PRESENTED BY• RN,BScN

• ABDULLA KHAMIS NGWALI• FROM • PEOPLES REPUBLICS OF ZANZIBAR

Module: critical care

Topic: pneumonia

Objectives

At the end of the presentation, we expect the learners to be knowledgeable about:

1. The definition of pneumonia.2. List the classification of pneumonia. 3. According to causes.4. According to area involved. 5. Understand the mode of transmission of pneumonia. 6. Illustrate the predisposing factors of pneumonia.7. Describe the path physiology of pneumonia.

Conti…

8.List the clinical manifestations of pneumonia.9.Discuss the diagnostic tests of the person with

pneumonia.10.Explain the medical management for the patient with

pneumonia.11.Describe the nursing intervention for the patient with

pneumonia.12.Understand preventive measures of pneumonia.13.Identify the prognosis of the patient with pneumonia.14.Analyze the complications of pneumonia.

Introduction

• 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.

Definition

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

OR • Pneumonia is inflammation (swelling) of the

tissue in one or both of your lungs. It is usually caused by an infection

Classification of pneumonia

According to causes • Bacterial (the most common cause of

pneumonia)• Viral pneumonia• Fungal pneumonia• Chemical pneumonia (ingestion of kerosene or

inhalation of irritating substance)• Inhalation pneumonia (aspiration pneumonia).•

According 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.

Conti…

• According to the manner in which the infection was acquired: This type of infection is acquired in the community and the causative organism is one that is prevalent in the community at the time.

• • Hospital acquired /nasocomian pneumonia:-this

type of infection is acquired in a health care institution due to cross infection and the causative organism is one that lead to infection.

•

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).

Conti….

• Chronic lung disease (COPD, bronchostasis)• Frequent suction• Other serious illness such as heart disease,

liver cirrhosis, and DM, recent cold, laryngitis or flu.

Pathophysiology

• The streptococci reach the alveoli and lead to inflammation and pouring of exudates into the air spaces. WBCs migrate to alveoli, the alveoli become thicker due to its filling consolidation, and involved areas by inflammation are not adequately ventilated, due to secretion and edema.

Conti….

• This will lead to partial occlusion of alveoli and bronchi causing a decrease in alveolar oxygen content. 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.

Sign and Symptoms • Shaking chills• Rapidly rising fever ( 39.5 to 40.5 degree)• Stabbing chest pain aggravated by respiration and coughing• Tachypnea, nasal flaring• Patient is very ill and lies on the affected side to decrease pain• Use of accessory muscles of respiration e.g. abdomen and

intercostals muscles• Cough with purulent, blood tinged, rusty sputum.• Shortness of breath.• Flushed cheeks.• Loss of appetite, low energy, and fatigue.• Cyanosed lips and nail beds.

Physical Examination

• • Chest x-ray• Blood test• History taking• Sputum culture•

Nursing management

• Maintain a patent airway and adequate oxygenation.• Obtain sputum specimens as needed.• Use suction if the patient can’t produce a specimen.• Perform chest physiotherapy.• Provide a high calorie, high protein diet of soft foods.• To prevent aspiration during nasogastric tube feedings, check

the position of tube, and administer feedings slowly.• 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

Preventive measures

• 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.

• 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.

Conti….

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 infection

Life styleSmoking, alcohol misuse and intravenous drug abuse can

increase your risk of developing pneumonia.

Conti…

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.

Conti….• Alcohol misuse Excessive and prolonged alcohol misuse is known to weaken your

lungs' natural defenses 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).

Prognosis

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

Treatment

• Antibiotic, depending on sputum and blood culture

• Oxygen therapy• Chest physiotherapy• Monitor the patient’s ABC levels, especially if

he’s hypoxic.• Monitor fluid intake and output.

Complication

• Acute respiratory distress syndrome (ARDS)• Pleural effusion• Lung abscesses• Respiratory failure (which requires mechanical

ventilator)• Sepsis, which may lead to organ fail

Refference

1. Bickey L.S. (2003), Bates Guide to Physical Examination. Textbook.

2. (8th Ed): Elsevier St Louis, Missouri.

3. Dirksen.L.H (2004), Medical Surgical Nursing. Textbook. (3th Ed): Elsevier St Louis, Missouri.

4. Fausi. B. (1998), Principles of internal medicine. Volume 2, page 1419-1426. Textbook. (14th Ed): New York. St Louis.

5. Luckman J. (2004) Medical- Surgical Nursing.Volume 4, page 550-557. Textbook. (4th Ed): Elsevier St Louis, Missouri.