PNEUMONIA

Pneumonia is an inflammatory illness of the lung. Frequently, it is described as lung

parenchyma/alveolar inflammation “and” abnormal alveolar fillimg with fluid (consolidation
and exudation)}. Pneumonia is a general term that refers to an infection of the lungs, whitch
can be caused by a variety of microorganisms, including viruses, bacteria, fungi, and
parasites.

The infection causes your lungs air sacs, called alveoll, to become inflamed. The air sacs may
fill up with fluid orr pus, causing symptoms such asa cough (with phlegm), fever, chills, and
trouble breathing.

TYPES OF PNEUMONIA

1.Infective Pneumonia: Inflammation and infection of the lungs and bronchial tubes that
occurs when a bacteria (bacterial pneumonia) or virus (viral pneumonia) gets into the lungs
and starts to reproduce. The most common cause of bacterial pneumonia in adults is a
bacteria called streptococcus pneumonias or Pneumococcus.

2.Community-Acquired Pneumonia: Community-Aquired pneumonia (CAP) occurs out-sides

of hospitals and other health care settings. Most people get CAP by breathing in germs
(especially while sleeping) that live in the mouth, nose, or throat. CAP is the most common
type of pneumonia. Most cases occur during the winter.

3.Hospital-Acquired Pneumonia: Some people catch Pneumonia during a hospital stay for
another illness. This is called hospital-acquired pneumonia (HAP). Patients are at higher risk
for getting HAP if on a mechanical ventilator. HAP tends to be more serious than CAP.
4.Health Care-Associated Pneumonia: Patients also may get pneumonia in other health care
setting, such as nursing homes, dialysis centers, and outpatient clinics. This is called health
care-associated pneumonia.

5.Fungal pneumonia: Candida and Aspergillus are two types of fungi that can causes
pneumonia Pneumocyitis carinil is a fungus that typically causes pneumonia in patients with
with AIDS.

6.Aspiration Pneumonia: This type of pneumonia occurs when person accidentally inhalo
food, drink, vomit, or saliva from mouth into lunges. This usually happens when something
disturbs normal gag reflex, such as a brain injury. Swallowing problems, or excessive use of
alcohol or drugs. Aspiration can cause pus to form in a cavity in the lug. This is called a lung
abscess.

7.Atypical Pneumonia: Several types of bacteria-Legionella pneumophila, mycoplasnsms

pneumonia, and Chlamydrophila pneumonise –cause this type of CAP. Atypical pneumonia
is passed from person to person.

CAUSES OF PNEUMONIA

Pneumonia can be due to a variety of bacteria and viruses, less commonly due to fungi and
rarely due to other microorganisms or parasites. Likely causes are associated with the age of
the person, the season, the person’s health status, and /or where the infection was contracted.

RISK FACTORS

• Age: 65 or older

• Cligarette smoking

• Chronic illness, such as heart or lung disease, liver ciorrhosis, or diabetes mellitus

• Stoke (aspiration pneumonia due to difilcult swallowing)

• Weakened immune system caused by AIDS or chemotherapy treatment

• Recent viral respiratory infection (common cold, laryngitis, influenza)

• Chronic exposure to certain chemicals

• Cerebral palsy

• Impaired consciousness

• Recent surgery or trauma

• Malnutrition

• Pregnancy

• Infants and very young children

• Alcohol or drug abuse

• Hospitalization in an intensive care unit

PATHOPHYSIOLOGY OF PNEUMONIA

Pneumonia is an acute infection of the lungs, occurring when an infectious agent enters and
multiplies in the lungs of a susceptible person. When the microorganisms multiply, they
release toxins that induce inflammation in the lung tissue, causing damage to mucous and
alveolar

membranes. This leads to the development of edema and exudate, which fills the alveoli and
reduces the surface area available for exchange of carbon dioxide and oxygen. Some bacteria
also cause necrosis of lune tissue.

