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3. An inflammation in the lungs that produces excess fluid. It is triggered by: infectious organisms or aspiration of an irritant. The inflammatory process in the lung parenchyma results in edema and exudate that fills the alveoli.

5. Pneumonia may be: a primary disease or a complication of another disease or condition. It affects people of all ages, but the young, older adult clients, and clients who are immunocompromised are more susceptible. Immobility can be a contributing factor in the development of pneumonia

6. There are two types of pneumonia. Community acquired pneumonia 1. Community acquired pneumonia (CAP); the most common type and often occurs as a complication of influenza. Hospital acquired pneumonia 2. Hospital acquired pneumonia (HAP), OR nosocomial pneumonia, has a higher mortality rate and is more likely to be resistant to antibiotics

7. Bacteria Virus Fungi Mycobacteria Aspiration Also, pneumonia may be: Lobar Bronchial; patches through both lungs

9. An inflammatory reaction can occur in the alveoli, producing an exudate that interferes with the diffusion of O2 & CO2 ; bronchospasm may also occur if the patient has reactive airway disease.

10. Advanced age Recent exposure to viral or influenza infections Tobacco use Chronic lung disease (for example, asthma) Aspiration Clients with dysphagia Mechanical ventilation (ventilator acquired pneumonia) Impaired ability to mobilize secretions (decreased level of consciousness, immobility, recent abdominal or thoracic surgery) Immunocompromised status

11. CXR; Shows consolidation of lung tissue. Pulse Oximetry; Decreased oxygen saturation levels CBC; Leukocytosis (may not be present in older adult clients) Sputum Culture; Obtain specimen by suctioning if the client is unable to cough. Arterial Blood Gases (ABGs); Decreased PaO2 and increased PaCO2 due to impaired gas exchange in the alveoli Thoracentesis if pleural effusion present

12. Monitor for signs and symptoms; vary depending on the causative organism and the patient’s disease. Fever; sudden & rapid ((38.5C to 40.5C)) Dyspnea, tachypnea (25 to 45 breaths/min); orthopnea Pleuritic chest pain; aggravated by respiration and coughing Sputum production Crackles and wheezes Coughing Dull chest percussion over areas of consolidation Poor oxygen saturation (low SaO2)

13. URTI, headache, low-grade fever, pleuritic pain, myalgia, rash, and pharyngitis; mucopurulent secretion. Severe pneumonia: flushed cheeks; lips and nail beds demonstrating central cyanosis. Sputum purulent, rusty, blood-tinged, viscous, or green depending on etiologic agent. Appetite is poor, and the patient is diaphoretic and tires easily.

14. Respiratory status (airway, respiratory, use of accessory muscles, oxygenation) before and following interventions Sputum (amount, color) Hx: smoking and chronic lung conditions Recent exposure to influenza or other viral agents Factors increasing the risk of aspiration (for example, following a stroke) Difficulty mobilizing secretions (generalized weakness) General appearance (temperature, skin color) Laboratory findings (ABGs, sputum culture results, WBCs)

15. Impaired gas exchange Ineffective airway clearance Activity intolerance Imbalanced nutrition: Less than body requirements Acute pain Risk for deficient fluid volume Deficient knowledge about treatment regimen and preventive health measures

16. Administer heated and humidified oxygen therapy as prescribed. Position the client in high-Fowler’s position. Encourage coughing, or suction to remove secretions. Encourage deep breathing with an incentive spirometer to prevent alveolar collapse. Administer medications as prescribed. Antibiotics are given to destroy the infectious pathogens ( penicillins and cephalosporins, IV and then switched to an oral). Obtain culture before the first dose of the antibiotic.

17. Bronchodilators Short-acting beta2 agonists, such as Ventolin, Methylxanthines (theophylline ), require close monitoring of serum medication levels due to narrow therapeutic range. Corticosteroids decrease airway inflammation; monitor for serious side effects Immunizations can decrease a client’s risk of developing CAP. Influenza vaccine is recommended annually for clients at risk of complications from influenza

18. Supportive treatment includes hydration, antipyretics, antitussive medications, antihistamines, or nasal decongestants. Bed rest is recommended until infection shows signs of clearing. Respiratory support includes endotracheal intubation, and mechanical ventilation. Treatment of atelectasis, pleural effusion, shock, respiratory failure, or super-infection if needed.

19. Determine the client’s physical limitations and structure activity to include periods of rest. Promote adequate nutrition. Increased work of breathing increases caloric demands. Proper nutrition aids in the prevention of secondary respiratory infections. Provide support to the client and family. Encourage verbalization of feelings.

20. Atelectasis Airway inflammation and edema leads to alveolar collapse and increases the risk of hypoxemia. Diminished or absent breath sounds over affected area. CXR shows area of density. Acute Respiratory Failure Persistent hypoxemia Monitor oxygenation levels and acid-base balance. Prepare for intubation and mechanical ventilation as indicated. Bacteremia (sepsis) can occur if pathogens enter the bloodstream from the infection in the lungs.