PneumoniPneumoniaa

Dr. Walaa NasrDr. Walaa Nasr

Lecturer of Adult Nursing Lecturer of Adult Nursing Second year Second year

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PneumoniaPneumonia Out linesOut lines

DefinitionDefinition Classification of pneumonia Classification of pneumonia According to causesAccording to causes According to area involved According to area involved Mode of transmission Mode of transmission Predisposing factorsPredisposing factors PathophysiologyPathophysiology Clinical manifestationsClinical manifestations Diagnostic testsDiagnostic tests Medical managementMedical management Nursing interventionNursing intervention Preventive measuresPreventive measures Prognosis Prognosis ComplicationsComplications Brought to you

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PneumoniaPneumonia DefinitionDefinition

Is an inflammatory Is an inflammatory process of the lung process of the lung parenchymaparenchyma that is that is commonly caused by commonly caused by infectious agents.infectious agents.

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Classification of pneumonia

According to causesAccording to causes BacterialBacterial (the most common cause (the most common cause

of pneumonia)of pneumonia) ViralViral pneumonia pneumonia FungalFungal pneumonia pneumonia ChemicalChemical pneumonia (ingestion of pneumonia (ingestion of

kerosene or inhalation of irritating kerosene or inhalation of irritating substance)substance)

InhalationInhalation pneumonia (aspiration pneumonia (aspiration pneumonia)pneumonia)

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Classification of pneumonia (cont…)

According to areas involvedAccording to areas involved

Lobar pneumonia; if one or more lobe is involved

Broncho-pneumonia; the pneumonic process has originated in one or more bronchi and extends to the surrounding lung tissue.

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PneumoniaPneumonia Mode of transmission

Ways you can get pneumonia include:Ways you can get pneumonia include:

Bacteria and viruses living in your nose, Bacteria and viruses living in your nose, sinuses, or mouth may spread to your sinuses, or mouth may spread to your lungs.lungs.

You may breathe some of these germs You may breathe some of these germs directly into your lungs (droplets infection).directly into your lungs (droplets infection).

You breathe in (inhale) food, liquids, vomit, You breathe in (inhale) food, liquids, vomit, or fluids from the mouth into your lungs or fluids from the mouth into your lungs ((aspiration pneumonia).

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PneumoniaPneumonia Predisposing factors

Immuno-suppresed patients Cigarette smoking Difficult swallowing (due to stroke,

dementia,parkinsons disease, or other neurological conditions)

Impaired consciousness ( loss of brain function due to dementia, stroke, or other neurological conditions)

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PneumoniaPneumonia Predisposing factors

Chronic lung disease (COPD, bronchostasis)

Frequent suction Other serious illness such as

heart disease, liver cirrhosis, and DM

Recent cold, laryngitis or flu

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PneumoniaPneumonia Pathophysiology

The streptococci reach the alveoli and lead to inflammation and pouring of an exudates into the air spaces.

WBCs migrates to alveoli, the alveoli become more thick due to its filling consolidation, involved areas by inflammation are not adequately ventilated, due to secretion and edema. This will lead to partial occlusion of alveoli and bronchi causing a decrease in alveolar oxygen content. Brought to you

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PneumoniaPneumonia Pathophysiology (cont…)

Venous blood that goes to affected areas without being oxygenated and returns to the heart. This will lead to arterial hypoxemia and even death due to interference with ventilation.

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PneumoniaPneumonia Clinical manifestations

SShaking chillshaking chills RRapidly rising fever ( 39.5 to 40.5 degree)apidly rising fever ( 39.5 to 40.5 degree) SStabbing chest pain aggravated by respiration and tabbing chest pain aggravated by respiration and

coughingcoughing TTachypnea, nasal flaringachypnea, nasal flaring PPatient is very ill and lies on the affected side to atient is very ill and lies on the affected side to

decrease paindecrease pain UUse of accessory muscles of respiration e.g. abdomen se of accessory muscles of respiration e.g. abdomen

and intercostals musclesand intercostals muscles CCough with purulent, blood tinged, rusty sputumough with purulent, blood tinged, rusty sputum SShortness of breathhortness of breath FFlushed cheekslushed cheeks LLoss of appetite, low energy, and fatigueoss of appetite, low energy, and fatigue CCyanosed lips and nail beds yanosed lips and nail beds Brought to you

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History takingHistory taking Physical examinationPhysical examination Chest x-rayChest x-ray Blood testBlood test Sputum cultureSputum culture

PneumoniaDiagnostic tests

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Antibiotic, depending on sputum and blood culture

Oxygen therapy

Chest physiotherapy

PneumoniaMedical management

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PneumoniaNursing interventionNursing intervention

Maintain a patent airway Maintain a patent airway and adequate oxygenation.and adequate oxygenation.

Obtain sputum specimens Obtain sputum specimens as needed.as needed.

Use suction if the patient Use suction if the patient cancan’’t produce a specimen.t produce a specimen.

perform chest perform chest physiotherapy.physiotherapy.

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PneumoniaNursing intervention (contNursing intervention (cont……))

Provide a high calorie, high protein Provide a high calorie, high protein diet of soft foods.diet of soft foods.

To prevent aspiration during To prevent aspiration during nasogastric tube feedings, check the nasogastric tube feedings, check the position of tube, and administer position of tube, and administer feedings slowly.feedings slowly.

To control the spread of infection, To control the spread of infection, dispose secretions properly.dispose secretions properly.

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PneumoniaNursing intervention (contNursing intervention (cont……))

Provide a quiet, calm environment, with frequent rest periods.

Monitor the patient’s ABG levels, especially if he’s hypoxic.

Assess the patient’s respiratory status. Auscultate breath sounds at least every 4 hours.

Monitor fluid intake and output.

Evaluate the effectiveness of administered medications.

Explain all procedures to the patient and family.

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PneumoniaPreventive measures

Frequent turning of bed ridden patients and early ambulation as much as possible.

Coughing and breathing techniques.

Sterilization of respiratory therapy equipment

Suctioning of secretion in the unconscious who have poor cough and swallowing reflexes, to prevent aspiration of secretions and its accumulation.

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PneumoniaPrognosis

With treatment, most patients will improve within 2 weeks. Elderly or very sick patients may need longer treatment.

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PneumoniaComplications

Acute respiratory distress syndrome (ARDS)Acute respiratory distress syndrome (ARDS) Pleural effusionPleural effusion Lung abscessesLung abscesses Respiratory failure (which requires Respiratory failure (which requires

mechanical ventilator)mechanical ventilator) Sepsis, which may lead to organ failureSepsis, which may lead to organ failure http://www.youtube.com/watch?http://www.youtube.com/watch?

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