pneumonia are

sometimes used, but refer to the same condition with the same causes

and treatment.

Common symptoms of pneumonia include:

a cough

fever

difficulty breathing

Pneumonia is an infection in one or both lungs. The infection may be

caused by fungi, bacteria, or viruses. Pneumonia causes inflammation in

your lung’s air sacs, also referred to as alveoli. The alveoli fill with fluid or

pus, making it difficult to breathe. Symptoms of pneumonia can range from

mild to life threatening. In fact, pneumonia causes more deaths worldwide

than any other illness. The severity of pneumonia usually depends on the

cause of the inflammation or by the type of organism causing the infection,

a person’s age, and their general health.

BAB 3Analisys / discussion

3.1 Etiologi / Cause

Pneumonia is most commonly caused by an infection, usually a bacterial

infection.However, many different bacteria, viruses and (rarely) fungi

cause pneumonia; the germ depends on where the pneumonia began. For

example, germs that cause pneumonia caught in hospitals are different to

those that cause pneumonia caught in the community.The germs that

cause an infection are usually breathed in. In rare cases, pneumonia can

develop from an infection elsewhere in your body, when germs enter your

lungs through your bloodstream

A. Bacteria

Haemophilus influenzae

Staphylococcus aureus

Chlamydophila psittac

Chlamydophila pneumoniae

Legionella pneumophila

B. Virus

respiratory syncytial virus (RSV)

flu (influenza) type A or B virus.

Viruses are a common cause of pneumonia in young children.

3. 2 symptom

You are likely to have a cough. This can be dry, or may produce phlegm

(thick mucus) that is yellow, green, brownish or blood-stained.

Other common symptoms include:

difficulty breathing – your breathing may be rapid and

shallow and you may feel breathless, even when resting

rapid heartbeat

fever

feeling generally unwell

sweating and shivering

loss of appetite

pain in your chest

Less commonly, symptoms of pneumonia can include:

coughing up blood (haemoptysis)

headaches

fatigue

nausea

vomiting

wheezing

pain in your joints and muscles

feeling confused and disorientated (particularly in elderly

people)

3.3 Transmission

Pneumonia can be spread in a number of ways. The viruses and bacteria

that are commonly found in a child's nose or throat, can infect the lungs if

they are inhaled. They may also spread via air-borne droplets from a

cough or sneeze. In addition, pneumonia may spread through blood,

especially during and shortly after birth. More research needs to be done

on the different pathogens causing pneumonia and the ways they are

transmitted, as this has critical importance for treatment and prevention.

3.4 Risk factor

Risk factors associated with increased risk of pneumonia include age> 65

years, and age <5 years, chronic diseases (eg, kidney, and lung), diabetes

mellitus, immunosuppression (eg, drugs, HIV), alcohol dependence,

aspiration (eg epilepsy), a recent viral illness (eg influenza), malnutrition,

mechanical ventilation, postoperative, environmental, employment, air-

conditioning (Jeremy, 2007; Misnadirly, 2008).

3.5 PATHOPHYSIOLOGY:

There are different categories of pneumonia. Two of these types are

hospital-acquired and community-acquired. Common types of community-

acquired pneumonia are pneumococcal pneumonia and Mycoplasma

pneumonia. In some people, particularly the elderly and those who are

debilitated, pneumonia may follow influenza. Hospital-acquired pneumonia

tends to be more serious because defense mechanisms against infection

are often impaired. Some of the specific pneumonia-related disorders

include:

aspiration pneumonia, pneumonia in immunocompromised host and viral

pneumonia

3.6 suport examination

In laboratory tests a routine blood test there is an increase of white blood

cells (White Blood Cells, WBC) WBC counts are usually obtained 15.000-

40.000/mm3, if it is caused by a virus or mikoplasme WBC count may be

normal or decreased (Supandi, 1992; Jeremy, 2007). In case of

leukopenia erythrocyte sedimentation rate (ESR) usually rises to 100/mm3

Radiological features of pneumonia can not show significant differences

between viral infections with bacteria. Pneumonia virus generally show a

picture interstitial infiltrates and hyperinflation. Pneumonia, and C-reactive

protein confirmed bacterial infection. Blood gas identifies respiratory failure

(Jeremy, 2007). Blood cultures may be positive in 20-25% of untreated

patients. Sometimes found elevated levels of blood urea, creatinine but

still within normal limits (Supandi, 1992).

3.7 Diagnostic

Pneumonia can sometimes be difficult to diagnose as it shares

many symptoms of other conditions, such as the common cold, bronchitis,

TBC, and asthma.