Pneumonia may be confined to one lobe, or it may be scattered throughout the lungs. If it
affects only one lobe, it is called lobar pneumonia. Generalized pneumonia is much more
seriousand is called bronchopneumonia. Bronchopneumonia occurs more often as a
nosocomial (hospital acquired) infection in hospitalized patients.

Pathyophysiology of pneumonia is characterized by four stages. The first stage of the disease
occurs within 24 hours of infection and it is distinguished by vascular congestion and alveolar
derma. The lungs are also invaded by bacteria and few neutrophils. Typical symptorms
include cough, fever, and sputum production, usually developing over days and sometimes
accompanied by pleurisy.
The second stage of the disease is called “red hepatization”. In this stage lungs are similar to
the consistency of liver, with the presence of many erythrocytes, neutrophils, desquamated
epithelial cells, and fibrin within the alveoli.

The third stage is the “gray hepatization” in the lung is gray-blown to yellow because of
fibrinopurulent exudates, disintegration ofred cells, and hemosiderian.

The fourth, and the final, stage is called “resolution” and it is characterized by breakdown of
the substances causing inflammation. In this stage, white blood cells are fighting off invading
micro-organisms, and the remains are usually coughed up. This stage is characterized by
restoration of the pulmonary architecture

CLINICAL MANIFESTATIONS

Symptoms of pneumonia vary, depending on the age of the child and the cause of the
pneumonia. Common symptoms include:

bacterial pneumonia viral pneumonia atypical pneumonia

nasal congestion and sore throat nasal congestion and sore throat nasal congestion
and sore throat fever, often low grade

shaking chills

dyspnea, shortness of breath

cough that produces green, yellow, or rust-coloured mucus dry cough coughing; may be
violent at times; produce white mucus

chest pain headache possible nausea or vomiting

perfuse sweating muscle pain weakness

bluish color of nails or lips: cyanosis , hypoxemia bluish color of nails or lips : cyanosis ,
hypoxemia

confused mental status weakness

DIAGNOSTIC EVLUATIONS

The doctor will ask about symptoms and medical history. A physical exam wil be done.
Diagnosis is based on symptoms and listening to chest. Tests may be include:
• Chest x-ray

• CT scan

• Blood test

• Bronchoscopy – Direct examination of airways

• Sputum culture – Testing mucus coughed up from deep in the lungs

• Pulse oximetry – Measurers the amount of oxygen in the blood

• Pleural fluid culture – If there is fluid in thespace surrounfing the lungs

• Arterial blood gas – Measure oxygen, carbon dioxide, and acid in the blood

MANAGEMENT

Most cases of pneumonia can be treated without hospitalization. Typically, oral antibiotics,
rest, fluids, and home care are sufficient for complete resolution. However, people with
pneumonia who are having trouble breathing, people with other medical problems, and the
elderly may need more advanced treatment. If the symptoms get worse, the pneumonia does
not improve with home treatment, or complications occur, the person will often have to be
hospitalized.

NON PHARMACOLOGIC INTERVENTIONS :

• Turning, coughing, deep breathing to remove secretions

• perform postural drainage and chest physiotherapy

• supplemental oxygen via nasal cannula or mask and warm moist inhalation

• increased fluid intake (2 – 3 liters per day) to thin and loosen secretions

PHARMACOLOGIC INTERVENTIONS :

antibiotic are used to treat bacterial pneumonia.in contrast, antibiotics are not useful for viral
pneumonia, although they sometimes are used to treat or prevent bacterial infections that can
occur in lungs damaged by a viral pneumonia.

patients with mild pneumonia who are otherwise healthy are usually treated with oral
macrolide antibiotics (azithromycin, clarithromycin, or or erythromycin ). patient with other
seroius illlness, such as heart dieases, chronic obstructive pulmonary disease, or emphysema,
kidney diseases, or diabetes are often given one of the following: fluoroquinolone
( levofloxacin, levaquin ),sparfloxacin (zagam), or gemifloxacin ( factive), moxifloxacin
( avelox ) and high – dose amoxicillin or amoxicillin-clavulanate, plus a macrolide antibiotic
(azithromycin, clarithromycin, or erythromycin).