To make a diagnosis, your doctor may first ask:

whether you are breathing faster than usual

if you feel breathless

how long you have had your cough

whether you are coughing up sputum and what colour it is

if the pain in your chest is worse when you breathe in or out

Your doctor will probably take your temperature and listen to the back and

front of your chest with a stethoscope, to check for any crackling or rattling

sounds.

They may also listen to your chest by tapping it. If the lungs are filled with

fluid, this produces a different sound to normal, healthy lungs.

Most people with mild pneumonia do not need to have a chest X-ray or

other tests.

Chest X-ray and other tests

Your may arrange a chest X-ray or other tests if your symptoms have not

started to improve within 48 hours of starting treatment.

A chest X-ray can show how much your lungs are affected. It can also

help the doctor distinguish between pneumonia and other chest infections,

such as bronchitis.

Your  may also arrange:

a sputum test

blood tests  

Analysing samples of sputum or blood can help identify the bacterium or

virus causing the infection.

3.8 complication

Complications of pneumonia are more common in older people, young

children and people with existing health conditions such as diabetes.

If you develop complications, you will be admitted to hospital for treatment.

The most common complications of pneumonia are pleurisy, a lung

abscess and blood poisoning (septicaemia),

3.9 Treatment

Treatment

Most cases of pneumonia can be treated at home. However babies,

children, and people with severe pneumonia may need to be admitted to

hospital for treatment.Pneumonia is usually treated with antibiotics, even if

viral pneumonia is suspected as there may be a degree of bacterial

infection as well. The type of antibiotic used and the way it is given will be

determined by the severity and cause of the pneumonia.If able to be

treated at home, treatment usually includes:

- Antibiotics - given by mouth as tablets or liquid

- Pain relieving medications

- Paracetamol to reduce fever

- Rest.

If treatment in hospital is required, treatment usually includes:

- Antibiotics given intravenously (via a drip into a vein)

- Oxygen therapy - to ensure the body gets the oxygen it

needs

- Intravenous fluids - to correct dehydration or if the person is

too unwell to eat or drink

- Physiotherapy - to help clear the sputum from the lungs.

4.0 Preventiv

You can help stop germs spreading to others by practising good hygiene.

For example:

when you cough or sneeze, cover your mouth and nose with

a tissue to catch the germs

throw used tissues away immediately, in a bin or

toilet – germs can live for several hours after they leave your

nose or mouth

wash your hands regularly, to avoid transferring germs to

anyone else or other objects

Vaccinations

To help protect against pneumonia, people in higher risk groups should be

vaccinated. The recommended vaccinations are:

the pneumonia jab (pneumococcal vaccination), which

protects against pneumococcal infections

the flu jab

Lifestyle

Smoking, alcohol misuse and intravenous drug abuse can increase your

risk of developing pneumonia.

1. Smoking

Smoking damages your lungs, which means they become infected more

easily.If you smoke, the best thing you can do to prevent pneumonia is

quit smoking.

2. Alcohol misuse

Excessive and prolonged alcohol misuse is known to weaken your lungs'

natural defences against infections, making you more vulnerable to

pneumonia. One study found 45% of people admitted to hospital with

pneumonia had an alcohol misuse problem. Alcohol misuse is defined

as regularly drinking over the recommended weekly limits (21 units of

alcohol for men and 14 units of alcohol for women).

Not only does alcohol misuse increase your risk of developing pneumonia,

it also increases your risk of it being more serious. It is estimated that

people who misuse alcohol are three to seven times more likely to die

from pneumonia than the general population.

If you drink alcohol, do not exceed recommended daily limits (three to four

units a day for men and two to three units a day for women).

WHO response

In 2013, WHO and UNICEF launched the integrated Global action plan

for pneumonia and diarrhoea (GAPPD). The aim is to accelerate

pneumonia control with a combination of interventions to protect,

prevent, and treat pneumonia in children with actions to:

protect children from pneumonia include promoting exclusive

breastfeeding and adequate complementary feeding;

prevent pneumonia with vaccinations, hand washing with soap,

reducing household air pollution, HIV prevention and cotrimoxazole

prophylaxis for HIV-infected and exposed children;

treat pneumonia which are focused on making sure that every sick

child has access to the right kind of care -- either from a community-

based health worker, or in a health facility if the disease is severe -- and

can get the antibiotics and oxygen they need to get well.

BAB 4Conclution

pneumonia is a lung infection with a variety of clinical features that could

threaten kehidupan.hal can happen in that time lama.penyakit can strike at

any age. This disease affects the respiratory system, especially the way

we breathe. to avoid pneumonia, we recommend that in the not smoking,

drinking alcohol, exercise.

prevention is better than cure

BAB 5

Reference:

IPD Jilid 3

Scribd.com / pneumonia

http://www.nhs.uk/Conditions/Pneumonia/

Pathophysiology, pages 1211-1213