viral pneumonia caused by influenza A may be treated with rimantadine or amantadine, while
viral pneumonia caused by influenza A or B may be treated with oseltamivir or zanamivir.

control fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen
or naproxen), or acetaminophen. do not give aspirin to children.

some physicians advice taking exectorants, for example guaifenesin ( breonesin, glycotuss,
glytuss, hytuss, naldecon senior EX , robitussin), to loosen sputum. codeine or other stronger
pain relievers may be prescribed, for severe pain.however, it have to be noted

that codeine and other narcotics suppress coughing, so they should be used with care in
pneumonia and often require monitoring.

expectorants, bronchodilators, and analgesics may be given for comfort and symptom
relief.antitussive medication may be used for the associated cough. antihistamines may
provide benefit with reduced sneezing and rhinorrhea.

nasal decongestants may also be used to treat symptoms and improve sleep; however,
excessive use may cause rebound nasal congestion.nebulized mist treatments or metered dose
inhalers may be used to delivers bronchodilators.

NURSING MANAGEMENT

NURSING DIAGNOSIS :

1. Imparied gas exchanges relate to decreased ventilation

2. Ineffective airway clearance related to excessive tracheobronchial secretions

3. Ineffective breathing pattern related to chest pain and hypoxia.

4. Activity intolerance related to impaired respiratory function

5. Risk for deficient fluid volume related to fever and dyspnea

6. Deficient knowledge about the treatment regimen and preventive health measures
NURSING INTERVENTION :

1.Perform assessments every 4 hours of respiratory rate, temperature, and signs of airway
effectiveness.

2.perform scheduled chest physiotherapy. removing the secretion of the airway, preventing
obstruction

3.encourage her to take several deep breaths.deep

breathing promotes oxygenation before controlled coughing.encourage her to take a deep

breath, hold for 2 seconds,and cough two or three times in

successsion.controlled coughing is accomplished by closure of the glottis and the explosive

expulsion of air from the lungs by the work of abdominal and chest muscles.

4.encourage use of incentive spirometry, as appropriate. Breathing exercises help maximize

ventilation

5.promote systemic fluid hydration, as appropriate. Adequate fluid intake enhances

liquefaction pf pulmonary secretions and facilitates expectoration of mucus.

6.give oxygen.increased lung tissue oxygen supply

7.give antibiotics and antipyretics; assess the effectiveness and side effects (rash, diarrhea)

8.perform a gradual suction.helping airway clearance

9.record the results of the pulse oximeter when installed, every 2-4 hours. periodically
evaluate the success of therapy/health team action.

10.institute respiratory therapy (e.g., nebulizer) as needed.A varitey of respiratory therapy

treatments may be used to open constricted airways and liquefy secretions.

PREVENTION

1.Get vaccinated

2.Wash hands

3.Don’t smoke

4.Proper rest and a diet rich in fruits, vegetables and whole grains
5.Moderate exercise

6.Get treatment for GERD

BIBLIOGRAPHY

• BT Basavanthappa,”Text book of nursing foundation ”published by Jaypee brothers

medical

publishers (p) LTD .

• Javed ansari and davinder kaur,” Medical surgical nursing I “ published by pee vee
books.page no :359

• Kochuthresiamma thomas,” Medical surgical nursing”Volume I published by Jaypee

brothers medical

publishers (p) LTD .page no:130

• potter and perry,s,” Text book of fundamental of nursing published by elsevier .

• I clement,”Basic concepts of NURSING PROCEDURES” 3rd Edition , published by

Jaypee brothers

medical publishers (p) LTD . page no : 272